Nathan E Cook1,2,3, Donna S Huang4,5, Noah D Silverberg3,5,6,7,8, Brian L Brooks9,10,11, Bruce Maxwell12, Ross Zafonte5,8,13,14,15, Paul D Berkner16, Grant L Iverson3,4,5,8. 1. a Department of Psychiatry , Harvard Medical School , Boston , MA , USA. 2. b Learning and Emotional Assessment Program, Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA. 3. c MassGeneral Hospital for Children Sport Concussion Program , Boston , MA , USA. 4. d Spaulding Rehabilitation Hospital , Boston , MA , USA. 5. e Department of Physical Medicine and Rehabilitation , Harvard Medical School , Boston , MA , USA. 6. f Division of Physical Medicine & Rehabilitation , University of British Columbia , Vancouver , Canada. 7. g GF Strong Rehab Centre , Vancouver , Canada. 8. h Home Base, A Red Sox Foundation and Massachusetts General Hospital Program , Boston , MA , USA. 9. i Neurosciences and Vi Riddell Children's Pain and Rehabilitation Program , Alberta Children's Hospital , Calgary , Canada. 10. j Departments of Paediatrics, Clinical Neurosciences, and Psychology , University of Calgary , Calgary , Canada. 11. k Alberta Children's Hospital Research Institute, University of Calgary , Calgary , Canada. 12. l Department of Computer Science , Colby College , Waterville , ME , USA. 13. m Department of Physical Medicine and Rehabilitation , Spaulding Rehabilitation Hospital , Boston , MA , USA. 14. n Department of Physical Medicine and Rehabilitation , Massachusetts General Hospital , Boston , MA , USA. 15. o Department of Physical Medicine and Rehabilitation , Brigham and Women's Hospital , Boston , MA , USA. 16. p Health Services and the Department of Biology , Colby College , Waterville , ME , USA.
Abstract
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.
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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