Traumatic brain injury in adolescence: A review of the neurobiological and behavioural underpinnings and outcomes

Traumatic brain injury (TBI) is among the most prevalent causes of disability and death in childhood and adolescence. Although adolescents are commonly lumped in with either children or adults, their injury patterns, symptoms, and outcomes significantly differ from both groups and the effects of TBI during this period should be studied and treated as distinct. This review highlights these distinctions by demonstrating how adolescence differs from other developmental stages and how outcomes of all TBI severities during this phase contrast with those of children and adults. Within this framework, the review highlights three key points. First, adolescence represents a high-risk period for acquiring a TBI (mild, moderate, or severe). Second, adolescents do not respond and recover from these injuries in the same manner as young children or adults. Finally, there are significant gaps in the literature regarding adolescent neuropathology and most specifically the neuroinflammatory response in the adolescent brain, as well as relationships of these factors to cognitive, social, and emotional factors and decision making in adolescence, all of which contribute to risks and recovery from TBI. Future research should comprehensively characterize causal mechanisms ranging from neuropathophysiology, including neuroinflammatory processes, to social and psychological processes associated with adolescent TBI across the spectrum (mild to severe), as this may provide innovative pathways toward effective preventative and therapeutic strategies.