Influence of ADHD and Concussion History on Vestibular-Oculomotor Performance and Recovery Time in NCAA Division I Athletes with Sport-Related Concussion
Background: Sport-related concussion (SRC) can result in impairments in vestibular and oculomotor function, which are commonly assessed using the Vestibular Ocular Motor Screening (VOMS). Individual health factors such as attention deficit hyperactivity disorder (ADHD) and prior concussion history have been proposed as potential modifiers of symptom provocation and recovery time, though their effects remain unclear in collegiate athletes. Purpose: To investigate whether ADHD and prior concussion history independently or jointly influence VOMS symptom provocation and recovery time in NCAA Division I athletes with acute SRC. Methods: A retrospective cohort study was conducted including 186 NCAA Division I athletes evaluated within 1-7 days following SRC. Participants were grouped based on self-reported ADHD status and prior concussion history. VOMS symptom provocation was analyzed using total change scores and individual subtest scores. Recovery time was defined as days from injury to the first symptom-free evaluation. Nonparametric Mann-Whitney U tests were used to assess between-group differences, with significance set at p < 0.05. Results: ADHD status was not associated with differences in recovery time (p = 0.651) or VOMS total change score (p = 0.564). However, athletes with ADHD demonstrated significantly greater near point of convergence (NPC) distance compared to those without ADHD (p = 0.031, d = 0.53). Prior concussion history was not significantly associated with recovery time (p = 0.067) or VOMS total change score (p = 0.865), although a trend toward longer recovery time was observed. A significant difference was identified in smooth pursuit symptom provocation, with athletes without prior concussion history reporting greater symptoms than those with prior concussion history (p = 0.025, d = 0.59). No other VOMS subtests demonstrated significant differences. Conclusion: ADHD and prior concussion history were not associated with differences in overall VOMS symptom provocation or recovery time in collegiate athletes with acute SRC. However, ADHD was associated with greater NPC distance, and prior concussion history was associated with differences in smooth pursuit symptom provocation. These findings highlight the importance of evaluating specific domains of vestibular and oculomotor function for athletes with these health histories rather than relying solely on overall symptom scores. Keywords: sport-related concussion; VOMS; ADHD; concussion history; vestibular; oculomotor; recovery time
concussion history, oculomotor, recovery time, sport-related concussion, vestibular, VOMS
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