Age-related differences in neuropsychological testing among high school athletes

Abstract

Context: Clinicians have questioned the need to obtain annual baseline neuropsychological tests in high school athletes. If no difference among academic grades exists, annual baseline testing may not be necessary.

Objective: To examine differences at baseline testing on pencil-and-paper neuropsychological tests among grade levels in high school athletes.

Design: Cross-sectional, between-groups design.

Setting: Schools participating in a Georgia high school athletics association.

Patients or other participants: High school football players (n = 198) in the 9th through 12th grades, with a mean age of 15.78 +/- 1.16 years.

Main outcome measure(s): Participants were divided into 4 groups by grade and were administered a symptom checklist and brief neuropsychological test battery. Grade level served as the independent variable. Symptom and individual test scores within the neuropsychological test battery served as dependent variables.

Results: Differences were noted among grades on the Trail Making Test A (F(3,194) = 3.23, P = .024, eta(2) = 0.048), Trail Making Test B (F(3,194) = 3.93, P = .009, eta(2) = 0.057), Symbol Digit Modalities Test (F(3,194) = 4.38, P = .005, eta(2) = 0.064), dominant tap (F(3,194) = 3.14, P = .026, eta(2) = 0.046), and nondominant tap (F(3,194) = 4.902, P = .003, eta(2) = 0.070). Using the Bonferroni correction (P <or= .00625), we found differences between the 9th grade and 11th and 12th grades.

Conclusions: Baseline neuropsychological test scores in high school athletes improved as a function of age, with differences between the 9th grade and 11th and 12th grades. Because the differences were driven by 9th-grade test scores, baseline testing should be completed, at minimum, upon entrance into 9th and 10th grades; however, annual testing is still recommended until additional research is conducted.

Keywords: adolescents; cognitive maturity; concussions; mild traumatic brain injuries.