蜜芽app

College athletes and military cadets with attention-deficit/hyperactivity disorder (ADHD) face greater vulnerability to concussions, but those using stimulant medications, such as methylphenidate, exhibit faster symptom abatement post-injury versus non-medicated peers, a recent study reports.¹

As a heterogeneous traumatic brain injury, concussion management poses numerous challenges. Certain populations, including individuals with pre-existing conditions like ADHD, demonstrate an increased risk for concussions.^2,3 Furthermore, ADHD may also hinder concussion recovery.⁴ However, the interplay between treatment and concussion outcomes remains uncertain.¹

This study, recently published in the Journal of Sport and Exercise Psychology by Colt A. Coffman, a doctoral student in the Department of Kinesiology at Michigan State University, and colleagues, aimed to elucidate how ADHD and associated psychostimulants influence both prospective concussion risk and post-injury symptom course in National Collegiate Athletic Association (NCAA) athletes and military academy students.¹

Data from the NCAA-Department of Defense (NCAA-DOD) Grand Alliance Concussion Assessment, Research, and Education (CARE) Consortium from 2014 to 2017, including nearly 45,000 student athletes and cadets, were analyzed. Roughly 5.3% of the participants had an ADHD diagnosis, with nearly half (40.6%) taking psychostimulants to alleviate cognitive dysfunction. The remaining participants were classified as controls.¹

To study the impact of stimulant medication on concussion recovery, this group was narrowed down further when researchers focused on the participants who incurred a concussion during the study period. After further exclusions for missing data, analyses were conducted on 138 participants with ADHD who were not using stimulant medication and 109 who were. This group was matched in a 1:2 control ratio based on age, sex, and鈥攚hen possible鈥擭CAA contact category (eg, contact, limited contact, no contact, or non-NCAA injury) and whether the injury occurred during competition season.¹

Both ADHD diagnosis (odds ratio [OR] = 1.21; P=.027) and concurrent medication use (OR = 1.48; P<.001) were associated with higher concussion rates over the study period, compared with the control group. The use of stimulants made no difference in injury susceptibility (OR = 1.23; P=.1).¹

However, unmedicated ADHD individuals exhibited slower symptom abatement, with an average of 2鈥�3 more days post-concussion to be determined asymptomatic compared to controls. Whereas individuals taking psychostimulants resolved symptoms in a similar period compared to non-ADHD peers, suggesting a therapeutic effect.¹

Intriguingly, ADHD predicted consistently elevated symptom reporting across all time points, including baseline. This was also true, albeit to a lesser degree, in the medicated cohort.¹

Interpreting balance of risks and benefits

鈥淧ostconcussive symptoms appear mitigated by psychostimulant use,鈥� the authors concluded in the Journal of Sport and Exercise Psychology.¹

Indeed, individuals taking ADHD medications showed no delays returning to play or activity despite marginally higher baseline symptoms. Faster abatement of acute issues post-injury points to real-world recovery advantages from ongoing stimulant treatment after concussion.¹

Whether through direct concussion interactions or unmasking of symptoms, the drugs seem beneficial for symptomatic outcomes. However, heightened vulnerability still persists on medication鈥攑erhaps reflecting uncontrolled ADHD severity or direct medication risks.¹

These analyses inform a balanced perspective when advising collegiate athletes and military cadets on managing ADHD, weighing both elevated injury risks and faster symptom resolution that psychostimulants confer.¹

Strengths, limitations, and need for further study

The enormous dataset used in this study (nearly 45,000 student athletes and military cadets from multiple institutions) provides exceptional statistical power and reflects actual real-world injury patterns and clinical care in these at-risk populations.¹

Using this ecologically valid approach assessing future concussion vulnerability and post-injury outcomes based on pre-existing diagnoses has advantages over limited research cohorts. Carefully matching non-ADHD controls also isolates effects of the disorder itself and associated psychostimulant treatment on concussion risk and recovery. Overall, analyzing verified medical encounters from thousands of students represents a uniquely well-powered and generalizable study suited to address high-stakes questions around concussion modulation by ADHD and its common medications.¹

On the other hand, as a retrospective analysis relying on self-reported medical history, this study lacks objective confirmation and precision around diagnoses, symptom profiles, medication regimens, injury circumstances, and outcome measures. Specifically, the degree ADHD itself versus stimulant treatments independently confer risks remains entangled. Furthermore, the findings reflect care at major university clinics, limiting generalizability to other settings.¹

While uniquely powered by leveraging real-world records, the inability to tightly characterize, measure, and control the complex interplay between ADHD, medications, mechanisms, and myriad other concussion modulators inherent in the data source means the observed elevated risks and therapeutic benefits warrant prospective validation through robustly designed multi-site studies.¹

Disentangling interactions between ADHD severity, medications, and outcomes remains challenging. However, quantifying elevated susceptibility and faster recovery on treatment spotlights a complex risk-benefit calculus for clinicians and patients navigating concussion management.¹

Balancing considerations for clinical practice

For sports medicine physicians, athletic trainers, neurologists, and other clinicians caring for student-athletes and military populations, this study reveals clinically impactful considerations surrounding ADHD and associated psychostimulant medications.¹

On one hand, the substantially increased concussion vulnerability shown in both medicated and unmedicated ADHD patients demands preventative awareness and action. Counseling students around playing safer, using protective equipment, and avoiding dangerous behaviors merits emphasis for those with ADHD given the data on heightened susceptibility. Coaches and trainers noting distractibility, poor technique, or risky conduct in athletes with ADHD should refer them for assessment and management.¹

However, the finding of faster symptom abatement post-concussion among those on stimulants indicates medication discontinuation risks poorer outcomes. This suggests continuing ADHD treatment supports more optimal recovery, likely by controlling residual symptoms. But the complex interplay between enduring cognitive deficits, acute concussion effects, and medication responses poses diagnostic challenges. The study reveals that stopping stimulants automatically after head injuries overlooks real benefits.¹

Careful balancing of elevated injury risks versus faster improvement on appropriate ADHD therapy is required. The risks associated with uncontrolled ADHD itself also factor in prescribing decisions. Individualized treatment plans accounting for the multifaceted equation of safety and function for students with ADHD returning to demanding physical and cognitive activities merit nuanced consideration of medication risks versus rewards. Open dialogue around these issues can empower young patients to participate in the complex decision-making.¹

While prospectively validating the risk-benefit profiles is needed, this study provides tangible evidence that clinicians serving athletes and cadets with ADHD can apply towards more informed, ethical, and evidence-based practice.¹

Published: January 25, 2024