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Students Report Host of Academic Issues When Recovering From Concussions

While recovering from the symptoms of a concussion, a vast majority of students reported having one or more issues that impaired their academic work, including headaches, problems paying attention, and difficulty studying or understanding material, according to a new study published online Monday in the journal Pediatrics.

The study's authors examined 349 students between the ages of 5 and 18 who sustained a concussion and underwent an initial evaluation within 28 days of the injury. Parents of all 349 students reported their children's postconcussion symptoms, and 239 of the students did the same. Clinicians divided the children into two groups: those who had recovered from their concussions, based on a lack of symptoms and no impairments on neurocognitive testing, and those who had not yet recovered from their concussions, based on elevated symptoms or impaired performance on neurocognitive tests.

Among the 109 students who had fully recovered from their concussions by the time of the study, just five reported having headaches interfere with their academic work, eight reported having problems paying attention, and 11 said they were feeling too tired. Of the 240 who had not yet recovered from their concussions, however, 121 had headaches interfering with their work, 106 had problems paying attention, and 95 felt too tired. Likewise, a far greater number of students who had not yet recovered reported having to spend more time on homework, difficulty understanding material and studying, and difficulty taking class notes.

In total, 88 percent of the group still recovering from a concussion reported at least one school problem related to their concussion symptoms, such as headaches, fatigue, or concentration problems. In addition, 77 percent reported having some form of diminished academic skills, such as problems taking notes or studying. Among the fully recovered group, just 38 percent had symptom-interfering problems and 44 percent had a diminished academic skill. 

The fully recovered students reported consistent interfering symptoms and diminished academic skills across all age groups. The still-recovering group reported consistent interfering symptoms as well, but their diminished academic skills varied by age level. High school students in the latter group reported a greater number of academic-skill problems than middle and elementary school students.

A significantly smaller percentage of students in the fully recovered group reported having trouble with one or more classes compared to their peers still dealing with concussion symptoms, and the same was true in the parents' reports, too. In particular, math proved problematic for students still recovering from a concussion: 114 such students reported having trouble with that subject, more than any other class. (Language arts, science, and social studies followed, in that order.) The study's authors did find a positive correlation between symptom severity and the total number of school problems reported by students and parents.

"The range of reported postinjury school problems suggests the need to provide actively symptomatic students with targeted supports during the postinjury recovery period," the authors conclude.

The American Academy of Pediatrics made a similar recommendation in a 2013 clinical report, saying schools should create a multi-disciplinary team to ease a student-athlete's transition back to the classroom after he or she sustains a concussion.

"We know that children who've had a concussion may have trouble learning new material and remembering what they've learned, and returning to academics may worsen concussion symptoms," said Dr. Mark Halstead, a lead author of the AAP's report, at the time.

A handful of states have already begun taking matters into their own hands. The Illinois Senate recently approved a bill that would require schools to create a concussion oversight team responsible for establishing both a return-to-play and a return-to-learn protocol. Both Virginia and Nebraska implemented similar return-to-learn requirements for student-athletes last year.

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