Network structure of physical, cognitive, and emotional symptoms at preseason baseline in student athletes with attention-deficit/hyperactivity disorder

Grant L. Iverson, Payton J. Jones, Justin E. Karr, Bruce Maxwell, Ross Zafonte, Paul D. Berkner, Richard J. McNally

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objective: Preexisting attention-deficit/hyperactivity disorder (ADHD) may be a risk factor for worse outcome following sport-related concussion. We used a statistical and psychometric approach known as network analysis to examine the architecture of physical, cognitive, and emotional symptoms at preseason baseline among student athletes with ADHD. Method: A cohort of 44,527 adolescent student athletes completed baseline preseason testing with ImPACT® between 2009 and 2015. A subsample of athletes reporting a diagnosis of ADHD and at least one symptom were included in this study (N = 3,074; 14–18 years old, 32.7% girls). All participants completed the 22-item Post-Concussion Symptom Scale at preseason baseline. Results: Student athletes reported high frequencies of difficulty concentrating (boys/girls = 50.7%/59.4%), emotional symptoms (nervousness: boys/girls = 30.2%/51.0%; irritability: boys/girls = 23.6%/34.8%; sadness: boys/girls = 21.4%/39.7%), sleep/arousal-related symptoms (trouble falling asleep: boys/girls = 39.5%/49.4%; sleeping less than usual: boys/girls = 36.2%/43.4%; and fatigue: boys/girls = 29.8%/36.4%), and headaches (boys/girls = 27.6%/39.0%) during preseason baseline testing. The most central symptoms included dizziness, which was related to multiple somatic symptoms, and increased emotionality, which was related to a cluster of emotional symptoms. Girls reported symptoms at a greater frequency than boys, and there was evidence for variance in the global strength of the symptom network across gender, but not specific intersymptom relationships. Conclusion: In the absence of injury, symptoms that commonly occur after concussion interact and potentially reinforce each other among student athletes with ADHD at preseason. Symptoms common in ADHD (i.e., difficulty concentrating) are not necessarily the most central within the symptom network. These findings may inform more precise interventions for athletes with ADHD and prolonged recovery following concussion.

Original languageEnglish
Pages (from-to)1109-1122
Number of pages14
JournalArchives of Clinical Neuropsychology
Issue number7
StatePublished - 2021

Bibliographical note

Funding Information:
This study was funded in part by the National Football League for a program of research entitled “The Spectrum of Concussion: Predictors of Clinical Recovery, Treatment and Rehabilitation, and Possible Long-Term Effects” (Iverson, PI). Grant Iverson, PhD acknowledges unrestricted philanthropic support from ImPACT Applications, Inc., the Mooney-Reed Charitable Foundation, Boston Bolts, Heinz Family Foundation, and Spaulding Research Institute.

Funding Information:
The data were gathered as part of the Maine Concussion Management Initiative (MCMI) under the direction of the principal investigator Dr. Paul Berkner. The authors thank the Maine Athletic Trainers Association for their collaboration with the MCMI. Paul Berkner, D.O. acknowledges funding for the Maine Concussion Management Initiative from the Goldfarb Center for Public

Funding Information:
Policy and Civic Engagement/Colby College and the Bill and Joan Alfond Foundation. Grant Iverson, Ph.D. has a clinical and consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs (including athletes). He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He serves as a scientific advisor for Sway Operations, LLC, Highmark, Inc., and BioDirection, Inc. Drs. Zafonte and Iverson have received salary support from the Harvard Integrated Program to protect and improve the Health of National Football League Players Association Members. Dr Zafonte acknowledges unrestricted philanthropic support from the Heinz Family Foundation. Dr Zafonte serves on the Scientific Advisory Board of Myomo, Oxeia Pharma, and ElMInda. None of the authors nor their family members have a commercial or proprietary interest in ImPACT®.

Publisher Copyright:
© The Author(s) 2020. Published by Oxford University Press. All rights reserved.


  • ADHD
  • Adolescent
  • Brain concussion
  • Child
  • Rehabilitation
  • Sports
  • Statistical methods

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Clinical Psychology
  • Psychiatry and Mental health


Dive into the research topics of 'Network structure of physical, cognitive, and emotional symptoms at preseason baseline in student athletes with attention-deficit/hyperactivity disorder'. Together they form a unique fingerprint.

Cite this