63. ADHD Symptoms as a Predictor of Pupillary Light Reflex in Adolescents with Concussion

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ID: 324485
2026
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Ranked #69 of 79 articles by views in archives of clinical neuropsychology : the official journal of the national academy of neuropsychologists

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Abstract
Abstract Purpose Adolescents with ADHD demonstrate differences in autonomic nervous system (ANS) functioning, with studies reporting larger tonic pupil diameter compared to healthy controls. Change in pupillary light reflex (PLR) is a promising concussion biomarker indexing ANS function, yet the interaction between post-concussion changes and pre-existing neurodevelopmental differences remains unclear. This study investigated whether ADHD symptoms predict PLR changes from pre- to post-stress. Method Participants included adolescents ages 11-17.99 who were 7-35 days post-concussion (n=241). Participants completed an autonomic protocol including cognitive-emotional and physiological stressors, with pupillometry collected at pre- and post-stress timepoints. ADHD symptoms were measured using the Kiddie-Computerized Adaptive Test (K-CAT), and included continuous total score and four categorical severity levels. Linear effects models examined effects of ADHD score and category on pre- to post-stress PLR changes, covarying for age and sex. Results ADHD symptoms were associated with significant PLR changes from pre- to post-stress. Higher ADHD scores trended toward predicting reduced pupil dilation velocity (𝛽= -0.06, p=.070). Adolescents with normal ADHD severity demonstrated faster post-stress pupillary redilation recovery (T75, 𝛽=-0.30, p=.006); mild ADHD severity was associated with slower pupillary recovery (𝛽=0.77, p=.039). Conclusions Autonomic-driven pupillary response to stress varies with ADHD symptom burden after concussion, suggesting reduced sympathetic contribution to redilation recovery. However, these changes required provocation, indicating potential differences in the ability of adolescents with ADHD and concussion to respond to allostatic load. These findings emphasize the importance of considering ADHD symptoms when evaluating stress-recovery trajectories following concussion in adolescents.
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Authors K N Curtis, J B Williamson, C C Giza, M Choe, R Asarnow, A R Snyder
Journal archives of clinical neuropsychology : the official journal of the national academy of neuropsychologists
Year 2026
DOI
10.1093/arclin/acag055.063
URL
https://doi.org/10.1093/arclin/acag055.063
Keywords Keywords not found

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