Over the last decade, numerous studies tested the relationship between patients diagnosed with attention-deficit/hyperactivity disorder (ADHD) and their recovery with concussions. Both ADHD and concussion share some symptoms, such as loss of focus, which led researchers into wanting to learn more about the overlap between the two and whether traumatic brain injury (TBI) recovery was different for someone with ADHD.
In 2019 the American Academy of Neurology Sports Concussion Conference presented a study that found athletes who experience a concussion and already have been diagnosed with ADHD appeared to require a longer period of time to recover from their head injury than others.
The findings of this small (120 participants) study from the University of South Carolina, led by researcher Robert Moore,MS, Ph.D., and supported by the NCAA-DOD Grand Alliance: Concussion Assessment, Research and Education (CARE) Consortium, showed that this recovery time may be as much as three times greater than individuals who don’t have ADHD. Subjects who had concussions but did not have ADHD experienced concussion symptoms an average of four days, while subjects who had ADHD and took medication for it, experienced symptoms an average of 12 day.
More recent studies looking into the relationship between ADHD and concussions, similar indications have been found. In 2022, Dr. Moore and researchers from Michigan State University and the Pediatric Concussion Clinic at Prisma Health Children’s Hospital-Midlands published findings in The Journal of Sports Exercise Psychology from an assessment of 99 individuals during concussion recovery. They found that ADHD-Related self-reported symptoms are associated with elevated concussion symptomatology. This was the case even when the influence of parental observations of behavior impairments were removed.
Differing Views on ADHD and Concussion Recovery
However, a recent 2021 study published in Frontiers in Pediatrics found a surprising conclusion that differs from previous ADHD and concussion recovery literature. This five-year cohort study included 623 participants and found adolescents with ADHD did not take longer to recover from concussions—a direct opposition to the 2019 University of South Carolina study.
According to the results, on average both adolescents with and without ADHD recovered and returned to school and sports seven days after concussions.
Digging Deeper Into Concussion Recovery in Adolescents with ADHD
When asked about whether his stance on concussion recovery for patients with ADHD has changed since the publishing of this recent study compared to his 2019 findings, Moore responded, “No, my thought has not changed on the subject, and my stance has become even more firm as we have multiple research articles in the process of publication confirming our results in college athletes and adolescents.”
Moore added that the measures to account for recovery time used in his studies differ from the 2021 study, which might lead to the difference in results.
“An important distinction in our research is the usage of objective measures of recovery including cognitive testing, and in our ongoing research measures of psychophysiological functioning. This is critical as we and many others have observed that the return to play or school or even self-reported symptoms are very poor indicator of functional recovery. Adolescents in particular have limited say in when they return to school for various obvious and not so obvious reasons.”
The researchers in the 2021 study used the Head Injury Tracker (HIT), an injury surveillance application designed by the Maine Concussion Management Initiative. HIT relies on trainers or students to document and self-report their symptoms.
“Although large scale studies like this have limitations in what they can do, they include no actual measures of objective measures of functioning,” said Moore.
Where MAC Alliance Stands on ADHD and Concussions
Based on the current scientific literature and Dr. Schaller’s own observations from treating patients with and without ADHD, we at MAC Alliance are of the understanding that patients with ADHD may have a different recovery—including a longer length—than those without ADHD.
“In our literature search along with our experience with the MAC Alliance patient population, there are actually three pre-existing conditions that make concussion recovery more likely to be complicated and prolonged,” says MAC Alliance Medical Director and Founder Vincent Schaller, MD, DABFM, CIC. These three pre-existing conditions that raise our antennae at MAC are:
- Migraine Headaches
- Anxiety/Depression
- ADD/ADHD
Using objective measurements with repeated neurocognitive testing and VOMS exams (Vestibular Ocular Motor Screen) on each visit, Dr. Schaller notes that we definitely see that the recovery is notably more tedious and prolonged when these conditions precede the injury. “The apparent explanation is that injury to the brain usually aggravates and worsens these three conditions, even if they are under good control prior to the head injury. For ADD/ADHD patients, we never stop the prior medications after the concussion is diagnosed, but adjustment in these medications may be needed during the recovery,” he explains.
In addition to recovery length, a study from 2018 found student athletes with ADHD were more likely to report more severe concussion symptoms than those that didn’t have the disorder. Other studies have shown that since impulsivity is linked to riskier behavior, ADHD diagnosed youth are more likely to experience concussions as well. And in 2022, a study by researchers from Florida State University College of Medicine and published in The Journal of Neurotrauma and using an unanesthetized mouse model with a pre-existing condition, ADHD and repetitive concussions together contributed to transient novelty-seeking and depression-like behavior. The researchers found that this seems to support the notion that untreated ADHD may be a risk factor for poor neurocognitive outcomes after concussions.
If Your Child Athlete Has ADHD, Don’t Panic!
If your child has ADHD, you should not keep them from participating in sports due to possible longer recovery times or worse concussions. We just want you to be aware that you may have to be even more careful when monitoring concussion and concussion recovery. As with any child, always keep an eye out for signs of a concussion or head injury.
More About Attention Deficit Hyperactivity Disorder
Individuals of all ages can be diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD), but it’s typically diagnosed in early childhood. ADHD is considered a neurodevelopmental disorder that can interfere with everyday life. According to the National Institute of Mental Health (NIH), individuals with ADHD exhibit difficulty paying attention, may be overactive or act without thinking in an impulsive manner. People with ADHD can be treated with medication, education, training, or a combination of treatments, leading to successful lives.
For more on ADHD, visit the Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) website.
—Reporting by Nicole Schaller
[Originally posted on June 11, 2021]
[Post updated on 2.23.2023]
