The Impact of Attention-Deficit Hyperactivity Disorder on Clinical Measures and Outcomes Following Concussion in Adolescent Athletes

Journal of child neurology  ·  2026

Ashna Shah; Joshua A Beitchman; Cheryl H Silver; Jane S Chung; Jacob C Jones; Shane M Miller; C Munro Cullum; Mathew A Stokes;

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ABSTRACT

Adolescent athletes with attention-deficit hyperactivity disorder (ADHD) have a higher prevalence of concussion history, and ADHD symptoms may complicate post-concussion neurocognitive test interpretation. This study compared post-concussion testing results in adolescents with and without ADHD. Athletes (10-18 years) from the North Texas Concussion Registry (2015-2024) were categorized as ADHD-only or No-ADHD (no learning disorders or ADHD). Post-concussion testing included ImPACT and King-Devick at initial visit, and Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), and Pittsburgh Sleep Quality Index (PSQI) at initial visit and 3-month follow-up. Groups were compared using Mann-Whitney tests and longitudinal data were compared using paired Student tests (  < .05). A total of 1518 athletes were included (155 ADHD; 46.6% female). No differences were found in primary ImPACT cognitive domains or King Devick testing scores between groups. ADHD-only athletes had higher GAD-7 and PHQ-8 scores (μ = 4.24, μ = 5.46) than no-ADHD athletes (μ = 3.37, μ = 4.36) (  < .05) at initial visit, but no differences were observed at 3 months. Recognizing affective symptoms after concussion in athletes with ADHD is important for clinical intervention.

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