Traumatic brain injury (TB I) is defined by the CDC as an injury usually caused by “a bump, jolt, or blow” to the head that results in impairment in brain functioning. The CDC also categorizes TBI further into mild, moderate, or severe TBI depending on the level of brain damage and impairment that results. This article from the Boston Medical Journal focuses on the mental health implications of mild TBI (also known as concussion).  In this powerful systematic review, researchers aimed to shed more light on mental health symptoms post-concussion in children.

As reported in this article, one-third of children experience concussion before age 13. Yet, despite how common concussion is in this population, there continues to be a dearth of information on this topic. We have more information on adult concussion, but as the authors point out, it can be hard to generalize adult concussion findings to children. (For one thing, the mechanism is usually different in children compared to adults, with adult concussions more commonly involving sports.) Moreover, the psychiatric ramifications of concussion in children are poorly understood. This systematic review aggregated studies from the years of 1980-2020, which resulted in 89,114 children with concussion for analysis. Some key questions were answered from their findings.

• How common are mental health problems after a concussion in children?
  The studies assessed showed that mental health symptoms arose in 19-40% of children who had no previous psychiatric diagnosis. This is compared with 50-60% of children who had a prior psychiatric diagnosis. The takeaway here: kids with mental health issues prior to concussion may have more problems with mental health post-concussion and should be monitored accordingly.  

• What are some of the mental health problems that develop post-concussion in children?
  Here the results were pretty variable. Some kids began to show emotional lability and increased anxiety, with others showing symptoms of inattention and problems controlling anger. Strikingly, one third of kids who didn’t have a mental health diagnosis prior to their concussion, developed a novel psychiatric diagnosis after their injury, highlighting the need for continued vigilance in children post-concussion.
• How do mental health symptoms change over time post-concussion in children?
  Unlike some of the somatic issues post-concussion, the mental health issues took longer to clear up. The studies that assessed this suggested a range from around 3-6 months but stated that they could take longer in some children. If a child was to manifest psychiatric symptoms post-concussion, researchers found that these symptoms were most likely to develop within a year post concussion. 

While a lot more work needs to be done on this topic, this systematic review does shed light on the complex topic of pediatric concussion and the mental health issues that can follow. The authors urge clinicians to take previous mental health diagnoses into account and to continue to be vigilant for psychiatric symptoms that may develop in children. Child psychiatry is one of our specialties at CalPsychiatry, and all of our clinicians can help assess if post-concussive symptoms may be developing into a psychiatric condition. We are happy to work with a multidisciplinary team (primary doctor, neurologist, therapist) to help your child start their road to healing. Call or book your free consultation today.