Over the last few months I believe we have all observed an increase in the number of student-athletes undergoing concussion evaluations and protocols compared to previous years and more and more professional and student-athletes are being required to sit out. This is certainly a step in the right direction and, if we continue to be vigilant, the trend toward increasing awareness and improving outcomes should continue.
Even with the improvements in concussion identification, diagnosis, and treatment, there is one aspect, I have noticed, that has continued to be absent from the discussion: the psychology of concussion. By this I am referring to the constellation of behavioral and personality changes experienced by the individual or student-athlete who has sustained the concussion. I have discussed the roles that School Psychologists can and should play in the prevention, assessment, and management of student-athletes with respect to sports-related concussions (SRC), but even I have neglected to thoroughly review/discuss the psychological aspects of concussive events.
My review of the current research exploring the psychological impact of concussions has identified specific factors as possible explanations for the responses demonstrated by the injured athlete. There are studies that discuss pre-existing mental status and its role as a predictor of concussion occurrence and possible contributor to prolonged concussion recovery. Other studies were completed to catalog and define different psychological response patterns exhibited by student-athletes post-concussion, and whether these patterns are associated with either positive or negative outcomes. Lastly, were the more common retrospective studies, which attempt to track many of the psychological difficulties identified in long-term mTBI sufferers.
Studies that focused on the role of psychological and psychosocial factors in student-athlete injury and subsequent recovery were grouped together. The consensus findings suggest that there are specific factors that have shown to influence a student-athletes’ susceptibility to and recovery from sports-related concussions.
The diagnosis or presence of the following conditions, has been shown to increase the student-athlete vulnerability to and recovery from concussions:
- A prior history of migraine headaches
- Attention-Deficit/Hyperactivity Disorder
- Mood Disorders (Depression, Anxiety)
- Learning Disabilities
- Prior history of somatization (physical symptoms with no clear medical cause)
References: Harmon, et al., 2013 and Santopietro, Yeomans, Niemeier, White, &
What does this mean? If you are a parent, coach, or student-athlete and you know that your athlete or teammate experiences increased susceptibility of concussion due to one or more of these conditions, then you should be more vigilant with these individuals when it comes to brain injury. School administrators should encourage coaches to learn more about their players, review cumulative folders, and ask players and their parents about these conditions. Do not rely only on the pre-season physical to be your sole source of information. I never like to generalize, but with many years of experience, I have come to question the general reliability of information contained in these forms. To put it bluntly, information that is in the student’s best interest is not always presented. As we transition from pre- to post-concussion management, caregivers and the student-athletes themselves must have a better awareness of the unique situation they are facing.
In general, when an individual experiences a physically traumatic event, there is almost always a psychological response that occurs simultaneously with or soon after the physical response. The
degree of the psychological response typically mirrors the severity of the injury or trauma. Additionally, there are often additional concerns to consider in evaluating and managing concussion responses in student-athletes. Was the injury season or career ending? Is this the first significant injury experienced by the athlete? What level of competition is he/she at? How does the individual view his or her identity? Is he/she an athlete who goes to school or a student that plays a sport? These factors can directly influence the student-athlete’s reaction to a concussive event and should be considered throughout the recovery process.
Regardless of the actual vs expected recovery time, student-athletes are faced with a significant challenge as their world has been turned upside down. Initially they will face the physical aspect of
the injury (e.g., headaches, nausea, vision changes, etc.) that will be followed by questions like, “how long until I am ready to get back on the field, court, mat?” Subsequently, they will face the psychological or psychosocial aspect of the injury (e.g., questions of identity, social support, or anxiety about future injury) that may be followed by questions like, “what do I do if I can’t play again?” or thoughts such as, “no one understands what I’m going through.” Then there is the additional concern of school which may result in questions like, “can I take my exam on Friday?” or “how long until I can go back to class?”
For some student-athletes, concussions can trigger ineffective psychological responses and strong support becomes paramount to his/her recovery (Grubenhoff, et al., 2016; Root, et al., 2016). As caregivers, knowing is half the battle. If we are familiar with the student-athletes in our schools pre-injury, then we improve our chances of providing appropriate support post-injury.
Even though research has identified contributing factors to concussion incidence and recovery, at this point I do not believe that there is adequate support for requiring global personality or mental health evaluations for student-athletes. However, it appears that there is sufficient evidence to support the notion that more focus and attention on these factors will only have long-term benefits for student-athletes and their concussion recovery.
Grubenhoff, J. A., Currie, D., Comstock, R., Juarez-Colunga, E., Bajaj, L., & Kirkwood, M. (2016, July). Psychological Factors Associated with Delayed Symptom Resolution in Children with Concussion. The Journal of Pediatrics, 174, 27-32.
Harmon, K. G., Drezner, J. A., Gammons, M., Guskiewicz, K. M., Halstead, M., Herring, S. A., . . . Roberts, W. O. (2013). American Medical Society for Sports Medicine position statement: concussion in sport. British Journal of Sports Medicine, 47, 15-26.
Nelson, L. D., Tarim, S., LaRoche, A. A., Hammeke, T. A., Barr, W. B., Guskiewicz, K., . . . McCrea, M. A. (2016, May 17). Preinjury somatization symptoms contribute to clinical recovery after sport-related concussion. Neurology, 86(20), 1856-1863.
Root, J. M., Zuckerbraun, N. S., Wang, L., Winger, D. G., Brent, D., Kontos, A., & Hickey, R. W. (2016, July). History of Somatization Is Associated with Prolonged Recovery from Concussion. The Journal of Pediatrics, 174, 39-44.
Santopietro, J., Yeomans, J. A., Niemeier, J. P., White, J. K., & Coughlin, C. M. (2015). Traumatic Brain Injury and Behavioral Health: The State of Treatment and Policy. North Carolina Medical Journal, 26(2), 96-100.