Concussions have greater psychological impact in athletes with ADHD

Athletes with ADHD have a greater risk for anxiety and depression after a concussion, according to a study presented at the American Academy of Neurology’s Sports Concussion Conference.

Robert Davis Moore, MS, PhD, of the exercise science department at the University of South Carolina in Columbia, told Healio Family Medicine that he wanted to improve understanding about the impact of concussions.

“There is a lot about concussions that is misunderstood from a medical and scientific perspective,” he said in an interview. “I wanted to know more about what moderates injury outcomes and why some athletes were able to resume play within a few weeks and others were not, and was drawn to the possible connection between concussions and ADHD.”

Moore and colleagues divided 979 athletes into four groups: those who did not have a concussion history or ADHD; those with concussion history, but no ADHD; those with ADHD without a concussion history; and those with ADHD and a concussion history. All athletes completed the State-Trait Anxiety Inventory and Center of Epidemiological Studies Depression Scale.

Researchers found that depression (25.5 ± 10.2) and anxiety (42.1 ± 14.2) scores were significantly higher in patients with ADHD and concussion history than all other groups. Post hoc analyses also showed the anxiety score mean difference of 8.4 and depression score mean difference of 9.7 were also both statistically significant.

Moore hopes his research increases awareness across the medical community.

“I would hope our findings encourage primary care physicians to do a more comprehensive assessment of their patients. Unfortunately, most doctors rely on a basic symptom report or the Sideline Concussion Assessment Tool to determine an athlete’s ability to return to play. These tests don’t thoroughly assess the patient’s mental health, and many patients may answer the questions on those tests in a way that gets them back on the field faster,” he said.

Though Moore said longitudinal research is needed to corroborate his findings, he still encouraged PCPs to use State-Trait Anxiety Inventory, Beck Depression Inventory II, or any one of the clinically validated tools that ask questions about the person’s prior history of brain injuries; current caffeine and medication use; and familial and personal history of depression, anxiety, ADHD, and learning disability, to complete more comprehensive examinations of their patients with concussions and ADHD.

“Anything is better than nothing, and there are dozens of validated anxiety or depression screening forms that can be used,” he said. “PCPs should pick one or two that they really like and use them.” – by Janel Miller

Reference: Moore RD, et al. Attention Deficit Hyperactivity Disorder is associated with increased anxiety and depression in concussed college athletes. Presented at: American Academy of Neurology’s Sports Concussion Conference; July 22-26, 2018; Indianapolis.

Disclosure: Healio Family Medicine was unable to determine Moore’s relevant financial disclosures prior to publication.

For more information: Northwestern University's guide, Counseling After a Concussion addresses the signs and symptoms of a concussion, the psychological and emotional effects of them and how counseling may be an effective treatment option. The guide can be found at https://counseling.northwestern.edu/blog/counseling-help-after-concussion/