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

Alexia K. Martin, Ashley J. Petersen, Heather W. Sesma, Mary B. Koolmo, Katherine M. Ingram, Katie B. Slifko, Victoria N. Nguyen, Robert C. Doss, Amy M. Linabery

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)109-122
Number of pages14
JournalJournal of the International Neuropsychological Society
Issue number2
Early online dateMar 22 2021
StatePublished - Mar 22 2021

Bibliographical note

Funding Information:
All phases of this study were supported by a grant from the Children’s Minnesota Internal Research Grant Program.

Publisher Copyright:
Copyright © INS. Published by Cambridge University Press, 2021.


  • Adolescent
  • Attention deficit disorder with hyperactivity
  • Brain concussion
  • Child
  • Learning disabilities

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't


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