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Mild Traumatic Brain Injury and Attention-Deficit Hyperactivity Disorder in Young Student Athletes

Biederman, Joseph MD*†; Feinberg, Leah BS*; Chan, James MA*; Adeyemo, Bamidele O. MD†‡; Woodworth, K. Yvonne BA*; Panis, Walter MD§; McGrath, Neal PhD; Bhatnagar, Saurabha MD†§; Spencer, Thomas J. MD*†; Uchida, Mai MD*†; Kenworthy, Tara BA*; Grossman, Rebecca BA*; Zafonte, Ross DO†§; Faraone, Stephen V. PhD¶#

The Journal of Nervous and Mental Disease: November 2015 - Volume 203 - Issue 11 - p 813–819
doi: 10.1097/NMD.0000000000000375
Original Articles

A recent meta-analysis documented a significant statistical association between mild traumatic brain injury (mTBI) and attention deficit hyperactivity disorder (ADHD) (Adeyemo et al., 2014), but the direction of this effect was unclear. In this study, we hypothesized that ADHD would be an antecedent risk factor for mTBI. Participants were student athletes ages 12 to 25 who had sustained a mTBI and Controls of similar age and sex selected from studies of youth with and without ADHD. Subjects were assessed for symptoms of ADHD, concussion severity, and cognitive function. mTBI subjects had a significantly higher rate of ADHD than Controls, and in all cases the age of onset of ADHD was before mTBI onset. mTBI+ADHD subjects also had more severe concussion symptoms (fatigue and poor concentration) than mTBI-ADHD subjects. These results support ADHD as an antecedent risk factor for mTBI in student athletes and that its presence complicates the course of mTBI.

*Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital; †Harvard Medical School, Boston, MA; ‡Department of Physical Medicine & Rehabilitation, Emory University School of Medicine, Atlanta, GA; §Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital/Massachusetts General Hospital, Charlestown; ∥Sports Concussion New England, Brookline, MA; ¶Departments of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY; and #K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway.

Send reprint requests to Joseph Biederman, MD, Massachusetts General Hospital, 55 Fruit St., YAW 6A, Boston, MA 02114. E-mail:

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