High school athletes with attention-deficit/hyperactivity disorder may take longer to recover from sports-related concussions compared with those without the condition, according to a study that tracked nearly 1,000 cases over 8 years.

Investigators analyzed recovery data from 935 student athletes, including 78 who self-reported an attention-deficit/hyperactivity disorder (ADHD) diagnosis. On average, athletes with ADHD required 12.86 days to return to learning (RTL) without classroom accommodation and 20.82 days to return to sport (RTS) compared with 11.43 and 18.03 days, respectively, among athletes without ADHD.

Using statistical models that accounted for age and sex, the investigators found ADHD to be a significant factor in prolonging recovery. Athletes with ADHD took 1.16 times longer to return to learning and 1.17 times longer to return to sport. These differences were statistically significant.

“Health care providers must be aware of the elevated risk of prolonged concussion recovery among high school athletes with ADHD,” said lead study author Kyoko Shirahata, PhD, ATC, of the Department of Kinesiology and Rehabilitation Science in the College of Education at the University of Hawaii at Mānoa, and colleagues.

Sex and age also affected recovery times. Female athletes took longer than males to recover in both domains. RTL averaged 12.28 days among female athletes and 11.04 days among male athletes. RTS averaged 18.91 days among female athletes and 17.81 days among male athletes. The models showed that female sex was associated with a 13% longer RTL and 7% longer RTS.

Younger athletes had slower return-to-sport outcomes. Each additional year of age was associated with a modest reduction in RTS duration. This trend was statistically significant for RTS but not for RTL.

All concussion cases were managed under a standardized 7-step return-to-play protocol implemented across 60 high schools. Athletic trainers documented each athlete’s progression. RTL was defined as full classroom participation without academic support, and RTS was defined as full participation in practice with contact drills. Return to competition wasn't analyzed because of variability in sports schedules.

Only cases with complete data were included. Athletes with multiple concussions or coexisting conditions such as dyslexia or autism were excluded to isolate the effect of ADHD.

While the ADHD subgroup was small, the findings were consistent with earlier research on the condition’s role in concussion recovery. The investigators noted that some potential influences—such as symptom severity, medication use, and psychiatric comorbidities—weren't captured in the data set and may impact outcomes.

Using the model, a 15-year-old male athlete without ADHD would be expected to return to learning in 10.85 days. A male peer with ADHD would require 12.61 days, while a female peer with ADHD would need 14.22 days.

The investigators suggested that ADHD, sex, and age are relevant considerations in managing concussion recovery. They encouraged clinicians to incorporate these factors into patient counseling and recovery planning.

No author disclosures or competing interests were reported in the study.

Source: Journal of Athletic Training