When the Baseline Is Already Different: Concussion Testing for Athletes with Autism

One in 36 children in the United States has autism spectrum disorder (ASD), according to the CDC’s most recent prevalence data. Research from the National Survey of Children’s Health shows that 91% of adolescents with ASD report participating in and enjoying sports. Yet standard concussion baseline tools were not designed for, normed on, or validated in this population — creating a significant clinical gap.

What the research shows

Research from Saint Joseph’s University, reported by PR Newswire (2024), found that student-athletes with self-reported ASD perform more poorly on visual motor speed tasks on ImPACT and are more likely to produce invalid test results than their neurotypical peers. A 2021 study published in the Archives of Clinical Neuropsychology (Oxford Academic) by researchers examining the influence of autism and other neurodevelopmental disorders on cognitive and symptom profiles explicitly called for the development of normative reference data specifically for athletes with ASD — noting that current ImPACT normative databases do not include this population.

The same problem that affects ADHD athletes, compounded

The practical implications are significant and parallel the challenges faced by athletes with ADHD, but with additional complexity. Without ASD-specific norms, comparing a healthy athlete with ASD to the general population will likely flag their baseline as “impaired” — potentially leading to inappropriate clinical decisions if they later sustain a concussion. And without a personal baseline, post-injury evaluation becomes a guessing game, with clinicians unable to distinguish between ASD-related cognitive patterns and concussion-related deficits.

Testing environment considerations

Athletes with ASD may also present additional testing challenges. Sensory sensitivities (to lights, sounds, or the testing environment itself), difficulty with sustained attention on computer-based tasks, and variation in communication style can all affect testing performance and validity. Baseline testing protocols may need to be adapted — allowing for breaks, modifying the testing environment, and using trained administrators who understand neurodevelopmental differences.

How we accommodate

At Headquarters, we accommodate athletes with autism through individualized testing environments, modified administration procedures when needed, and interpretation that accounts for neurodevelopmental differences. Every brain deserves a baseline that reflects its unique function — and that includes neurodiverse brains. For the ADHD counterpart, see our ADHD baseline piece.

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