Influence of Autism and Other Neurodevelopmental Disorders on Cognitive and Symptom Profiles: Considerations for Baseline Sport Concussion Assessment

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.

Cognitive profiles following sport-related concussion in high school athletes.

“…These results provide further support that the symptom-reporting differences found between the clusters from baseline to postconcussion are likely the result of acute concussive effects rather than demographic or psychiatric history. Similarly, cognitive and symptom profiles have been reported to differ among athletes with neurodevelopmental conditions and those with history of concussion (Brooks et al, 2016; Cottle et al, 2017; Flood et al, 2020; Iverson et al, 2015; Maietta, Kuwabara, et al, 2021), and we did not find any differences between the clusters in neurodevelopmental diagnosis or history of concussion.…”

A systematic review and meta-analysis of factors influencing ImPACT concussion testing in high school and collegiate athletes with self-reported ADHD and/or LD.

“…There were 19 articles that investigated baseline cognitive performance and compared ADHD and/or LD groups to healthy athletes without self-reported neurodevelopmental diagnosis (see Table 1). Of these articles, 13 directly compared mean differences in performance on ImPACT Composite scores between ADHD and/or LD groups and healthy athletes (Biederman et al, 2015; Brooks et al, 2016; Cottle et al, 2017; Covassin et al, 2013; Elbin et al, 2013; Iaccarino et al, 2018; Kaye et al, 2019; Maietta, Kuwabara, et al, 2021; L. Manderino & Gunstad, 2018; Mautner et al, 2015; Peltonen et al, 2019; Salinas et al, 2016; Zuckerman et al, 2013), whereas five articles investigated additional aspects of baseline performance, for example, predictors of low performance (Brett, Solomon, et al, 2018; Brooks et al, 2018; Cook et al, 2017; Gardner et al, 2017; Houck et al, 2019) and one additional article utilized an experimental paradigm to assess ADHD effects on cognition post 10 soccer headings (Nowak et al, 2022).…”

“…For the Reaction Time composite, the I 2 statistic indicated high levels of heterogeneity between studies and the Q statistic was significant. Maietta, Kuwabara, et al (2021) was identified as an influential outlier for Reaction Time, and so an updated meta-analysis was conducted using a random t distribution to reduce the effect of this study. The updated summary effect for Reaction Time was reduced from −0.62 to −0.35…”

“…Three studies included data on co-occurring ADHD/LD for the Verbal Memory, Visual Memory, Visual Motor Speed, and Reaction Time composites (Elbin et al, 2013; Maietta, Kuwabara, et al, 2021; Zuckerman et al, 2013), whereas only two studies reported data for Impulse Control, which was not analyzed. Figure 5 presents the forest plots for ADHD/LD.…”

“…Further examination of symptom scores in these groups may be particularly useful since they are often primarily used to interpret concussion severity and make return-to-play decisions. In particular, at least two articles have demonstrated that athletes with co-occurring ADHD/LD have reduced cognitive performance, the highest rate of symptom reporting, and the highest rates of invalid classification compared to athletes with ADHD and LD only suggesting a possible additive effect of the two conditions together that warrants further investigation (Maietta, Barchard, et al, 2021; Maietta, Kuwabara, et al, 2021).…”