Objective To explore Special Olympics North America (SONA) coaches’ perceptions of barriers to concussion recognition and response among athletes with intellectual disabilities (ID).

Design Cross-sectional electronic survey.

Setting Community and school-based teams.

Participants SONA volunteer coaches (n=64) across 10 states.

Outcome Measures 21 select-all, Likert-type, and open-ended items related to Health Belief Model constructs. Analyses included descriptive statistics, and a qualitative review of open-ended items using a grounded theory approach.

Main Results Forty-three percent of respondents believe concussions are under-reported in SONA. Five themes emerged regarding challenges to concussion practices: 1) athlete communication barriers, including the ability to identify and initiate report of symptoms; 2) coach differentiation of concussion signs from baseline; 3) under-recognition and under-reporting of concussion signs and symptoms; 4) availability of healthcare providers (HCP) experienced in caring for persons with ID; 5) validated concussion assessment tools.

Conclusions Recognition of concussions among athletes with ID is especially complex. We identified barriers to quality concussion care and reliable concussion identification due to challenges with athlete communication when reporting symptoms, the coach’s ability to accurately differentiate post-injury signs and symptoms, and HCPs’ experience in caring for persons with ID. To reduce health disparities and decrease the risk of poor health outcomes, future education, practice, and research should address concussion policies and procedures to meet the unique needs of athletes with ID and organizations that offer opportunities to participate in athletics. A neurodiversity concussion toolkit is under development to better support athletes, coaches, and HCPs in concussion recognition and response.