The Impact of Attention-Deficit Hyperactivity Disorder on Clinical Measures and Outcomes Following Concussion in Adolescent Athletes

Adolescent athletes with attention-deficit hyperactivity disorder (ADHD) have a higher prevalence of concussion history, and ADHD symptoms may complicate post-concussion neurocognitive test interpretation. This study compared post-concussion testing results in adolescents with and without ADHD. Athletes (10-18 years) from the North Texas Concussion Registry (2015-2024) were categorized as ADHD-only or No-ADHD (no learning disorders or ADHD). Post-concussion testing included ImPACT and King-Devick at initial visit, and Generalized Anxiety Disorder–7 (GAD-7), Patient Health Questionnaire–8 (PHQ-8), and Pittsburgh Sleep Quality Index (PSQI) at initial visit and 3-month follow-up. Groups were compared using Mann-Whitney U tests and longitudinal data were compared using paired Student t tests ( P < .05). A total of 1518 athletes were included (155 ADHD; 46.6% female). No differences were found in primary ImPACT cognitive domains or King Devick testing scores between groups. ADHD-only athletes had higher GAD-7 and PHQ-8 scores (μ = 4.24, μ = 5.46) than no-ADHD athletes (μ = 3.37, μ = 4.36) ( P < .05) at initial visit, but no differences were observed at 3 months. Recognizing affective symptoms after concussion in athletes with ADHD is important for clinical intervention.