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Concussion Tied to Anxiety, Depression in College Athletes with ADHD (CME/CE)

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Concussion Tied to Anxiety, Depression in College Athletes with ADHD

Anxiety and depression scores higher in players with ADHD up to 6 months later

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  • by Contributing Writer, MedPage Today

Action Points

  • Athletes with attention deficit hyperactivity disorder (ADHD) may have greater risks of depression and anxiety after concussion
  • Note that the study suggests that players with ADHD might need more monitoring after concussion

Athletes with attention deficit hyperactivity disorder (ADHD) may have greater risks of depression and anxiety after concussion, a study of college players suggests.

Both anxiety and depression scores were significantly higher in college athletes with a history of concussion who had ADHD than athletes who did not have ADHD, reported Robert Davis Moore, PhD, of the University of South Carolina in Columbia, and co-authors, in an early-release abstract from the American Academy of Neurology (AAN) Sports Concussion Conference, to be held in Indianapolis July 20-22.

“Mental health outcomes are often overlooked in concussion, but often they’re the first indication of chronic brain injury,” Moore said in an interview with MedPage Today.

Adolescent and young athletes with ADHD have been reported to have lower scores on neurocognitive testing like the ImPACT (Immediate Post-Concussion Assessment and Cognitive Test), increased risk for concussion, and increased symptom reporting. Few studies have looked at how concussion might affect the mental health of young people with ADHD, Moore noted.

For the new study, he and his colleagues assessed 979 National Collegiate Athletic Association (NCAA) Division-I college athletes at the University of South Carolina as part of a larger athlete performance health and wellness program, using ADHD diagnoses and physician-diagnosed concussion reports. The athletes completed the State-Trait Anxiety Inventory (STA-I), which has scores ranging from 20 to 80, and the Center of Epidemiological Studies Depression Scale (CES-D), a depression symptom measure with a score range of 0 to 60.

The researchers divided athletes into four groups:

  • ADHD with a history of concussion (n=33)
  • ADHD without a history of concussion (n=81)
  • History of concussion but no ADHD (n=82)
  • Neither history of concussion nor ADHD (control group; n=783)

Athletes with both concussion and ADHD had an average state anxiety score of 42.1, compared with 33.4 for all other groups. The athletes also had higher depression scores of 25.5 versus 16.3 for all other groups. The anxiety mean difference of 8.4 and depression mean difference of 9.7 were statistically significant (P<0.05).

Athletes with ADHD and no history of concussion did not show increased anxiety or depression.

Players with a history of concussion were tested 6 or more months after their injury, which means the differences lasted longer than what might be expected, Moore pointed out.

While the currently recommended concussion assessment tool asks one question about depression and one question about anxiety, that might not be enough, Moore said: “What we see from our research is that even if players report not to be depressed or anxious, if you give them a full clinical assessment, you find that, in fact, they often have depression or anxiety.”

Players with ADHD might need more monitoring after concussion, he added, a thought echoed by Scott Zuckerman, MD, MPH, of the Vanderbilt Sports Concussion Center in Nashville, who helped develop the first standardized neurocognitive data on the ImPACT test for young athletes with ADHD and other learning disabilities.

“The approach to any athlete with concussion should be individualized about returning to school and returning to play,” Zuckerman told MedPage Today. “That’s for any athlete, regardless of whether they have many risk factors for post-concussion syndrome or none.

“I would argue that kids with ADHD or learning disabilities should have an even more individualized approach, especially with returning to school, making sure they go back in a staged manner and get the academic attention they deserve.”

A few extra minutes to administer anxiety or depression tests could help identify athletes who are struggling and can do so before they develop more full-blown depression or anxiety disorders, Moore added: “We may be able to intervene before anxiety or depression becomes a life-changing condition.”

The study was supported by the University of South Carolina Athlete Performance, Health and Wellness Program.

  • Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
2018-12-07T00:00:00-0500

last updated

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Medpage Today

Concussion Tied to Anxiety, Depression in College Athletes with ADHD

Anxiety and depression scores higher in players with ADHD up to 6 months later

MedpageToday

  • register today

    Earn Free CME Credits by reading the latest medical news in your specialty.

    sign up

  • by Contributing Writer, MedPage Today

Action Points

  • Athletes with attention deficit hyperactivity disorder (ADHD) may have greater risks of depression and anxiety after concussion
  • Note that the study suggests that players with ADHD might need more monitoring after concussion

Athletes with attention deficit hyperactivity disorder (ADHD) may have greater risks of depression and anxiety after concussion, a study of college players suggests.

Both anxiety and depression scores were significantly higher in college athletes with a history of concussion who had ADHD than athletes who did not have ADHD, reported Robert Davis Moore, PhD, of the University of South Carolina in Columbia, and co-authors, in an early-release abstract from the American Academy of Neurology (AAN) Sports Concussion Conference, to be held in Indianapolis July 20-22.

"Mental health outcomes are often overlooked in concussion, but often they're the first indication of chronic brain injury," Moore said in an interview with MedPage Today.

Adolescent and young athletes with ADHD have been reported to have lower scores on neurocognitive testing like the ImPACT (Immediate Post-Concussion Assessment and Cognitive Test), increased risk for concussion, and increased symptom reporting. Few studies have looked at how concussion might affect the mental health of young people with ADHD, Moore noted.

For the new study, he and his colleagues assessed 979 National Collegiate Athletic Association (NCAA) Division-I college athletes at the University of South Carolina as part of a larger athlete performance health and wellness program, using ADHD diagnoses and physician-diagnosed concussion reports. The athletes completed the State-Trait Anxiety Inventory (STA-I), which has scores ranging from 20 to 80, and the Center of Epidemiological Studies Depression Scale (CES-D), a depression symptom measure with a score range of 0 to 60.

The researchers divided athletes into four groups:

  • ADHD with a history of concussion (n=33)
  • ADHD without a history of concussion (n=81)
  • History of concussion but no ADHD (n=82)
  • Neither history of concussion nor ADHD (control group; n=783)

Athletes with both concussion and ADHD had an average state anxiety score of 42.1, compared with 33.4 for all other groups. The athletes also had higher depression scores of 25.5 versus 16.3 for all other groups. The anxiety mean difference of 8.4 and depression mean difference of 9.7 were statistically significant (P<0.05).

Athletes with ADHD and no history of concussion did not show increased anxiety or depression.

Players with a history of concussion were tested 6 or more months after their injury, which means the differences lasted longer than what might be expected, Moore pointed out.

While the currently recommended concussion assessment tool asks one question about depression and one question about anxiety, that might not be enough, Moore said: "What we see from our research is that even if players report not to be depressed or anxious, if you give them a full clinical assessment, you find that, in fact, they often have depression or anxiety."

Players with ADHD might need more monitoring after concussion, he added, a thought echoed by Scott Zuckerman, MD, MPH, of the Vanderbilt Sports Concussion Center in Nashville, who helped develop the first standardized neurocognitive data on the ImPACT test for young athletes with ADHD and other learning disabilities.

"The approach to any athlete with concussion should be individualized about returning to school and returning to play," Zuckerman told MedPage Today. "That's for any athlete, regardless of whether they have many risk factors for post-concussion syndrome or none.

"I would argue that kids with ADHD or learning disabilities should have an even more individualized approach, especially with returning to school, making sure they go back in a staged manner and get the academic attention they deserve."

A few extra minutes to administer anxiety or depression tests could help identify athletes who are struggling and can do so before they develop more full-blown depression or anxiety disorders, Moore added: "We may be able to intervene before anxiety or depression becomes a life-changing condition."

The study was supported by the University of South Carolina Athlete Performance, Health and Wellness Program.

  • Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
2018-12-07T00:00:00-0500

last updated

Take Posttest Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



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