Children with attention deficit hyperactivity disorder (ADHD) who sustain mild traumatic brain injury (mTBI) such as concussion are more likely to be moderately disabled after injury than those who sustain mTBI without ADHD, finds a new study [1], which suggests that children with ADHD be encouraged to avoid contact sports that put them at increased risk of TBI.
Researchers at Children's Hospital of Pittsburgh and the University of Chicago reviewed the charts of all patients with diagnosis of mTBI as a result of closed head injury (CHI) and ADHD admitted to the hospital between 2003 and 2010, and compared them to a control group of patients admitted with a diagnosis of CHI without ADHD. The most common causes of injury for the ADHD group were falls (17%), pedestrian versus car (15%), blunt object to head (15%), bicycle accidents (13%) and sports accidents (12.5%). In the control group, the most common injury mechanisms were falls (20%), motor vehicle collision (16%), all-terrain vehicle accident (16%), and blunt object to head (13%).
They found that outcomes for the ADHD patients were significantly worse than for those without ADHD, even when adjusting for sex, age, initial Glasgow Coma Scale [1] score, length of hospital stay, mechanism of injury, and presence of other (non-TBI) injuries:
"There are numerous explanations for these data," wrote Christopher M. Bonfield, MD, of the Department of Neurosurgery at Children's Hospital of Pittsburgh, including:
The study is significant in four ways, says Bonfield:
The takeaway message for parents, says Rosemarie Scolaro Moser, Ph D, MomsTEAM's expert sports concussion neuropsychologist and Director of the Sports Concussion Center of New Jersey, is "that ADHD is another risk factor that should be considered in contact/collision sports. All kids need exercise, all kids benefit from sports, all kids are at risk for concussion. The parent's job is to minimize that risk."
"There is no clear evidence that says a child with ADHD should not play hockey, football, lacrosse or skateboard, ski, or play any other sport. But parents should be wise in considering all risk factors, whether ADHD, gender, history of headaches [2], number of previous head injuries/concussions [3], age and any other modifying factors [4] [including an overly aggressive and dangerous style of play] when making decisions about starting or returning [5] to a high-risk sport," says Dr. Moser.
"This study adds more information to our field, and intuitively many of us are concerned that ADHD may be a strong risk factor, but the lack of controls in the study make the results difficult to clearly interpret," she says. "If both groups had been administered the KOSCHI questionnaire as a baseline, prior to injury, those findings could have accounted for the differences seen after concussion. We just don't know. Also, the psychometrics of the questionnaire are not as tight as those of other instruments, so there may be a lot of leeway in the administration/interpretation/reliability."
1. Bonfield CM, Lam S, Lin Y, Greene S. The impact of attention deficit hyperactivity disorder on recovery from mild traumatic brain injury. J Neurosurg: Pediatrics 2013. DOI:10.3171/2013/5.PEDS12424 (published online ahead of print, June 25, 2013)
2. Crouchman M, Rossiter L, Colaco L, Colaco T, et al. A practical outcome scale for paediatric head injury. Arch Dis Child 2001;84:120-124.
Most recently reviewed December 4, 2015
Links:
[1] https://momsteam.com/node/3568
[2] https://momsteam.com/node/6270
[3] https://momsteam.com/node/156
[4] https://momsteam.com/node/2695
[5] https://momsteam.com/node/3914
[6] https://momsteam.com/health-safety/concussion-evaluation-management-return-to-play-decision-involves-many-factors
[7] https://momsteam.com/health-safety/concussion-safety-education-personal-momsteam-founder
[8] https://momsteam.com/health-safety/glasgow-coma-scale-used-in-evaluating-level-consciousness-not-concussion-severity
[9] https://momsteam.com/health-safety/retiring-from-sports-after-concussion-no-magic-number
[10] https://momsteam.com/health-safety/concussion-safety/multiple-concussion-history-important-factor-in-concussion-management
[11] https://momsteam.com/health-safety/concussion-safety/general/concussion-history-important-in-prevention-and-treatment
[12] https://momsteam.com/migraines-as-risk-factor-prolonged-concussion-recovery