Behavioral and emotional difficulties after pediatric concussion

Pediatric concussion is a major public health concern. Despite the prevalence of behavior problems following concussion and their potential role in prolonged symptoms, little is known about how child and adolescent behavior may impact post-concussion recovery. We sought to examine change in behavioral and emotional functioning in a sample of children ages 5 to <18 years with concussion. This study reports on data collected as part of a larger single-site prospective longitudinal cohort study. Participants were recruited from the Emergency Department (ED) of a tertiary children's hospital and completed the Child Behavior Checklist (CBCL) at 2 weeks (acute; T2) and 3 months (post-acute; T4) post-injury. Children with concussion (n = 231) showed a significant reduction in internalizing (p < 0.001, d = 0.27), externalizing (p < 0.001, d = 0.23), and total behavior problems (p < 0.001, d = 0.36) at 3 months compared with 2 weeks post-injury. Multiple regression models found a significant interaction between age and sex with higher rates of internalizing (p = 0.048, η_p² = 0.02) and total (p = 0.040, η_p² = 0.02) behavior problems as age increased in females. The results show that pediatric concussion is associated with temporary behavioral disturbances that are likely to improve considerably in the months following injury. Nonetheless, as age increases, females may be at increased risk for experiencing ongoing internalizing problems several months after concussion and may require targeted clinical intervention.