B-10: Longitudinal Changes in Post-Concussion Symptom Connectivity in Adolescents With ADHD

Abstract

Objective: Concussion assessment relies on integrating self-reported symptoms and neurocognitive performance to monitor recovery and guide return-to-play decisions. The Post-Concussion Symptom Scale (PCSS) captures symptoms that may interact and reorganize across time. Prior studies suggest athletes with attention-deficit/hyperactivity disorder (ADHD) endorse more concussion symptoms than those without, but no studies have used network analysis to determine if symptom relationships also differ across time. This study examined changes in PCSS symptom network structure from baseline to post-concussion follow-up in adolescents with ADHD. Method/Data Selection: Using a large statewide archival ImPACT database, symptom networks were estimated at baseline and post-injury follow-up (within two weeks post-injury) for adolescents with self-reported ADHD (N = 296; 19% female). Gaussian graphical networks were estimated for time points, where nodes represented the 22 PCSS items and edges represented the relationships among them. Network Comparison Tests evaluated differences in global strength and overall network structure across timepoints. Results/Data Synthesis: Baseline and follow-up networks did not significantly differ in overall structure (M = 0.37, p = .07). However, the global strength invariance test was significant, with greater global strength at follow-up than baseline (11.3 vs. 9.11; S = 2.21, p = .01) indicating that symptoms became more strongly interconnected following concussion. Conclusions: These findings suggest denser symptom associations at follow-up despite relative stability in the broader pattern of symptom relationships. Among adolescents with ADHD, symptoms may become more tightly interconnected over time, with potential implications for symptom monitoring and recovery tracking. This pattern is consistent with findings from prior studies in non-ADHD populations.