With football season in full swing and hockey ramping up, concussions seem to be in the news on a weekly basis. While all concussions are serious, injuries that children and teens sustain to their still-developing brains can bring additional complications. Here, I answer the most common questions our Neurotrauma Clinic hears from parents and kids.
Q: What is different about concussions in children vs. adults?
A: Children are still developing, so their recovery after a concussion involves a “moving target.” Unlike an adult, they are not expected to return to their previous level of functioning after an injury—they should continue to progress and develop over time. A concussion may disrupt that process.
In addition, children are expected to function in many more complex settings than adults with expectations from numerous individuals: school, child care centers, families, peer relationships. These varied settings may challenge children even under normal circumstances, so any injury that impacts performance in these areas can be particularly difficult.
Q: What are some risk factors for prolonged recovery?
A: The vast majority of children and teens recover from concussion within one month; however, individuals with a history of psychological difficulties (anxiety, depression), learning disabilities or Attention Deficit Hyperactivity Disorder (ADHD) are at risk for a lengthier recovery. A history of multiple concussions also increases the risk for longer recovery time.
Children and teens who have difficulty understanding how their bodies respond to stress (e.g. my heart races when I am nervous) or have trouble listening to bodily cues (e.g. paying attention to a mild headache before it becomes severe) may have difficulty recovering as well.
Q: What are some common symptoms of concussion?
A: In addition to physical symptoms (e.g. headache, dizziness, fatigue), children and teens can experience cognitive difficulties following an injury. The most common complaints include attention and concentration problems, slowed processing speed, and short-term memory difficulties.
Emotional and behavioral symptoms are also quite common, including irritability, sadness, and low frustration tolerance. With prolonged removal from typical routines and activities (school, leisure activities, time spent with peers), emotional factors are often exacerbated. Both cognitive and emotional symptoms of a concussion can significantly impact academic performance.
Q: Who can help?
A: Depending of the severity of the injury and the child’s pre-injury history, psychologists or neuropsychologists may evaluate a child with prolonged recovery to determine cognitive, emotional, or behavior factors that may be impacted by the child’s injury. Following evaluation, these experts collaborate with schools to provide accommodations that address cognitive difficulties and physical symptoms that may be interfering with a child’s return to school and/or academic performance. School accommodations may include reduced workload, breaks during the school day to rest, additional time to complete work or tests, avoidance of loud hallways or lunch rooms, or alternate grading during the recovery period (e.g. Pass/Fail).
If a child is having emotional symptoms that are interfering with functioning, psychologists can provide therapy services to help improve coping strategies during the recovery period. Removal from typical leisure activities (e.g. sports) can be stressful for children and often deprives them of their normal peer interactions. Psychology services can help children with these difficult adjustments.
Sometimes, children will benefit from practicing biofeedback—a technique that helps people improve their health by controlling body functions like heart rate, blood pressure and muscle tension. Psychologists can help children who experience ongoing headache pain, or who struggle with symptoms of anxiety, using the biofeedback technique.