Attention-Deficit/Hyperactivity Disorder Status and Sex Moderate Mild Traumatic Brain Injury Symptom Severity in Children and Adolescents: Implications for Clinical Management

Sarah A Orban; Jeffery N Epstein; Devon Carr; Kelsey Logan; Paul J Gubanich; Craig Sidol; Gregory D Myer

doi:10.1097/JSM.0000000000000821

Attention-Deficit/Hyperactivity Disorder Status and Sex Moderate Mild Traumatic Brain Injury Symptom Severity in Children and Adolescents: Implications for Clinical Management

Clin J Sport Med. 2021 Nov 1;31(6):e298-e305. doi: 10.1097/JSM.0000000000000821.

Authors

Sarah A Orban¹, Jeffery N Epstein^{2

3

4}, Devon Carr⁵, Kelsey Logan^{2

3}, Paul J Gubanich^{2

3}, Craig Sidol^{3

4}, Gregory D Myer^{2

3

5

6}

Affiliations

¹ Department of Psychology, College of Mathematics, Social Sciences, and Education, University of Tampa, Tampa, FL.
² Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
³ Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
⁴ Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, Ohio.
⁵ Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and.
⁶ Reddy Medical Group, Athens, Georgia.

PMID: 32058452
DOI: 10.1097/JSM.0000000000000821

Abstract

Objective: To investigate the impact of pediatric mild traumatic brain injury (mTBI), using a broad parent-reported measure, and to determine whether parent-ratings of mTBI symptoms are higher among those with premorbid attention-deficit/hyperactivity disorder (ADHD) and females.

Design: Retrospective case-control.

Setting: Hospital-based sports medicine clinic.

Participants: The retrospective chart review included 1346 (age: M = 13.11 years, SD = 2.6; 61.7% male) pediatric patients with (n = 209) and without (n = 1137) ADHD.

Independent variables: Group membership (ADHD vs non-ADHD) and sex (male vs female).

Main outcome measures: Baseline and current Post-Concussion Symptom Inventory-Parent Report Form (PCSI-P) Physical, Emotional, Cognitive, and Fatigue subscale scores. This study used a retrospective chart review; therefore, the hypotheses reported for the current study were formed after data were collected.

Results: Controlling for patient age and days from mTBI, patients with ADHD had significantly higher retrospective parent-reported pre-mTBI ratings of physical, emotional, and cognitive symptoms (ds = 0.17-0.62) and higher post-mTBI ratings across all 4 symptom domains (ds = 0.18-0.57) than those without ADHD. There was no group × time interaction for any of the PCSI-P subscales. Females overall had higher retrospective parent-reported pre-injury Fatigue and Emotional symptoms (ds = 0.13-0.19) and higher post-mTBI symptoms in all 4 PCSI-P symptom domains (ds = 0.23-0.35), relative to males.

Conclusions: Attention-deficit/hyperactivity disorder-related postinjury exacerbations in parent-reported symptoms can be explained, in part, by elevated retrospective parent-reported ADHD-related pre-mTBI ratings. These results highlight the importance of assessing a patient's baseline symptoms post-mTBI. These data also indicate that ADHD status and sex should be considered when interpreting mTBI symptom severity during clinical evaluation of concussion.

MeSH terms

Adolescent
Attention Deficit Disorder with Hyperactivity* / diagnosis
Brain Concussion* / complications
Brain Concussion* / diagnosis
Child
Fatigue
Female
Humans
Male
Post-Concussion Syndrome* / diagnosis
Retrospective Studies