1 / 22

ADHD and the Concussed Athlete

ADHD and the Concussed Athlete. S. David Blake, MD Fellow Department of Developmental-Behavioral Pediatrics Children’s Hospital Greenville Hospital System. ADHD and the Concussed Athlete. Quick review of ADHD ADHD and concussion

finn
Télécharger la présentation

ADHD and the Concussed Athlete

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ADHD and the Concussed Athlete S. David Blake, MD Fellow Department of Developmental-Behavioral Pediatrics Children’s Hospital Greenville Hospital System

  2. ADHD and the Concussed Athlete • Quick review of ADHD • ADHD and concussion • Special considerations for treatment concussed athletes with ADHD

  3. Attention Deficit Hyperactivity Disorder • A neurodevelopmental disorder characterized by the core symptoms of hyperactivity, impulsivity, and/or inattention • Three types • Predominantly inattentive type • Predominantly hyperactive/impulsive type • Combined type • 3-10 percent of children and teenagers • Male to female ratio of 3:1 • Related to impairments in Executive Functioning

  4. Attention Deficit Hyperactivity Disorder

  5. Treatment of ADHD • Behavioral Interventions • Medications • Stimulants • Methylphenidate: Concerta, Metadate, Ritalin, Daytrana, Focalin • Amphetamine: Adderall, Vyvanse, Dexedrine • Non-stimulants • Atomexetine (Strattera) • Alpha-2 adrenergic receptor agonists: guanfacine (Tenex, Intuniv), clonidine (Kapvay)

  6. Significance of ADHD in the Concussed Athlete • Children and teens with ADHD are at higher risk for injuries (including concussion) than children and teens without ADHD • ADHD is one of several conditions that predispose concussed athletes to a prolonged recovery • Many post-concussive symptoms are similar to the impairments in Executive Functioning associated with ADHD

  7. Significance of ADHD in the Concussed Athlete Symptoms of Concussion Fatigue Symptoms Drowsiness Fatigue Increased sleep Dazed Fogginess Feeling slowed down Cognitive Symptoms Concentration Difficulty Remembering Confused Answering More Slowly Affective Symptoms Sadness Nervousness More Emotional Noise sensitivity Irritability Sleep Problems Difficulty sleeping Physical Symptoms Headache Nausea Balance problems Dizziness Light sensitivity Visual Problems Clumsiness Amnesia Anterograde Retrograde

  8. Management of Concussion • Pre-participation assessment • On-field or sideline evaluation • Evaluation in ER or physician’s office • Management of post-concussive symptoms • Graduated return to play protocol

  9. ADHD and Management of Concussion • Pre-participation assessment • Pre-participation history and physical • Concussive history • Baseline Neuropsychological Testing • Baseline Symptoms

  10. Baseline Neuropsycholigical Testing • Baseline testing allows for comparison of the post-concussed athlete’s performance to his pre-injury performance rather than to normative data • This is particularly important for the athlete with ADHD • Normative data generation often excludes individuals with neurodevelopmental differences such as ADHD • Depending on the test, individuals with ADHD may perform differently than individuals without ADHD

  11. ADHD and Neuropsych Testing Computerized Neuropsychological Screening of Adolescents with ADHD Grant Iverson PhD and Carrie Strangway BA Presented at the National Association of School Psychologists Dallas, Texas, April 1, 2004

  12. ADHD and Neuropsych Testing • Study compared the performance of 38 adolescents with self-reported ADHD and 38 healthy students on ImPACT, a computerized neuropsychological screening battery • The students were matched for age, education, gender, and history of head injury • ImPACT generates composite scores for five areas: Verbal Memory, Visual Memory, Processing Speed, Reaction Time, and Impulse Control • Adolescents with self-reported ADHD performed more poorly on the Visual Memory Composite (p<.006), the Processing Speed Composite (p<.004) and the Impulse Control Composite (p<.001)

  13. ADHD and Neuropsych Testing A 2008 study by the same group compared 41 student athletes with academic problems (either in special education or had repeated a grade) with 41 randomly selected controls. Results revealed significantly worse scores for students with academic problems on Verbal Memory and Processing Speed composites. The students with academic problems also reported more symptomatology on the Post-Concussion Scale

  14. ADHD and Management of Concussion • Evaluation in [ER or] physician’s office • Team approach is ideal • Medical evaluation • Neuropsychological testing

  15. Neuropsych Testing and the Concussed Adolescent Athlete • From the Zurich Consensus Statement: “If cognitive testing is performed [in the child and adolescent athlete] then it must be developmentally sensitive until late teen years due to the ongoing cognitive maturation that occurs during this period which, in turn, makes the utility of comparison to either the person’s own baseline performance or to population norms limited. In this age group it is more important to consider the use of trained neuropsy-chologists to interpret assessment data, particularly in children with learning disorders and/or ADHD who may need more sophisticated assessment.”

  16. Post-Concussion Neuropsych Testing • Within 24-48 hours after the concussion • Administered by an individual trained in administering the instrument being used • Consultation with a neuropsychologist for interpretation of results • Periodic testing until performance returns to baseline

  17. ADHD and Management of Concussion • Management of post-concussive symptoms

  18. Management of Post-Concussive Symptoms • Individualized Treatment Program to Address: • Cognitive Symptoms • Physical Symptoms • Sleep Problems • Fatigue Symptoms • Affective Symptoms

  19. Concussion and ADHD Medications • Some Controversy  No good evidence • Stimulants and Strattera associated with slight rise in blood pressure and heart rate • In treatment of concussion, trying to keep athlete at rest  trying to AVOID raising blood pressure and heart rate • Increased risk of cerebral vascular accident in the area of injury? • Alpha-2 adrenergic receptor agonists associated with decreased blood pressure and heart rate

  20. Greenville Hospital System’s “Expert” Dr. James Beard

  21. Concussion and ADHD Medications Dr. Beard: Stop a stimulant or Strattera until headache and neurological symptoms resolve and neuropsychological testing approaching baseline. Continue alpha-2 adrenergic agonists.

  22. Summary Points • ADHD is a common diagnosis in children and adolescents • Athletes with ADHD may be more susceptible to suffering a concussive injury and may have protracted recovery time with concussion • Baseline Neuropsychological testing is important for all athletes but particularly important for athletes with ADHD • There is no consensus recommendation on when a concussed athlete with ADHD should restart medications

More Related