Research Reports - Baseline cognitive test performance and concussion-like symptoms among adolescent athletes with ADHD: examining differences based on medication use

Clin Neuropsychol. 2017 Apr 21:1-12. doi: 10.1080/13854046.2017.1317031. [Epub
ahead of print]

Cook NE(1,)(2,)(3), Huang DS(4,)(5), Silverberg ND(3,)(5,)(6,)(7,)(8), Brooks
BL(9,)(10,)(11), Maxwell B(12), Zafonte R(5,)(8,)(13,)(14,)(15), Berkner PD(16),
Iverson GL(3,)(4,)(5,)(8).

OBJECTIVE: Youth with attention deficit hyperactivity disorder (ADHD) perform
more poorly on preseason cognitive testing and report more baseline
concussion-like symptoms but prior studies have not examined the influence of
medication use on test performance or symptom reporting. This study investigated
whether medication use is relevant when interpreting baseline ImPACT® results
from student athletes with ADHD.
METHOD: Participants were 39,247 adolescent athletes, ages 13-18 (mean
age = 15.5 years, SD = 1.3), who completed baseline cognitive testing with
ImPACT®. The sample included slightly more boys (54.4%) than girls. Differences
in ImPACT® composite scores and concussion-like symptom reporting (between
ADHD/No medication, ADHD/Medication, No ADHD/Medication, and Control groups) were
examined with ANOVAs, conducted separately by gender.
RESULTS: In this large, state-wide data-set, youth with ADHD had greater rates of
invalid ImPACT results compared to control subjects (ADHD/No Medication:
girls = 10.9%, boys = 10%; ADHD/Medication: girls = 8.1%, boys = 9.1%; Controls:
girls = 5.2%, boys = 6.7%). Groups differed across all ImPACT® composites
(invalid profiles were removed), in the following order (from worse to better
performance): ADHD/No Medication, ADHD/Medication, and Control participants.
Pairwise effect sizes indicated that the largest differences were on the Visual
Motor Speed composite, with the ADHD/No medication group performing worse than
the ADHD/Medication group and the Controls. The ADHD/Medication group did not
differ meaningfully from Controls on any composite, for either sex (d = 0 to
.19). The ADHD groups did not differ on total symptom scores but both ADHD groups
endorsed significantly more symptoms compared to Controls.
CONCLUSIONS: Contrary to our hypothesis, we found medication use had only a
subtle effect on cognitive performance and no significant effect on
concussion-like symptom reporting. Student athletes reporting medication use for
ADHD performed comparably to student athletes with no ADHD on baseline testing. 

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