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19 Preseason Neurocognitive Test Performance and Symptom Reporting Among Student Athletes with Autism Spectrum Disorders
- Nathan E. Cook, Ila A. Iverson, Bruce Maxwell, Ross Zafonte, Paul D. Berkner, Grant L. Iverson
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 628-629
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Objective:
Participation in sports likely confers multiple benefits for children and adolescents with autism spectrum disorder (ASD). Adolescent student athletes often undergo preseason testing as part of a broader concussion management program for schools. This study compares preseason neurocognitive functioning and symptom reporting between high school athletes with and without ASD.
Participants and Methods:Participants were derived from a database of 60,751 adolescent student athletes from Maine (aged 13-18) who completed preseason testing between 2009 and 2019 and did not have missing data on the history question relating to ASD. There were 425 students (0.7%) who self-reported having been diagnosed with ASD in their health history. Cognitive functioning was measured by ImPACT, and the Post-Concussion Symptom Scale (PCSS) was used to obtain symptom ratings. Group differences between the ASD and the population control group on the five ImPACT cognitive test composite raw scores and the total symptom score from the PCSS were examined using Mann-Whitney U tests.
Results:Compared to the population control sample, those with ASD reported much greater rates of comorbid conditions: attention deficit/hyperactivity disorder (50.1% vs. 10.3%), special education (39.2% vs. 4.4%), learning disabilities (43.8% vs. 4.4%), and prior treatment for a psychiatric condition (23.4% vs. 7.5%). Groups differed significantly across all neurocognitive composites (p values <.002). However, all differences were negligible in terms of the magnitude of the effects (r values range from 0.01-0.03). The groups also differed significantly on the PCSS total symptom score (p<.001), but the magnitude of the difference was negligible (r=.031). Among boys, the ASD group endorsed 21 of the 22 symptoms at a greater rate. Among girls, the ASD group endorsed 11 of the 22 individual baseline symptoms at a greater rate than the control group. Examples of symptoms that were endorsed at a higher rate among both boys and girls with ASD: sensitivity to noise (girls: odds ratio, OR=4.38; boys: OR=4.99), numbness or tingling (girls: OR=3.67; boys: OR=3.25), difficulty remembering (girls: OR=2.01; boys: OR=2.49), difficulty concentrating (girls: OR=1.82; boys: OR=2.40), sleeping more than usual (girls: OR=1.94; boys: OR=1.97), sensitivity to light (girls: OR=1.82; boys: OR=1.76), sadness (girls: OR=1.72; boys: OR=2.56), nervousness (girls: OR=1.80; boys: OR=2.27), and feeling more emotional (girls: OR=1.79; boys: OR=2.84).
Conclusions:Students with ASD participating in organized sports are likely high functioning, on average. There were small differences in their cognitive test scores compared to the population control sample. They endorsed more symptoms, however, during baseline preseason testing. If they sustain a concussion, their clinical management should be more intensive to maximize the likelihood of swift and favorable recovery.
1 Perceived Cognitive Impairment in High School Students in the United States During the COVID-19 Pandemic
- Ila A. Iverson, Charles E Gaudet III, Nathan E. Cook
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 874-875
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- Article
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Objective:
The Youth Risk Behavior Survey (YRBS), conducted by the United States Centers for Disease Control and Prevention (CDC) in 2019, revealed that a large percentage of boys (30%) and girls (45%) reported serious difficulty concentrating, remembering, or making decisions as a result of a physical, mental, or emotional problem. In 2021, the CDC conducted the Adolescent Behaviors and Experiences Survey (ABES). The ABES included similar methodology and content as the YRBS. This study analyzed ABES data to examine correlates of perceived cognitive impairment among high school students in the United States during the COVID-19 pandemic.
Participants and Methods:The ABES was a one-time, online survey that was conducted to assess and evaluate the challenges that high-school aged youth experienced during the COVID-19 pandemic. Students’ perceived cognitive impairment was assessed using the same question used in the 2019 YRBS: 'Because of a physical, mental, or emotional problem, do you have serious difficulty concentrating, remembering, or making decisions?' Response options were binary: 'Yes’ or 'No.' The students’ responses were evaluated in relation to nine adversity, mental health, and lifestyle variables.
Results:Participants were 6,992 students, age 14 to 18, with 3,294 boys (47%) and 3,698 girls (53%). A large proportion endorsed experiencing serious difficulties concentrating, remembering, and making decisions (45%). Girls (56%) were significantly more likely to endorse perceived cognitive impairment compared to boys (33%) [X2(1)=392.55, p<.001; OR=2.66, 95% CI=2.41-2.93]. Youth who reported that their mental health was poor most of the time or always were very likely to report perceived cognitive impairment (boys: 67%; girls: 81%). Binary logistic regressions were used to examine the associations between perceived cognitive impairment, adversity, and lifestyle variables while controlling for mental health. These analyses were conducted separately for boys [X2(9)=596.70, p<.001; Nagelkerke R2=.24] and girls [x2(9)=883.35, p<.001; Nagelkerke R2=.30]. After controlling for current mental health, significant independent predicters of cognitive problems in boys and girls included: a lifetime history of discrimination based on race or ethnicity, lifetime history of being sexually assaulted or abused, lifetime history of using illicit drugs, being bullied in the past year, current marijuana use, and getting insufficient sleep (5 of fewer hours per night). Participation in sports and exercising regularly were both independently associated with lower rates of cognitive impairment.
Conclusions:Perceived cognitive impairment was endorsed by a strikingly high percentage of high school students in 2021 during the COVID-19 pandemic. More than half of high school aged girls and one third of boys reported having serious difficulty concentrating, remembering, and making decisions. These rates are considerably higher than in 2019. Current mental health, unfair treatment because of race or ethnicity, being sexually assaulted, being bullied, drug use, and insufficient sleep were associated with perceived cognitive impairment. Indicators of a physically active lifestyle (participation in sports and exercising regularly) were associated with lower rates of cognitive problems.