Behavioral and Emotional Difficulties after Pediatric Concussion

Gornall, Alice; Takagi, Michael; Clarke, Cathriona; Babl, Franz E; Dunne, Kevin; Anderson, Nicholas; Hearps, Stephen; Demaneuf, Thibaut; Rausa, Vanessa C; Anderson, Vicki

doi:10.1089/neu.2018.6235

Cited by 25 publications

(34 citation statements)

References 33 publications

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“…The results from the present study support the notion that delayed recovery from post-concussive symptoms in children cannot be attributed to disruption of white matter microstructure, at least with current technological constraints. Although it is beyond the scope of this study to suggest what may cause ongoing postconcussive symptoms, there is some evidence to suggest that psychological factors such as anxiety, depression and post-traumatic symptoms, 38 as well as internalization behaviors, 39 are linked to the development and maintenance of PCS. Although it cannot be conclusively stated that there is no white matter microstructural difference between children who recover normally and children who do not, this study raises the notion that in children, PCS may not be related to white matter microstructural damage.…”

Section: Dwi In Pediatric Concussion Recovery 1303mentioning

confidence: 96%

Examining Microstructural White Matter Differences between Children with Typical and Those with Delayed Recovery Two Weeks Post-Concussion

Shapiro

Silk

Takagi

et al. 2020

Journal of Neurotrauma

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Delayed recovery from concussion can dramatically affect a child's social, emotional, and educational development, yet little is known about what causes some children to recover faster than others. The contribution of white matter disruption in children with delayed recovery has been hypothesized, but findings are limited by methodological issues such as: small heterogeneous samples, bias toward children with delayed recovery, and inconsistencies in timing of brain imaging, both within and between studies. The aim of the present study was to assess diffusion neuroimaging correlates of delayed recovery post-concussion in children. A prospective, longitudinal, observational cohort study was conducted at a statewide tertiary pediatric hospital. Forty-three children who presented to the emergency department (ED) with concussion (defined according to the Zurich/Berlin Consensus Statement on Concussion in Sport) underwent magnetic resonance imaging (MRI) at a 2 weeks post-injury and were classified as either normally recovering (n = 26) or delayed recovering (n = 17). Diffusion imaging comparison using voxelwise tract-based spatial statistics (TBSS) analysis found no difference between the groups in fractional anisotropy, axial diffusion, radial diffusion, or mean diffusivity metrics ( p > 0.05 threshold-free cluster enhancement [TFCE] corrected). Post-hoc tract-based Bayesian analysis found evidence for the null in 11 unique white matter tracts (Bayes factor >3). These findings indicate that delayed recovery from post-concussive symptoms in children is unlikely to be caused by white matter microstructural damage.

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Section: Dwi In Pediatric Concussion Recovery 1303mentioning

confidence: 96%

Examining Microstructural White Matter Differences between Children with Typical and Those with Delayed Recovery Two Weeks Post-Concussion

Shapiro

Silk

Takagi

et al. 2020

Journal of Neurotrauma

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“…Evidence suggests that mental health changes with time postconcussion. 21 However, it is unclear how internalising and externalising difficulties may evolve from very acute stages to longer term impact. We therefore included a wider range of time since injury, to capture and comment on time in the context of recovery.…”

Section: Data Classificationmentioning

confidence: 99%

“…Female adolescents are particularly vulnerable to internalising difficulties such as depression, anxiety and withdrawal after concussion. 21 Meanwhile, externalising behaviours, such as conduct problems, attention difficulties, hyperactivity and temper problems are more common among younger children. 22 Whether these findings reflect risk factors associated with participant factors, such as age and sex, versus design characteristics require further exploration.…”

Section: Introductionmentioning

confidence: 99%

Mental health after paediatric concussion: a systematic review and meta-analysis

et al. 2021

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ObjectiveThis systematic review and meta-analysis sought to rigorously examine mental health outcomes following paediatric concussion. To date, heterogeneous findings and methodologies have limited clinicians’ and researchers’ ability to meaningfully synthesise existing literature. In this context, there is a need to clarify mental health outcomes in a homogeneous sample, controlling for key methodological differences and applying a consistent definition of concussion across studies.DesignSystematic review and meta-analysis.Data sourcesWe searched Medline, Embase, PsycINFO, CINAHL, SportDiscus, Scopus and PubMed.EligibilityPeer-reviewed studies published between 1980 and June 2020 that prospectively examined mental health outcomes after paediatric concussion, defined as per the Berlin Consensus Statement on Concussion in Sport.ResultsSixty-nine articles characterising 60 unique samples met inclusion criteria, representing 89 114 children with concussion. Forty articles (33 studies) contributed to a random effects meta-analysis of internalising (withdrawal, anxiety, depression, post-traumatic stress), externalising (conduct problems, aggression, attention, hyperactivity) and total mental health difficulties across three time points post-injury (acute, persisting and chronic). Overall, children with concussion (n=6819) experienced significantly higher levels of internalising (g=0.41–0.46), externalising (g=0.25–0.46) and overall mental health difficulties compared with controls (g=0.18–0.49; n=56 271), with effects decreasing over time.Summary/conclusionsOur review highlights that mental health is central to concussion recovery. Assessment, prevention and intervention of mental health status should be integrated into standard follow-up procedures. Further research is needed to clarify the mechanisms underlying observed relationships between mental health, post-concussion symptoms and other psychosocial factors. Results suggest that concussion may both precipitate and exacerbate mental health difficulties, thus impacting delayed recovery and psychosocial outcomes.

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“…Thus, by providing patients and their caregivers with a clear sense of what a typical pediatric concussion presentation looks like, clinicians can collaborate with families to build patients' self-efficacy and optimism for a positive prognosis (e.g., patient may gradually return to sport over time following concussion, rather than being permanently restricted from sport). For child and adolescent concussion patients who exhibit elevated levels of depressive symptoms, it is important to consider whether the patient might benefit from evidence-based treatment [e.g., Cognitive behavioral therapy (CBT), medication management] to efficiently triage mood concerns alongside intervention efforts targeting self-efficacy (Gornall et al, 2019). In sum, clinicians should feel empowered to promote optimal recovery outcomes for child and adolescent concussion patients by fostering their self-efficacy and addressing affective concerns.…”

Section: Discussionmentioning

confidence: 99%

Impact of Self-Efficacy and Affective Functioning on Pediatric Concussion Symptom Severity

Ramsey

Vaughan²,

Wagner

et al. 2021

J Int Neuropsychol Soc

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Objective: The purpose of this study was to examine whether self-efficacy predicted pediatric concussion symptom severity and explore whether affective mood states (e.g., depression) influenced this relationship. Method: Children (8–17 years) who were diagnosed with a concussion within 30 days of injury participated in the study (n = 105). Following a clinical assessment, participants and caregivers completed questionnaires that assessed overall concussion symptom severity and current depression symptoms. Participants also completed ratings capturing self-efficacy for managing concussion recovery. Results: Linear regression models revealed that greater levels of self-efficacy predicted lower parent- (R2 = 0.10, p = .001) and youth-rated (R2 = 0.23, p < .001) concussion symptom severity. Interestingly, depression symptoms moderated the relationship between self-efficacy and concussion symptom severity. Conclusions: Findings provide initial support for a relationship between self-efficacy and concussion outcomes and highlight the influence of depressive symptoms. Interventions that optimize youth’s self-efficacy have the potential to increase treatment adherence, reduce concussion symptom severity, and improve recovery prognosis.

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Behavioral and Emotional Difficulties after Pediatric Concussion

Cited by 25 publications

References 33 publications

Examining Microstructural White Matter Differences between Children with Typical and Those with Delayed Recovery Two Weeks Post-Concussion

Examining Microstructural White Matter Differences between Children with Typical and Those with Delayed Recovery Two Weeks Post-Concussion

Mental health after paediatric concussion: a systematic review and meta-analysis

Impact of Self-Efficacy and Affective Functioning on Pediatric Concussion Symptom Severity

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