A recent study published in the British Journal of Sports Medicine suggests that approximately one-third of all kids who experience prolonged concussion symptoms go on to develop a mental health condition. Researchers found that mental health symptoms are a secondary risk of concussion linked to the recovery process rather than from the injury itself. Therefore, they offer preventative steps for parents to take during a child’s concussion recovery.
What the Research Shows
Researchers from the Murdoch Children’s Research Institute found that kids who had prolonged physical concussion symptoms were at increased risk of developing mental health concerns during their recovery. Defining “prolonged” concussion symptoms can be difficult for parents and health professionals because every child and concussion is different. Vicki Anderson, PhD, a pediatric neuropsychologist and study coauthor suggests parents seek professional advice if their child has signs of mental health concerns that last longer than 2 weeks after a concussion. “Having any kind of symptoms for up to 10 days to 2 weeks is pretty typical,” explains Dr. Anderson. Beyond that, you may want to talk with your healthcare provider. The research also showed that some kids are more at risk than others. Kids with a higher risk for developing mental health challenges after a concussion include:
Those with preexisting mental health conditions. A concussion can worsen preexisting conditions but can also increase the risk of new symptoms developing.Children who have extended physical symptoms of concussion that limit their return to normal activities.Kids with family members who are very anxious about the concussion. The anxiety of a caregiver can impact the child’s own levels of anxiety.
“Kids will be irritable, and they will be a bit more anxious than normal. That just goes together. So, we don’t worry in the first 2 weeks," says Dr. Anderson. “After that, we really would encourage parents to be looking at those [symptoms] fairly carefully and going and seeking some medical input.”
Mental Health Symptoms to Consider
Typically, mental health conditions in children are categorized as internalizing or externalizing. You may notice either or both in your child. As a rule, you should watch for unfamiliar behaviors as a priority, says Kate Labiner, MD, pediatric sports neurologist. “The biggest things to watch for are changes that seem out of character for [your] child,” she says.
Internalizing Behaviors
After a concussion, kids can begin to internalize their experience and develop a mental health condition, says pediatric neuropsychologist, Kalina Hurley, PhD. Internalizing behavior occurs when kids direct their negative emotions internally. “These conditions include depression, anxiety, eating disorders, somatization, and trauma disorders,” she explains. “Internalizing conditions are often less noticeable, especially in the beginning, because your child may seem more withdrawn than they typically are.” There are a number of signs that could indicate that your child is internalizing their emotions. Here are some symptoms to watch for:
Sleeping more or less than usualAppetite changesAvoiding activities they usually find enjoyableSocially isolating themselvesOngoing pain such as regular headaches or stomach achesChanges in grades
Externalizing Behaviors
It’s also not uncommon for kids to externalize their emotions after a concussion as well. You may see this in the form of acting out in anger or being aggressive. “These [behaviors] can manifest as emotional outbursts, irritability, and aggression, and include conditions such as attention-deficit/hyperactivity disorder (ADHD), conduct disorder, and oppositional defiant disorder,” explains Dr. Hurley. “These conditions are often more easily identified because of the harmful behaviors that are evident in children.” If your child is behaving differently after a concussion, it’s important to pay attention to those changes. Watch for the following signs and symptoms:
Losing their temper more than usualExcessive verbal or physical aggressionDestroying propertyInability to control emotional outburstsWorsening preexisting conditions
These behaviors illustrate that a child struggling to cope with their pain, distress, or emotions, says Dr. Hurley. Helping them to understand the emotion behind the behavior can be helpful.
Prevention Is Better Than Cure
Researchers explain that prevention and early intervention for mental health symptoms in kids are paramount. The earlier treatment is provided, the better the outcome. “If we can manage those early [concussion] symptoms, then we’re reducing the likelihood that they’ll go on and have the mental health problems,” Dr. Anderson says. Make sure you follow your healthcare provider’s guidelines for concussion recovery. In the meantime, here are some general guidelines for recovery from concussions.
Rest
After a concussion, kids are advised to rest. Their brain needs recovery time. This means avoiding anything that is hard work for the brain including schoolwork, or excessive physical activity. This exclusion from activities, while important, increases the risk for mental health concerns though, explains Dr. Labiner. “Having children pulled out of activities or school, which is common post-injury, also worsens their mental health by further isolating them,” she says. Meanwhile, Dr. Anderson suggests that it’s OK to let kids jump on screens for a while. Limited activity helps keep them connected to their friends and is really important socially. It’s also a great distraction method. If kids have nothing to do but think about their concussion, what they are missing out on or their symptoms, they’ll be more likely to become anxious.
Sport
When they are ready to get back to activity, start slowly. After a few days of rest, start with light walking and increasing only at a pace that does not worsen any symptoms. Remember, though, that children should only return to their sport once they are cleared to do so by their doctor. “Returning to sports can be nerve-wracking [for kids] after an injury,” says Dr. Labiner. “So, [allow] kids to make the decision on how and when to return and [allow] them to slowly integrate back into…activity at their own rate.”
School
It’s also wise to return to school slowly. Start with a lunchtime visit to support social connection but avoid high-stress learning. Then add in the subjects your child finds easy or relaxing like art or music. Leave the high-brain functioning classes like math and science to the end. This reintegration into school must be approached on an individual basis. The stress of getting behind in certain subjects also may cause anxiety in some kids, which is what we are trying to avoid. Work with your child and their teachers to find the best return to school approach for them.
When to Call a Doctor
If you notice your child is showing signs of a mental health condition after a concussion, it is important to seek professional assistance. Call your healthcare provider for an evaluation and to discuss your concerns. They can refer you to the most appropriate mental health professionals for your child. For the best outcome, make sure everyone on your child’s healthcare team is aware of their concussion recovery plan.
