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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0584

The masked champion: neurobiological profiles and precision psychiatric interventions in the twice-exceptional athlete

THE MASKED CHAMPION: NEUROBIOLOGICAL PROFILES AND PRECISION PSYCHIATRIC INTERVENTIONS FOR THE TWICE-EXCEPTIONAL ATHLETE

In twice-exceptional athletes, in whom elite athletic ability coexists with a neurodevelopmental or psychiatric diagnosis, talent masks pathology, necessitating multidimensional dual screening; however, the proposed precision neuromodulation approaches have not yet been tested in this population.

The aim is to characterize the neurocognitive, psychological, and neurobiological architecture of the twice-exceptional (2e) athlete—an elite or near-elite athlete who also has a psychiatric or neurodevelopmental diagnosis—and to critically evaluate precision interventions such as EEG neurofeedback, heart rate variability biofeedback, and prefrontal tDCS. The method is an integrative narrative review of the literature on elite athletes, neurodevelopment, and interventions; each claim is explicitly distinguished as either empirically supported within the source disciplines or a conceptual extension, and no pooled effect size was calculated. In the section on the recognition gap, anxiety/depression rates were reported as 34% among current elite athletes and 26% among former elite athletes, while the pooled rate of formal help-seeking was 22.4%; among elite female athletes, clinically significant anxiety was reported at 19.4%, depression at 18.7%, and disordered eating at 18.6%, representing rates 2.5–3 times those in the general population, while ADHD prevalence among athletes was reported as 7–8%, compared with approximately 4.4% among adults. Cognitive superiority was shown to be domain-specific: a meta-analysis of 136 reports involving 8,860 participants found g=0.77 for domain-specific decision-making, 0.44 for higher-order executive functions, 0.39 for basic cognitive functions, and an overall effect of 0.59; as only 11 of 142 studies were prospective, there was no evidence that executive function tests predicted future performance or talent selection. Psychological correlates included motivation (d=0.53; 127 studies, N=24,358), self-efficacy (d=0.41), extraversion (d=0.34), and conscientiousness (d=0.32), whereas anxiety/neuroticism showed no significant association with performance; among collegiate athletes with both ADHD and a history of concussion, the odds of clinically significant anxiety were 16.4 times higher and those of depression were 7.9 times higher. Regarding interventions, EEG neurofeedback (a Bayesian meta-analysis of 41 randomized controlled trials found standardized mean differences [SMDs] of 0.88 for performance, 0.76 for mental health, and 0.81 for cognition) and heart rate variability biofeedback, supported by a meta-analysis of 58 studies, were rated as supported by evidence, whereas prefrontal tDCS was rated as having mixed evidence (SMD 0.39 in athletes and 0.57 in elite athletes; the effect on sports performance becomes nonsignificant after correction for publication bias). The poster proposes a threshold hypothesis, suggesting that as the burden of neurodevelopmental traits increases, the performance advantage rises up to a threshold, beyond which it gives way to clinical impairment, as well as a closed-loop neuroadaptive talent optimization model. Emphasizing that no neuromodulation study has recruited a sample of twice-exceptional athletes, the authors present the framework as hypothesis-generating rather than as an evidentiary standard; two linked studies at Rutgers, one retrospective (n=40) and the other prospective and multimethod, are awaiting ethics committee approval.

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