My name is Muhammad Ali. I'm a third-year medical student at the Chowdhury Lab at Icon Sewell Medicine in Mount Sinai. Today, I'll be discussing concussion trends among youth athletes with ADHD taking stimulants. Approximately 1 million cases of youth recreational and sports-related concussions occur in the United States annually. Even though 30% of the 3 million adolescents with ADHD use stimulants to treat their disorder, the effects of stimulants and concussion risk and recovery are debated or remain unclear. To address the controversy, we examined concussion incidents and longitudinal neurocognitive testing among a large cohort of adolescent athletes with differential stimulant use and immediate post-concussion assessment and cognitive testing, IMPACT, administered at baseline and twice post-injury. In doing so, we seek to improve our understanding of how stimulants may affect concussion among youth athletes with ADHD. IMPACT was administered to 7,400 youth athletes at the beginning of the season. Throughout the season, concussions were diagnosed by physicians, followed by re-administration of IMPACT at the first post-injury follow-up, a median of two days post-concussion, and again at the second post-injury follow-up, a median of seven days post-concussion. Patients were divided into three categories. Those diagnosed with ADHD taking one of either amphetamine, methylphenidate, or less dexamethamine, a total of 167 patients. Those diagnosed with ADHD but not taking any stimulants, a total of 354 patients, and those not diagnosed with ADHD, a total of 6,900 patients. Concussion incidents was calculated as total number of diagnosed concussions per total number of patient years. Recovery of neurocognitive measures post-injury was calculated as standard deviation from baseline to PD1 and PD2 in the five composite IMPACT scores. Symptom score, verbal memory, visual memory, visual motor skills, and reaction time. Univariate results were confirmed with multivariate analysis. Table 1 shows cohort demographics and univariate analysis, with the final column showing significant differences between the three groups. Table 2 shows univariate analysis of concussion incidents at IMPACT at post-injury. Most significantly shows that concussion incidents at 37.3 per 100 patient years was significantly lower in those with ADHD taking medications as compared to those with ADHD not taking medications and those without ADHD. Additionally, verbal memory and reaction time changes from baseline to post-injury were significantly greater in the ADHD group as compared to the non-ADHD group. Multivariate analysis accounting for multiple confounding variables confirmed univariate results. Concussion incidents was indeed lower in the cohort of ADHD patients taking medications as compared to ADHD patients not taking medications and non-ADHD patients. At follow-up, a median of seven days post-injury, deviations from baseline were significantly lower in the ADHD plus meds cohort as compared to the ADHD only cohort or the non-ADHD cohort, specifically in visual memory, visual motor skills, and verbal memory, suggesting improved recovery in the ADHD plus meds cohort. In conclusion, in a retrospective study of 7,400 youth athletes, stimulant use among those with ADHD was independently associated with 1. reduced incidence for concussion and 2. lower deviation from baseline in verbal memory, visual memory, and visual motor skills, a median of seven days after concussion, suggesting lower neurocognitive impairment and follow-up as compared to their peers. These are the references and thank you for taking the time to listen to our presentation.

concussion trends

youth athletes

ADHD

stimulants

neurocognitive testing