Should You Take Your Baseline on ADHD Medication or Off? The Question Nobody Has a Clear Answer To

This is one of the most practically important and least resolved questions in concussion baseline testing: if a student-athlete takes stimulant medication for ADHD, should they take it before their baseline test or skip it?

What the research shows

The science is clear on one point: medication status matters. A study by Elbin et al. (2016) published in the American Journal of Sports Medicine compared baseline and post-concussion ImPACT scores in young athletes with stimulant-treated and untreated ADHD. They found significant differences in cognitive performance between medicated and unmedicated states — athletes on stimulants performed better on processing speed and memory tasks, as expected given the pharmacological effects of these medications.

The clinical dilemma

This creates a genuine clinical dilemma. If the athlete baselines without medication and their scores are lower, the baseline reflects their unmedicated cognitive function. If they later sustain a concussion while on medication and are tested post-injury on medication, the comparison is between their unmedicated baseline and their medicated-but-concussed post-injury state — potentially masking cognitive deficits that the medication is compensating for.

Conversely, if they baseline on medication and later sustain a concussion, but don’t take their medication before the post-injury test (perhaps because they’re symptomatic, vomiting, or in an emergency setting), the unmedicated post-injury scores will be compared to a medicated baseline — potentially overstating the magnitude of concussion-related decline.

The current best practice

The current best practice — endorsed by most concussion management experts but not codified in any formal consensus guideline — is to test in whatever state the athlete will typically be playing in. If they compete on medication, baseline on medication. If they don’t typically take medication during sports participation, baseline without. The critical step is documentation: record the medication name, dose, and timing relative to the test so that post-injury testing can replicate the conditions as closely as possible.

How we handle it

At Headquarters, we document medication status and timing as part of every baseline. We advise families to replicate their baseline medication conditions during any post-injury testing. And we note this information prominently in the athlete’s record so any provider accessing the baseline knows the testing context. See also our primer on ADHD and baseline testing.

Frequently asked questions