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Finley JCA. Performance validity testing: the need for digital technology and where to go from here. Front Psychol 2024; 15:1452462. [PMID: 39193033 PMCID: PMC11347285 DOI: 10.3389/fpsyg.2024.1452462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 07/29/2024] [Indexed: 08/29/2024] Open
Affiliation(s)
- John-Christopher A. Finley
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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2
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Liu BC, Iverson GL, Cook NE, Schatz P, Berkner P, Gaudet CE. The prevalence and correlates of scores falling below ImPACT embedded validity indicators among adolescent student athletes. Clin Neuropsychol 2024; 38:1175-1192. [PMID: 38233364 DOI: 10.1080/13854046.2023.2287777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/20/2023] [Indexed: 01/19/2024]
Abstract
Objective: Valid performance on preseason baseline neurocognitive testing is essential for accurate comparison between preseason and post-concussion test results. Immediate Post-Concussion and Cognitive Testing (ImPACT) is commonly used to measure baseline neurocognitive function in athletes. We examined the prevalence of invalid performance on ImPACT baseline testing and identified correlates of invalid performance. Method: The sample included 66,998 adolescents (ages 14-18, M = 15.51 years, SD = 1.22) who completed ImPACT baseline tests between 2009 and 2019. Invalid performance was determined by the embedded validity indicators (EVI). Associations between invalid performance, demographic characteristics, and health conditions were assessed using chi-square tests and odds ratios (ORs). Results: Overall, 7.2% of adolescents had baseline tests identified as invalid by one or more of the EVIs. Individual validity indicators classified between 0.5% and 3.7% tests as invalid. Higher frequencies of invalid scores were observed among youth with neurodevelopmental, academic, and medical conditions. Youth who reported having learning disabilities (n = 3126), receiving special education (n = 3563), or problems with attention-deficit/hyperactivity disorder (ADHD; n = 5104) obtained invalid baselines at frequencies of 16.4%, 16.0%, and 11.1%, respectively. Moreover, youth who reported receiving treatment for a substance use disorder (n = 311) or epilepsy (n = 718) obtained invalid baselines at frequencies of 17.0% and 11.1%, respectively. Conclusions: The base rate of invalid performance on ImPACT's EVIs was approximately 7%, consistent with prior research. Adolescents self-reporting neurodevelopmental conditions, academic difficulties, or a history of treatment for medical conditions obtained invalid baseline tests at higher frequencies. More research is needed to better understand invalid scores in youth with pre-existing conditions.
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Affiliation(s)
- Brian C Liu
- Mass General for Children Sports Concussion Program, Waltham, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Grant L Iverson
- Mass General for Children Sports Concussion Program, Waltham, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and the Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, USA
| | - Nathan E Cook
- Mass General for Children Sports Concussion Program, Waltham, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Philip Schatz
- Department of Psychology, Saint Joseph's University, Philadelphia, PA, USA
| | - Paul Berkner
- College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Charles E Gaudet
- Mass General for Children Sports Concussion Program, Waltham, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
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Gureck AE, Crockett Z, Barsky BW, Samuels S, Frank JS, Storer SK, Fazekas ML. Do Differences Exist in Impact Test Domains between Youth Athletes with and without an Anterior Cruciate Ligament Injury? Healthcare (Basel) 2023; 11:2764. [PMID: 37893838 PMCID: PMC10606848 DOI: 10.3390/healthcare11202764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Poor baseline reaction time, as measured via the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), has been associated with anterior cruciate ligament (ACL) injury risk in adult athletes. Our study sought to determine whether the reaction time and impulse control ImPACT test domains differed between ACL injured and uninjured pediatric athletes. A total of 140 high-school aged athletes comprising 70 athletes who went on to sustain an ACL injury between 2012 and 2018 and 70 age- and sex-matched uninjured controls were included in the study. Mean reaction times were similar for the injured (0.67 s) and uninjured (0.66 s) athletes (p = 0.432), and the impulse control scores were also similar for those with (5.67) and without (6.07) an ACL injury (p = 0.611). Therefore, neurocognitive risk factors for sustaining an ACL injury in adults cannot necessarily be extrapolated to adolescent athletes. Further research is needed to understand why differences exist between injury risk in youth and adult athletes.
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Affiliation(s)
- Ashley E. Gureck
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | - Zack Crockett
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | - Brandon W. Barsky
- Department of Sports Medicine, Kettering Health, Kettering, OH 45429, USA
| | - Shenae Samuels
- Memorial Healthcare System, Office of Human Research, Hollywood, FL 33021, USA
| | - Jeremy S. Frank
- Department of Orthopaedic Surgery and Sports Medicine, JoeDiMaggio Children’s Hospital, Hollywood, FL 33021, USA
| | - Stephen K. Storer
- Department of Orthopaedic Surgery and Sports Medicine, JoeDiMaggio Children’s Hospital, Hollywood, FL 33021, USA
| | - Matthew L. Fazekas
- Department of Orthopaedic Surgery and Sports Medicine, JoeDiMaggio Children’s Hospital, Hollywood, FL 33021, USA
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Hoare E, Reyes J, Olive L, Willmott C, Steer E, Berk M, Hall K. Neurodiversity in elite sport: a systematic scoping review. BMJ Open Sport Exerc Med 2023; 9:e001575. [PMID: 37342788 PMCID: PMC10277550 DOI: 10.1136/bmjsem-2023-001575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/23/2023] Open
Abstract
The objective of this systematic scoping review is to understand the extent and scope of evidence regarding neurodiversity in elite sport. This systematic scoping review considered epidemiological studies, com mentary and viewpoints papers, systematic review and meta-analyses, and any intervention or clinical treatment, management and practice studies in relation to neurodiversity in elite sport. Case studies and grey literature were ineligible for review. Neurodivergence included neurodevelopmental disorders such as autism spectrum disorder, attention-deficit hyperactivity disorder (ADHD) and specific learning disorders. Elite sport was defined as Olympic, Paralympic, national, international, professional and semiprofessional sport. The final 23 studies included in this review comprised 10 observational studies, 4 systematic/narrative reviews, 6 commentary/position statements and 3 qualitative studies. The literature reflected a major focus on ADHD as a risk factor for concussion and prognosis for postconcussion recovery. Further, there was a focus on the medical management of ADHD, regarding adherence to sporting antidoping regulations. One study focused on the experience of autism in athletes in elite sport settings through qualitative interviews. One study focused on anxiety disorders in elite athletes, with ADHD emerging as a major risk factor. There is a strong rationale for future research to build on the evidence for neurodiversity in elite sport to foster supportive and inclusive elite sporting environments.
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Affiliation(s)
- Erin Hoare
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
- Australian Football League, Melbourne, Victoria, Australia
| | - Jonathan Reyes
- Australian Football League, Melbourne, Victoria, Australia
- Turner Institute for Brain & Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, VIC, Australia
| | - Lisa Olive
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
- School of Psychology, Deakin University, Burwood, Victoria, Australia
- Orygen, National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Centre of Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Willmott
- Australian Football League, Melbourne, Victoria, Australia
- Turner Institute for Brain & Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, VIC, Australia
| | - Emma Steer
- Clinical and Educational and Developmental Psychologist, Melbourne, Victoria, Australia
| | - Michael Berk
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
- Orygen, National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Centre of Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Psychiatry, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Kate Hall
- Australian Football League, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Burwood, Victoria, Australia
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Messa I, Korcsog K, Abeare C. An updated review of the prevalence of invalid performance on the Immediate Post-Concussion and Cognitive Testing (ImPACT). Clin Neuropsychol 2022; 36:1613-1636. [PMID: 33356881 DOI: 10.1080/13854046.2020.1866676] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: Performance validity assessment is an important component of concussion baseline testing and Immediate Post-Concussion and Cognitive Testing (ImPACT) is the most commonly used test in this setting. A review of invalid performance on ImPACT was published in 2017, focusing largely on the default embedded validity indicator (Default EVI) provided within the test. There has since been a proliferation in research evaluating the classification accuracy of the Default EVI against independently developed, alternative ImPACT-based EVIs, necessitating an updated review. The purpose of this study was to provide an up-to-date review of the prevalence of invalid performance on ImPACT and to examine the relative effectiveness of ImPACT-based EVIs. Method: Literature related to the prevalence of invalid performance on ImPACT and the effectiveness of ImPACT-based EVIs, published between January 2000 and May 2020, was critically reviewed. Results: A total of 23 studies reported prevalence of invalid performance at baseline testing using ImPACT. Six percent of baseline assessments were found to be invalid by the ImPACT's Default EVI, and between 22.31% and 34.99% were flagged by alternative EVIs. Six studies assessed the effectiveness of ImPACT-based EVIs, with the Default EVI correctly identifying experimental malingerers only 60% of the time. Alternative ImPACT-based EVIs identified between 73% and 100% of experimental malingerers. Conclusions: The ImPACT's Default EVI is not sufficiently sensitive, and clinicians should consider alternative indicators when assessing invalid performance. Accordingly, the base rate of invalid performance in athletes at baseline testing is likely well above the 6% previously reported.
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Affiliation(s)
- Isabelle Messa
- Department of Psychology, University of Windsor, Windsor, Canada
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Nowak MK, Ejima K, Quinn PD, Bazarian JJ, Mickleborough TD, Harezlak J, Newman SD, Kawata K. ADHD May Associate With Reduced Tolerance to Acute Subconcussive Head Impacts: A Pilot Case-Control Intervention Study. J Atten Disord 2022; 26:125-139. [PMID: 33161816 PMCID: PMC8102643 DOI: 10.1177/1087054720969977] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To test our hypothesis that individuals with ADHD would exhibit reduced resiliency to subconcussive head impacts induced by ten soccer headings. METHOD We conducted a case-control intervention study in 51 adults (20.6 ± 1.7 years old). Cognitive assessment, using ImPACT, and plasma levels of neurofilament-light (NF-L), Tau, glial-fibrillary-acidic protein (GFAP), and ubiquitin-C-terminal hydrolase-L1 (UCH-L1) were measured. RESULTS Ten controlled soccer headings demonstrated ADHD-specific transient declines in verbal memory function. Ten headings also blunted learning effects in visual memory function in the ADHD group while the non-ADHD counterparts improved both verbal and visual memory functions even after ten headings. Blood biomarker levels of the ADHD group were sensitive to the stress induced by ten headings, where plasma GFAP and UCH-L1 levels acutely increased after 10 headings. Variance in ADHD-specific verbal memory decline was correlated with increased levels of plasma GFAP in the ADHD group. CONCLUSIONS These data suggest that ADHD may reduce brain tolerance to repetitive subconcussive head impacts.
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Affiliation(s)
| | - Keisuke Ejima
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington, USA
| | - Patrick D. Quinn
- Department of Applied Health, Indiana University-Bloomington, USA
| | - Jeffrey J. Bazarian
- Department of Emergency Medicine, University of Rochester Medical Center, USA
| | | | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington, USA
| | - Sharlene D. Newman
- Department of Psychological and Brain Sciences, Indiana University-Bloomington, USA
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University-Bloomington, USA
- Program in Neuroscience, Indiana University-Bloomington, USA
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Maietta JE, Kuwabara HC, Cross CL, Flood SM, Kinsora TF, Ross SR, Allen DN. Influence of Autism and Other Neurodevelopmental Disorders on Cognitive and Symptom Profiles: Considerations for Baseline Sport Concussion Assessment. Arch Clin Neuropsychol 2021; 36:1438–1449. [PMID: 33611342 DOI: 10.1093/arclin/acab006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The presence of neurodevelopmental disorders (ND) such as attention-deficit/hyperactivity disorder (ADHD) and learning disorders (LD) have demonstrated effects on Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) performance. No current research has directly examined whether autism spectrum disorder (ASD) has similar effects. The current study compared ImPACT cognitive and symptom profiles in athletes with self-reported ASD to other NDs and healthy controls using case-control matching. METHOD The current study compared ImPACT baselines of high school athletes with ASD to athletes with other NDs (ADHD, LD, and co-occurring ADHD/LD) and healthy controls on cognitive composites and symptom reporting. Participants included 435 athletes (87 controls, 87 with ASD, 87 with ADHD, 87 with LD, and 87 with ADHD/LD) selected from a larger naturalistic sample. Athletes were matched to the ASD group based on age, sex, and sport using randomized case-matched selection from the larger database. RESULTS Results revealed that athletes with ASD performed more poorly than healthy controls on the Visual Motor Speed composite. No differences were found for Post-concussion Symptom Scale (PCSS) domain scores. Differences in cognitive and symptom profiles among the athletes with other NDs were also found. CONCLUSIONS Results elucidate patterns of baseline performance for athletes with ASD, demonstrating that there may not be significant differences between ASD and healthy controls on four of the five ImPACT composites, and no symptom reporting differences. Cognitive and symptom differences found for other NDs should be considered when interpreting baseline performance and for making return-to-play decisions in the absence of baseline assessment.
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Affiliation(s)
- Julia E Maietta
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Hana C Kuwabara
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Chad L Cross
- UNLV School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Sarah M Flood
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | | | - Staci R Ross
- Center for Applied Neuroscience, Las Vegas, NV, USA
| | - Daniel N Allen
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
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Influence of Special Education, ADHD, Autism, and Learning Disorders on ImPACT Validity Scores in High School Athletes. J Int Neuropsychol Soc 2021; 27:461-471. [PMID: 33292913 DOI: 10.1017/s1355617720001149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is commonly used to assist with post-concussion return-to-play decisions for athletes. Additional investigation is needed to determine whether embedded indicators used to determine the validity of scores are influenced by the presence of neurodevelopmental disorders (NDs). METHOD This study examined standard and novel ImPACT validity indicators in a large sample of high school athletes (n = 33,772) with or without self-reported ND. RESULTS Overall, 7.1% of athletes' baselines were judged invalid based on standard ImPACT validity criteria. When analyzed by group (healthy, ND), there were significantly more invalid ImPACT baselines for athletes with an ND diagnosis or special education history (between 9.7% and 54.3% for standard and novel embedded validity criteria) when compared to athletes without NDs. ND history was a significant predictor of invalid baseline performance above and beyond other demographic characteristics (i.e., age, sex, and sport), although it accounted for only a small percentage of variance. Multivariate base rates are presented stratified for age, sex, and ND. CONCLUSIONS These data provide evidence of higher than normal rates of invalid baselines in athletes who report ND (based on both the standard and novel embedded validity indicators). Although ND accounted for a small percentage of variance in the prediction of invalid performance, negative consequences (e.g., extended time out of sports) of incorrect decision-making should be considered for those with neurodevelopmental conditions. Also, reasons for the overall increase noted here, such as decreased motivation, "sandbagging", or disability-related cognitive deficit, require additional investigation.
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Abstract
PURPOSE OF REVIEW The goal of the present paper is to provide a comprehensive overview of mental health concerns in young athletes, with a focus on common disorders, as well as population-specific risk factors. RECENT FINDINGS Athletes experience similar mental health concerns as non-athlete peers, such as anxiety, depression and suicidal ideation, ADHD, eating disorders, and substance abuse. However, they also experience unique stressors that put them at risk for the development or exacerbation of mental health disorders. Student athletes have to balance academics with rigorous training regimens while focusing on optimal performance and managing high expectations. Physical injuries, overtraining, concussion, sleep disorders, and social identity are some of the factors that also impact the mental health of student athletes. Existing literature highlights the need to develop proactive mental health and wellness education for young athletes, and to develop services that recognize the unique needs of this population.
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Affiliation(s)
- Melissa S Xanthopoulos
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Tami Benton
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jason Lewis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Julia A Case
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Christina L Master
- Pediatric and Adolescent Sports Medicine, Division of Pediatric Orthopedics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that manifests in difficulties with sustaining attention in tasks and/or hyperactivity/impulsivity. Prevalence rates vary and difficulties in objectively diagnosing ADHD may lead to overdiagnosis or underdiagnosis. Assessment should include a comprehensive evaluation, including history, physical, psychological evaluation, and questionnaires for ADHD. Stimulant medications are effective for treatment, but their use, side effects, and potential for misuse and abuse are a concern, particularly in athletes. Athletes and physicians also need to be aware of the governing body's drug policy for the sport.
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Affiliation(s)
- Mario Ciocca
- Orthopeadics and Internal Medicine, UNC Sports Medicine, James A Taylor Campus Health Service, CB#7470, Chapel Hill, NC 27599, USA.
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Current Evidence in Management of Concussion Baseline Testing in ADHD and Learning Difficulties Patients: A Critically Appraised Topic. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY AND TRAINING 2019. [DOI: 10.1123/ijatt.2018-0089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Clinical Question: In concussed patients, will having attention deficit hyperactivity disorder (ADHD) or learning difficulties (LD) versus not having ADHD or LD cause higher symptom severity scores or invalid baseline protocols? Clinical Bottom Line: Research supports the concept that there is a difference at baseline for individuals with ADHD and/or LD compared with those who do not.
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Manderino LM, Zachman AM, Gunstad J. Novel ImPACT validity indices in collegiate student-athletes with and without histories of ADHD or academic difficulties. Clin Neuropsychol 2018; 33:1455-1466. [DOI: 10.1080/13854046.2018.1539191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lisa M. Manderino
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Angela M. Zachman
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
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13
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Nuwer MR, Nuwer JM, Tsao JW. Student athlete concussions and postconcussion syndrome: ADHD as a risk factor. Neurol Clin Pract 2018; 8:377-378. [PMID: 30564490 PMCID: PMC6276342 DOI: 10.1212/cpj.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marc R Nuwer
- Department of Neurology (MRN), David Geffen School of Medicine at UCLA; Department of Clinical Neurophysiology (MRN), Ronald Reagan UCLA Medical Center; Sports and Family Medicine (JMN), Bay Health Center, Palo Alto, CA; Departments of Neurology, Pediatrics, and Anatomy & Neurobiology (JWT), the University of Tennessee Health Science Center, and the Department of Neurology (JWT), Memphis Veterans Affairs Medical Center, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN
| | - Jamie M Nuwer
- Department of Neurology (MRN), David Geffen School of Medicine at UCLA; Department of Clinical Neurophysiology (MRN), Ronald Reagan UCLA Medical Center; Sports and Family Medicine (JMN), Bay Health Center, Palo Alto, CA; Departments of Neurology, Pediatrics, and Anatomy & Neurobiology (JWT), the University of Tennessee Health Science Center, and the Department of Neurology (JWT), Memphis Veterans Affairs Medical Center, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN
| | - Jack W Tsao
- Department of Neurology (MRN), David Geffen School of Medicine at UCLA; Department of Clinical Neurophysiology (MRN), Ronald Reagan UCLA Medical Center; Sports and Family Medicine (JMN), Bay Health Center, Palo Alto, CA; Departments of Neurology, Pediatrics, and Anatomy & Neurobiology (JWT), the University of Tennessee Health Science Center, and the Department of Neurology (JWT), Memphis Veterans Affairs Medical Center, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN
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