Children With ADHD May Be More Likely to Report Concussion Symptoms

Children with ADHD who play sports may be more likely to report a greater number of concussion-like symptoms and perform worse on balance tests when administered a common concussion assessment than those who do not have ADHD, according to a report in the Journal of Pediatrics. Children in the study were assessed using the Child Sport Concussion Assessment Tool Fifth Edition (Child SCAT5).

“These findings highlight the challenges of interpreting Child SCAT5 performance in children with ADHD following a concussion or suspected concussion and illustrate the value of administering the measure to children to document their pre-injury performance,” wrote Nathan Cook, Ph.D., of Harvard Medical School and colleagues. “[P]roviders using the Child SCAT5 following a concussion or suspected concussion should anticipate that children with ADHD are likely to endorse several symptoms when given concussion symptom rating scales and may also demonstrate balance weaknesses even if they have recovered or were never injured in the first place.”

Cook and colleagues analyzed data obtained from a study of 464 middle school athletes aged 11 to 12, who received preseason testing with the Child SCAT5. Of the total sample, 28 (6%) children reported having been diagnosed with ADHD. For the study, the authors compared how 27 children with ADHD performed on the Child SCAT5 with those without ADHD who were of the same age and sex, played the same sport, and reported the same concussion history.

The children with ADHD reported an average 13.33 concussion symptoms compared with an average of 6.44 reported by children without ADHD. They also reported significantly greater severity of symptoms than children without ADHD. Some of the common symptoms reported by the children with ADHD were those that are commonly associated with ADHD, such as difficulty paying attention and getting distracted easily; however, children with ADHD also more commonly reported headaches, dizziness, feeling nauseous, and neck pain—symptoms not commonly attributed to ADHD.

Children with ADHD also performed worse on the Child SCAT5 balance assessment, committing more errors on average when required to stand on one leg than controls. In contrast, the groups performed similarly on cognitive tests that are part of the Child SCAT5.

“It is important for pediatricians and other providers treating children and adolescents to understand factors and comorbidities that influence results on pediatric concussion assessments,” Cook and colleagues wrote. “This information can help inform concussion diagnosis, evaluation of recovery from the injury, and return-to-activity decisions.”

For related information, see the Psychiatric News article “Saliva Biomarkers May Predict How Long Concussion Symptoms Will Last in Youth.”

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