Are Self-Reported and Parent-Reported Attention Problems and Hyperactivity Associated With Higher Rates of Concussion in Youth Ice Hockey Players?

Objective: To examine the association between self-reported and parent-reported attention problems and hyperactivity and rates of injury and concussion in Canadian youth ice hockey players.
Design: Secondary analyses of 2 prospective cohort studies.
Setting: Canadian youth ice hockey teams.
Participants: Ice hockey players (ages 11-17 years) were recruited by team, over 4 seasons (2011-2016). A combined 1709 players contributing 1996 player-seasons were analyzed (257 players participated in more than one season).
Assessment of Risk Factors: Data were collected from preseason baseline questionnaires, including child and parent proxy forms of the Behavior Assessment System for Children, second edition.
Main Outcome Measures: Injury and concussion rates and incidence rate ratios (IRR) comparing players with and without self-identified or parent-identified attention problems and hyperactivity, adjusted for covariates (ie, body checking policy, previous injury/concussion, and age) and a random effect for team, were estimated using multiple multilevel negative binomial regression.
Results: When analyzed continuously, rates of concussion increased with higher self-reported and parent-reported measures of attention problems [IRR SELF = 1.025; 95% confidence interval (CI): 1.011-1.040; IRR PARENT = 1.032; 95% CI: 1.008-1.057]. Self-reported hyperactivity was significantly associated with concussion (IRR = 1.021; 95% CI: 1.007-1.035), but parent-reported hyperactivity was not (IRR = 1.005; 95% CI: 0.983-1.028). A T score ≥ 60 cutoff combining attention problems and hyperactivity scores (an estimate of probable attention-deficit hyperactivity disorder) was not significantly associated with rates of injury or concussion.
Conclusions: Attention problems and hyperactivity may place youth ice hockey players at increased risk of concussion and injury. Preseason assessments could identify players for targeted concussion education and risk reduction strategies.
Competing Interests: K. O. Yeates receives book royalties from Guilford Publications, Cambridge University Press, and Taylor & Francis, research grants from the Canadian Institutes of Health Research, and an editorial stipend from the American Psychological Association. B. L. Brooks reports the following conflict of interest: He is a coauthor of the Child and Adolescent Memory Profile (ChAMP, Sherman and Brooks, 2015, PAR, Inc), Memory Validity Profile (MVP; Sherman and Brooks, 2015, PAR, Inc), and Multidimensional Everyday Memory Ratings for Youth (MEMRY, Sherman and Brooks, 2017, PAR, Inc), and he receives royalties for the sales of these tests; he is a coeditor of the Pediatric Forensic Neuropsychology textbook (2012, Oxford University Press) and receives royalties for the sales of this book; and he has previously been provided with free test credits from CNS Vital Signs as an in-kind support for his research. Brian Brooks also acknowledges that he receives funding as a principal investigator, coinvestigator, and collaborator for research projects on concussion and has received honoraria for talks on concussion. For the remaining authors, none were declared.
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