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Emotional Symptoms Found to Develop While Recovering From a Concussion

After children and adolescents suffer a concussion, physical symptoms such as headache, nausea, and fatigue tend to present immediately, while emotional symptoms such as frustration, irritability, and restlessness may take days or weeks to appear, finds a new study published online today in the journal Pediatrics.

The study authors conducted an analysis of 235 patients between the ages of 11 and 22 who were seen in the emergency department of Boston Children's Hospital with a concussion. Patients completed the Rivermead Post-Concussion Symptoms Questionnaire to assess the duration of their concussion symptoms.

Headache (85.1 percent of patients), fatigue (64.2 percent), dizziness (61.3 percent), and taking longer to think (57.8 percent) were the symptoms that most commonly presented immediately following the concussion. In the days and weeks after the injury, 21.6 percent of patients began experiencing sleep disturbance, 17.4 percent felt frustration, 15.8 percent developed forgetfulness, and 15.4 percent felt fatigued. Of the four emotional symptoms evaluated—depression, frustration, irritability, and restlessness—depression was the only that didn't develop in at least 14 percent of patients after initial presentation.

In terms of the median duration of symptoms, irritability (16 days), sleep disturbance (16 days), frustration (14 days), and poor concentration (14 days) tended to last the longest amount of time. Contrastingly, nausea (nine days), depression (nine days), dizziness (10 days), and double vision (10 days) resolved most quickly.

Twenty-eight days following a concussion, just under a quarter of children were still experiencing headaches, while 21.6 percent still felt fatigue and 18.3 percent reported taking longer to think. Blurry vision (6 percent) and double vision (1.8 percent) were the symptoms least likely to persist through four weeks.

One week following their concussions, 197 of the 235 patients completed a questionnaire assessing their return to academic and athletic activities. A majority of subjects (57 percent) reported limiting their cognitive activity moderately, while 15.2 percent only minimally did so and 27.4 percent reported no such limitations. Eighteen percent of patients reported worse performance on schoolwork compared to before their concussion. A majority (63.8 percent) also hadn't returned to any sort of athletic activity, while 8.2 percent had already made a full return to athletics.

In total, 77 percent of patients reported having some form of symptoms seven days after suffering a concussion, 32 percent had at least one symptom 28 days out, and 15 percent still had symptoms a full 90 days after the injury. The median time of resolution from all symptoms was 13 days.

"Cognitive symptoms were particularly burdensome in our cohort, as they were present in substantial percentages initially, still went on to develop in many additional patients, and had greater than average duration of symptoms, with the exception of forgetfulness, which resolved on average within 11 days," the authors write. "These findings support the importance of academic accommodations for children after concussion."

A clinical report from the American Academy of Pediatrics released last October recommended easing student-athletes back into their normal academic routine following a concussion for that very reason. Certain symptoms of concussions can clearly affect a student-athlete's learning ability, the academy suggested, and forcing student-athletes to return to their normal classroom routine immediately following a concussion could also delay their recovery from their injury, since cognitive rest is considered the best course of action for recovery.

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