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Learning and Attention Deficit/Hyperactivity Disorders as Risk Factors for Prolonged Concussion Recovery in Children and Adolescents

Published online by Cambridge University Press:  22 March 2021

Alexia K. Martin ,
Ashley J. Petersen ,
Heather W. Sesma ,
Mary B. Koolmo ,
Katherine M. Ingram ,
Katie B. Slifko ,
Victoria N. Nguyen ,
Robert C. Doss  and
Amy M. Linabery Open the ORCID record for Amy M. Linabery [Opens in a new window]
Alexia K. Martin
Affiliation:
Children’s Minnesota Neuroscience Institute, 2525 Chicago Ave S, Minneapolis, MN55404, USA University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, MN55455, USA
Ashley J. Petersen
Affiliation:
University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, MN55455, USA
Heather W. Sesma
Affiliation:
Children’s Minnesota Neuroscience Institute, 2525 Chicago Ave S, Minneapolis, MN55404, USA
Mary B. Koolmo
Affiliation:
Children’s Minnesota Neuroscience Institute, 2525 Chicago Ave S, Minneapolis, MN55404, USA
Katherine M. Ingram
Affiliation:
Children’s Minnesota Neuroscience Institute, 2525 Chicago Ave S, Minneapolis, MN55404, USA
Katie B. Slifko
Affiliation:
Children’s Minnesota Neuroscience Institute, 2525 Chicago Ave S, Minneapolis, MN55404, USA
Victoria N. Nguyen
Affiliation:
Children’s Minnesota Neuroscience Institute, 2525 Chicago Ave S, Minneapolis, MN55404, USA
Robert C. Doss
Affiliation:
Children’s Minnesota Neuroscience Institute, 2525 Chicago Ave S, Minneapolis, MN55404, USA
Amy M. Linabery*
Affiliation:
Children’s Minnesota Neuroscience Institute, 2525 Chicago Ave S, Minneapolis, MN55404, USA University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, MN55455, USA
*
Correspondence and reprint requests to: Amy M. Linabery, Ph.D., Children’s Minnesota Neuroscience Institute, 2525 Chicago Avenue South, MS 40-460, Minneapolis, MN55404, USA. E-mail: amy.linabery@childrensmn.org
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Abstract

Objective:

Examine pre-existing learning disorders (LD) and attention deficit/hyperactivity disorders (ADHD) as risk factors for prolonged recovery and increased symptomology following pediatric mild traumatic brain injury (mTBI).

Methods:

We conducted a retrospective cohort study of children/adolescents (5-17 years) with mTBI who presented to a Children’s Minnesota Concussion Clinic between April 2018 and March 2019. Differences across strata of pre-existing conditions (present vs. absent) in time to recovery measures were estimated via Kaplan–Meier and Cox proportional hazards analyses and differences in symptom trajectories were examined via linear mixed-effects regression models. Regression models were adjusted for age, sex and other confounders.

Results:

In our cohort of 680 mTBI patients, those with LD (n = 70) or ADHD (n = 107) experienced significantly longer median durations of symptoms (58 and 68 days, respectively) than those without (43 days). Accordingly, LD was significantly associated with delayed symptom recovery (adjusted hazard ratio (aHR) = 1.63, 95% CI: 1.16–2.29), return to school (1.47, 1.08–2.00), and return to physical activity (1.50, 1.10–2.04). Likewise, ADHD was associated with delayed recovery (1.69, 1.28–2.23), return to school (1.52, 1.17–1.97) and physical activity (1.55, 1.19–2.01). Further, patients with LD or ADHD reported, on average, significantly more concussion symptoms and higher vision symptom scores throughout recovery versus those without. There was no evidence that concussion or vision symptom recovery trajectories varied over time between those with/without LD or ADHD (joint P-interactions > 0.05).

Conclusion:

Pre-existing LD and ADHD are risk factors for prolonged and more symptomatic mTBI recovery in youth. These results can inform clinical concussion management and recovery expectations.

Keywords

AdolescentAttention deficit disorder with hyperactivityBrain concussionChildLearning disabilities
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 28 , Issue 2 , February 2022 , pp. 109 - 122
Copyright
Copyright © INS. Published by Cambridge University Press, 2021

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