Autism spectrum disorder and mild traumatic brain injury in the pediatric population: a scoping review

OBJECTIVE: Concussions (i.e., mild traumatic brain injuries [mTBIs]) commonly produce transient neurocognitive and somatic symptoms that may overlap with baseline characteristics of neurodiverse populations. The relationship between autism spectrum disorder (ASD) and concussion/mTBI remains poorly characterized. This scoping review sought to synthesize existing literature evaluating concussion/mTBI risk, baseline neurocognitive testing, and symptom reporting in individuals with ASD. METHODS: A scoping review was conducted in accordance with PRISMA guidelines. Embase, Scopus, PubMed, Web of Science, PsycINFO, and CENTRAL databases were searched for studies evaluating ASD and concussion or mTBI. The central research question was the following: What is the current state of knowledge related to concussions/mTBI in patients with ASD? This review sought to evaluate the areas of baseline testing, acute symptomatology, injury characteristics, and recovery. Studies were required to explicitly evaluate ASD in relation to concussion/mTBI outcomes or neurocognitive testing. Studies that did not isolate ASD from other neurodevelopmental disorders, as well as reviews, editorials, and conference abstracts, were excluded. RESULTS: The search identified 374 studies, of which 7 (1.9%) met full inclusion criteria after screening. Most studies evaluated baseline neurocognitive testing using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) platform in pediatric/adolescent athletes. Three studies (42.9%) reported that individuals with ASD were more likely to produce invalid baseline neurocognitive scores and demonstrated differences in certain cognitive composites compared with controls. Two studies (28.6%) evaluated baseline concussion-like symptoms, with one reporting higher symptom endorsement among athletes with ASD and the other finding no statistically significant differences from controls. Epidemiological studies did not demonstrate a clear association between ASD and increased risk of concussion. Notably, no identified studies evaluated acute postinjury symptom trajectories or recovery outcomes following concussion in individuals with ASD. CONCLUSIONS: Existing literature examining ASD and concussion/TBI primarily evaluated baseline neurocognitive testing and suggested potential differences in testing performance and symptom reporting among individuals with ASD. However, the authors identified a critical lack of studies evaluating acute symptoms and recovery trajectories following concussion/mTBI in this population, which represents a significant barrier for clinicians-from athletic trainers to pediatricians to pediatric neurosurgeons-in accurately diagnosing, risk stratifying, and managing these patients in the postinjury setting. Prospective investigations are needed to better define concussion/mTBI presentation, recovery patterns, and optimal management strategies for individuals with ASD.