Long-term Effects of Concussion on Kids

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Long-term Effects of Concussion on Kids

Jim Windell

           Kids are always getting hurt, but they are fast healers and very resilient. They even bump their heads and sometimes sustain concussions. But no need to worry because they bounce back quickly, right?

           Maybe not.

           A recent literature review, published in the British Journal of Sports Medicine, found that a third of children and adolescents develop a mental health problem after a concussion. These mental health problems could persist for several years after the injury.

           The research led by the Murdoch Children's Research Institute (MCRI) in Melbourne, Australia, discovered that mental health should be evaluated as part of the standard pediatric concussion assessment and management. A review of 69 articles published between 1980 and June, 2020, involved almost 90,000 children, aged 0-18 years, from nine countries including Australia, US, Canada and New Zealand, who had a concussion. Falls (42.3 per cent) and sporting injuries (29.5 per cent) were the most common cause of injury, followed by car accidents (15.5 per cent).

           The literature review found that up to 36.7 percent of the children in these articles experienced significantly high levels of internalizing problems such as withdrawing, anxiety, depression and post-traumatic stress after a concussion compared to healthy children or children who had other types of injuries. In addition, 20 percent of the children gave evidence of externalizing problems, such as aggression, attention problems and hyperactivity, after a concussion.

           Researchers also found that pre-existing mental health problems were a strong predictor of post-concussion mental health issues. The review stated that 29 percent of children with a pre-injury mental health diagnosis received a new mental health diagnosis post-concussion. Up to 26 percent without prior mental health problems went on to develop symptoms.

           Alice Gornall, MCRI researcher and Monash University Ph.D. candidate, said that despite many post-concussion and mental health symptoms overlapping, the relationship between delayed recovery and mental health had remained poorly understood until this literature review. She went on to say that while significant improvements in mental health emerged between three and six months post-injury, a minority of children experienced persisting symptoms for several years afterwards.

           These findings come after a recent study, led by MCRI and published in The Journal of Head Trauma Rehabilitation, revealed that having a traumatic brain injury in early childhood was associated with lower IQ scores that persist up to seven years post-injury.

           "Despite the high incidence of concussion among children and adolescents,” Ms. Gornall said, “identifying those at risk of ongoing difficulties after concussion remains a prominent challenge for clinicians. On top of this, children take twice as long to recover from concussion than adults, with one in four children experiencing symptoms beyond one-month post-injury."

           MCRI researchers are also working on an intervention, called Concussion Essentials, to help prevent children suffering long term post-concussion symptoms. The eight-session intervention combines physiotherapy and psychology treatments that target presenting symptoms with education around common concerns such as headache, fatigue and return to exercise, school and sports. Early data suggests that the intervention is effective in accelerating recovery.

           Vicki Anderson, MCRI Professor, said assessment, prevention and intervention of mental health difficulties after concussion should be integrated into standard concussion management. "Mental health is central to concussion recovery,” she said. “Concussion may both precipitate and exacerbate mental health difficulties, impacting delayed recovery and psychosocial outcomes."

           MCRI and the Royal Children’s Hospital have developed an app called HeadCheck. This app helps parents, coaches and first responders to recognize the signs of concussion and manage the child's safe return to school, play and organized sports.

           To read the original literature review, find it with this reference:

Gornall, A., Takagi, M., Morawakage, T., Liu, X. & Anderson, V. (2021). Mental health after paediatric concussion: a systematic review and meta-analysis. British Journal of Sports Medicine; bjsports-2020-103548 DOI: 10.1136/bjsports-2020-103548

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