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Examining the Biopsychosocial Factors Related to Lifetime History of Concussion in Children and Youth

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Abstract

This study investigated the prevalence of lifetime concussions, related psychosocial problems, and post-concussion recovery rates in a clinical sample of children and youth. Participants were 24,186 children and youth (M = 11.9 years, SD = 3.5) who completed an interRAI Child and Youth Mental Health Assessment at mental health agencies across Ontario, Canada. In addition to the expected physiological correlates, results found concussions to be more prevalent in children and youth with attention deficit hyperactivity disorders, anxiety disorders, disruptive behaviour disorders, mood disorders, and those involved in self-harm, harm to others, destructive aggression, and internalizing and externalizing symptoms. The results of this study add to our understanding of children and youth’s experiences with concussions. Clinical implications and recommendations are discussed to maximize the effectiveness of evidence-based interventions related to concussion recovery.

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References

  1. McCallum J, Emery C, Eliason PH, Schneider K, Black AM (2020) 326 Lifetime prevalence and one-year incidence of sport-related concussion in adolescents. Br J Sports Med 54:A133–A134

    Google Scholar 

  2. Dufour SC, Adams RS, Brody DL, Puente AN, Gray JC (2020) Prevalence and correlates of concussion in children: data from the adolescent brain cognitive development study. Cortex 131:237–250

    Article  PubMed  Google Scholar 

  3. Stazyk K, DeMatteo C, Moll S, Missiuna C (2017) Depression in youth recovering from concussion: correlates and predictors. Brain Inj 31:631–638

    Article  PubMed  Google Scholar 

  4. Centers for Disease Control and Prevention (CDC; 2021, May 12) Symptoms of mild TBI and concussion. Traumatic Brain Injury and Concussion. https://www.cdc.gov/traumaticbraininjury/concussion/symptoms.html

  5. Gornall A, Takagi M, Morawakage T, Liu X, Anderson V (2021) Mental health after paediatric concussion: a systematic review and meta-analysis. Br J Sports Med 55:1048–1058

    Article  PubMed  Google Scholar 

  6. Fischer JT, Hannay HJ, Alfano CA, Swank PR, Ewing-Cobbs L (2018) Sleep disturbances and internalizing behavior problems following pediatric traumatic injury. Neuropsychology 32:161–175

    Article  PubMed  PubMed Central  Google Scholar 

  7. McMakin DL, Alfano CA (2015) Sleep and anxiety in late childhood and early adolescence. Curr Opin Psychiatry 28:483–489

    Article  PubMed  PubMed Central  Google Scholar 

  8. Shay N, Yeates KO, Walz NC, Stancin T, Taylor HG, Beebe DW et al (2014) Sleep problems and their relationship to cognitive and behavioral outcomes in young children with traumatic brain injury. J Neurotrauma 31:1305–1312

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sarmiento K, Miller GF, Jones SE (2017) Sports-or physical activity-related concussions and feelings of sadness or hopelessness among U.S. high school students: results from the 2017 Youth Behaviour Risk Survey. J Sch Nurs. https://doi.org/10.1177/1059840520945389

    Article  Google Scholar 

  10. McKinlay A, Grace R, Horwood J, Fergusson D, MacFarlane M (2009) Adolescent psychiatric symptoms following preschool childhood mild traumatic brain injury: evidence from a birth cohort. J Head Trauma Rehabil 24:221–227

    Article  PubMed  Google Scholar 

  11. McKinlay A, Grace RC, Horwood LJ, Fergusson DM, MacFarlane MR (2010) Long-term behavioural outcomes of pre-school mild traumatic brain injury. Child Care Health Dev 36:22–30

    Article  PubMed  Google Scholar 

  12. Lowry R, Haarbauer-Krupa J, Breiding MJ, Simon TR (2021) Sports- and physical activity–related concussion and risk for youth violence. Am J Prev Med 60:352–359

    Article  PubMed  Google Scholar 

  13. Cook NE, Karr JE, Iverson GL (2022) Children with ADHD have a greater lifetime history of concussion: results from the ABCD study. J Neurotrauma 39:86–92

    Article  PubMed  Google Scholar 

  14. Cook NE, Teel E, Iverson GL, Friedman D, Grilli L, Gagnon I (2021) Lifetime history of concussion among youth with ADHD presenting to a specialty concussion clinic. Front Neurol 12:780278–780278

    Article  PubMed  Google Scholar 

  15. Iverson GL, Atkins JE, Zafonte R, Berkner PD (2016) Concussion history in adolescent athletes with attention-deficit hyperactivity disorder. J Neurotrauma 33:277–2080

    Article  Google Scholar 

  16. Iverson GL, Kelshaw PM, Cook NE, Caswell SV (2020) Middle school children with attention-deficit/hyperactivity disorder have a greater concussion history. Clin J Sport Med 31:438–441

    Article  Google Scholar 

  17. Manley G, Gardner AJ, Schneider KJ, Guskiewicz KM, Bailes J, Cantu RC et al (2017) A systematic review of potential long-term effects of sport-related concussion. Br J Sports Med 51:969–977

    Article  PubMed  Google Scholar 

  18. Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA et al (2013) Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the guideline development subcommittee of the American Academy of Neurology. Neurology 80:2250–2257

    Article  PubMed  PubMed Central  Google Scholar 

  19. Harmon KG, Clugston JR, Dec K, Hainline B, Herring S, Kane SF et al (2019) American medical society for sports medicine position statement on concussion in sport. Br J Sports Med 53:213–225

    Article  PubMed  Google Scholar 

  20. Lumba-Brown A, Yeates KO, Sarmiento K, Breiding MJ, Haegerich TM, Gioia GA et al (2018) Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children. JAMA Pediatr 172:e182853

    Article  PubMed  PubMed Central  Google Scholar 

  21. Seema S, Aggarwal SD, Ott SD, Padhye NS, Schulz PE (2020) Sex, race, ADHD, and prior concussions as predictors of concussion recovery in adolescents. Brain Inj 34:811–819

    Article  Google Scholar 

  22. Iverson GL, Atkins JE, Zafonte R, Berkner PD (2016) Concussion history in adolescent athletes with attention-deficit hyperactivity disorder. J Neurotrauma 33:2077–2080

    Article  PubMed  Google Scholar 

  23. Wojcik SM (2014) Predicting mild traumatic brain injury patients at risk of persistent symptoms in the emergency department. Brain Inj 28:422–430

    Article  PubMed  Google Scholar 

  24. Schatz P, Moser RS, Covassin T, Karpf R (2011) Early indicators of enduring symptoms in high school athletes with multiple previous concussions. Neurosurgery 68:1562–1567

    Article  PubMed  Google Scholar 

  25. Hang B, Babcock L, Hornung R, Ho M, Pomerantz WJ (2015) Can computerized neuropsychological testing in the emergency department predict recovery for young athletes with concussions? Pediatr Emerg Care 31:688–693

    Article  PubMed  Google Scholar 

  26. Ewing-Cobbs L, Cox CS Jr, Clark AE, Holubkov R, Keenan HT (2018) Persistent postconcussion symptoms after injury. Pediatrics (Evanston). https://doi.org/10.1542/peds.2018-0939

    Article  Google Scholar 

  27. Laursen B, Nielsen JW (2008) Influence of sociodemographic factors on the risk of unintentional childhood home injuries. Eur J Public Health 18:366–370

    Article  PubMed  Google Scholar 

  28. Lin AC, Salzman GA, Bachman SL, Burke RV, Zaslow T, Piasek CZ et al (2015) Assessment of parental knowledge and attitudes toward pediatric sports-related concussions. Sports Health 7:124–129

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lariviere K, Bureau S, Marshall C, Holahan MR (2019) Interaction between age, sex, and mental health status as precipitating factors for symptom presentation in concussed individuals. J Sports Med 2019:1–10

    Article  Google Scholar 

  30. Anderson V, Brown S, Newitt H, Hoile H (2009) Educational, vocational, psychosocial, and quality-of-life outcomes for adult survivors of childhood traumatic brain injury. J Head Trauma Rehabil 24:303–312

    Article  PubMed  Google Scholar 

  31. Ellis MJ, Ritchie LJ, Koltek M, Hosain S, Cordingley D, Chu S et al (2015) Psychiatric outcomes after pediatric sports-related concussion. J Neurosurg 16:709–718

    Google Scholar 

  32. Gornall A, Takagi M, Clarke C, Babl FE, Davis GA, Dunne K et al (2020) Behavioral and emotional difficulties after pediatric concussion. J Neurotrauma 37:163–169

    Article  PubMed  Google Scholar 

  33. Stewart SL, Hirdes JP Curtin-Telegdi N, Perlman C, MacLeod K, Ninan A et al (2015) InterRAI Child and Youth Mental Health (ChYMH) assessment form and user’s manual, version 9.3. interRAI, Washington, DC

  34. Stewart SL, Hamza CA (2017) The Child and Youth Mental Health Assessment (ChYMH): an examination of the psychometric properties of an integrated assessment developed for clinically referred children and youth. BMC Health Serv Res 17:82–82

    Article  PubMed  PubMed Central  Google Scholar 

  35. Hirdes JP, Smith TF, Rabinowitz T, Yamauchi K, Perez E, Telegdi NC et al (2002) The Resident Assessment Instrument-Mental Health (RAI-MH): inter-rater reliability and convergent validity. J Behav Health Serv Res 29:419–432

    Article  PubMed  Google Scholar 

  36. Hirdes JP, Ljunggren G, Morris JN, Frijters DHM, Finne Soveri H, Gray L et al (2008) Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Serv Res 8:277–277

    Article  PubMed  PubMed Central  Google Scholar 

  37. Hirdes JP, van Everdingen C, Ferris J, Franco-Martin M, Fries B, Heikkila J et al (2020) The interRAI suite of mental health assessment instruments: an integrated system for the continuum of care. Front Psychiatry 10:926–926

    Article  PubMed  PubMed Central  Google Scholar 

  38. Stewart SL, Celebre A, Semovski V, Hirdes JP, Vadeboncoeur C, Poss JW (2022) The interRAI child and youth suite of mental health assessment instruments: an integrated approach to mental health service delivery. Front Psychiatry 13:710569–710569

    Article  PubMed  PubMed Central  Google Scholar 

  39. Stewart SL, Poss JW, Thornley E, Hirdes JP (2019) Resource intensity for children and youth: the development of an algorithm to identify high service users in children’s mental health. Health Serv Insights 12:1178632919827930

    PubMed  PubMed Central  Google Scholar 

  40. Stewart SL, Morris JN, Asare-Bediako YA, Toohey A (2020) Examining the structure of a new pediatric measure of functional independence using the interRAI child and youth mental health assessment system. Dev Neurorehabil 23:526–533

    Article  PubMed  Google Scholar 

  41. Stewart SL, Hirdes JP (2015) Identifying mental health symptoms in children and youth in residential and in-patient care settings. Healthc Manag Forum 28:150–156

    Article  Google Scholar 

  42. Stewart SL, Celebre A, Hirdes JP, Poss JW (2020) Risk of suicide and self-harm in kids: the development of an algorithm to identify high-risk individuals within the children’s mental health system. Child Psychiatry Hum Dev 51:913–924

    Article  PubMed  PubMed Central  Google Scholar 

  43. Stewart SL, Celebre A, Hirdes JP, Poss JW (2021) Risk of injury to others: the development of an algorithm to identify youth at high-risk of violence perpetration within the mental health system. J Psychopathol Behav Assess 12:750625–750625

    Google Scholar 

  44. Lau C, Stewart SL, Saklofske DH, Tremblay PF, Hirdes J (2018) Psychometric evaluation of the interRAI Child and Youth Mental Health Disruptive/Aggression Behaviour Scale (DABS) and Hyperactive/Distraction Scale (HDS). Child Psychiatry Hum Dev 49:279–289

    Article  PubMed  Google Scholar 

  45. Perlman CM, Hirdes JP, Barbaree H, Fries BE, McKillop I, Morris JN et al (2013) Development of mental health quality indicators (MHQIs) for inpatient psychiatry based on the interRAI mental health assessment. BMC Health Serv Res 13:15–15

    Article  PubMed  PubMed Central  Google Scholar 

  46. Li Y, Babcock SE, Stewart SL, Hirdes JP, Schwean VL (2021) Psychometric evaluation of the Depressive Severity Index (DSI) among children and youth using the interRAI Child and Youth Mental Health (ChYMH) assessment tool. Child Youth Care Forum 50:611–630

    Article  Google Scholar 

  47. Stewart SL, Babcock SE, Li Y, Dave HP (2020) A psychometric evaluation of the interRAI Child and Youth Mental Health instruments (ChYMH) anxiety scale in children with and without developmental disabilities. BMC Psychiatry 20:390–390

    Article  PubMed  PubMed Central  Google Scholar 

  48. Lau C, Stewart SL, Saklofske DH, Hirdes J (2019) Scale development and psychometric properties of internalizing symptoms: the interRAI Child and Youth Mental Health internalizing subscale. Psychiatry Res 278:235–241

    Article  PubMed  Google Scholar 

  49. Lau C, Stewart SL, Saklofske DH, Hirdes J (2021) Development and psychometric validation of the interRAI ChYMH externalizing subscale. Clin Child Psychol Psychiatry 26:295–305

    Article  PubMed  Google Scholar 

  50. Li L, Liu J (2013) The effect of pediatric traumatic brain injury on behavioral outcomes: a systematic review. Dev Med Child Neurol 55:37–45

    Article  PubMed  Google Scholar 

  51. Anderson V, Catroppa C, Morse S, Haritou F, Rosenfeld J (2005) Functional plasticity or vulnerability after early brain injury? Pediatrics 116:1374–1382

    Article  PubMed  Google Scholar 

  52. Yang MN, Clements-Nolle K, Parrish B, Yang B (2019) Adolescent concussion and mental health outcomes: a population-based study. Am J Health Behav 43:258–265

    Article  PubMed  Google Scholar 

  53. Chrisman SP, Richardson LP (2014) Prevalence of diagnosed depression in adolescents with history of concussion. J Adolesc Health 54:582–586

    Article  PubMed  Google Scholar 

  54. Chrisman SP, Whelan BM, Zatzick DF, Hilt RJ, Wang J, Marcynyszyn LA et al (2021) Prevalence and risk factors for depression, anxiety and suicidal ideation in youth with persistent post-concussive symptoms (PPCS). Brain Inj 35:1637–1644

    Article  PubMed  PubMed Central  Google Scholar 

  55. Papachristou E, Flouri E (2020) Distinct developmental trajectories of internalising and externalising symptoms in childhood: links with mental health and risky behaviours in early adolescence. J Affect Disord 276:1052–1060

    Article  PubMed  Google Scholar 

  56. Kimonis ER, Frick PJ (2016) Externalizing disorders of childhood and adolescence. In: Maddux JE, Winstead BA (eds) Psychopathology: foundations for a contemporary understanding. Routledge/Taylor & Francis Group, London, pp 365–389

    Google Scholar 

  57. Deschamps PK, Verhulp EE, de Castro BO, Matthys W (2018) Proactive aggression in early school-aged children with externalizing behavior problems: a longitudinal study on the influence of empathy in response to distress. Am J Orthopsychiatry 88:346–353

    Article  PubMed  Google Scholar 

  58. Ganson KT, O’Connor J, Benabou SE, Nagata JM (2021) Associations between interpersonal violence victimisation and concussions among US college students. Health Soc Care Community 30:175–183

    Article  PubMed  Google Scholar 

  59. Ma Z, Bayley MT, Perrier L, Dhir P, Dépatie L, Comper P et al (2019) The association between adverse childhood experiences and adult traumatic brain injury/concussion: a scoping review. Disabil Rehabil 41:1360–1366

    Article  PubMed  Google Scholar 

  60. Daigle LE, Harris MN (2018) Recurring victimization: what role does head injury play? J Crim Justice 58:78–86

    Article  Google Scholar 

  61. Truss K, Godfrey C, Takagi M, Babl FE, Bressan S, Hearps S et al (2017) Trajectories and risk factors for post-traumatic stress symptoms following pediatric concussion. J Neurotrauma 34:2272–2279

    Article  PubMed  Google Scholar 

  62. Varner C, Thompson C, de Wit K, Borgundvaag B, Houston R, McLeod S (2021) Predictors of persistent concussion symptoms in adults with acute mild traumatic brain injury presenting to the emergency department. Can J Emerg Med 23:365–373

    Article  Google Scholar 

  63. Covassin T, Moran R, Wilhelm K (2013) Concussion symptoms and neurocognitive performance of high school and college athletes who incur multiple concussions. Am J Sports Med 41:2885–2889

    Article  PubMed  Google Scholar 

  64. World Health Organization (WHO) (2021, November 17) Adolescent mental health. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health. Accessed 17 Dec 2021

  65. Must A, Phillips S, Curtin C, Bandini LG (2015) Barriers to physical activity in children with autism spectrum disorders: relationship to physical activity and screen time. J Phys Act Health 12:529–534

    Article  PubMed  PubMed Central  Google Scholar 

  66. Rosenkranz MA, Dean DC 3rd, Bendlin BB, Jarjour NN, Esnault S, Zetterberg H et al (2021) Neuroimaging and biomarker evidence of neurodegeneration in asthma. J Allergy Clin Immunol 149(2):589–598

    Article  PubMed  PubMed Central  Google Scholar 

  67. Corman SR, Adame BJ, Tsai JY, Ruston SW, Beaumont JS, Kamrath JK et al (2019) Socioecological influences on concussion reporting by NCAA Division 1 athletes in high-risk sports. PLoS ONE 14:e0215424

    Article  PubMed  PubMed Central  Google Scholar 

  68. Del Giacco SR, Firinu D, Bjermer L, Carlsen KH (2015) Exercise and asthma: an overview. Eur Clin Respir J 2:27984–27984

    Article  PubMed  Google Scholar 

  69. Rosenkranz MA, Davidson RJ (2009) Affective neural circuitry and mind-body influences in asthma. NeuroImage 47:972–980

    Article  PubMed  Google Scholar 

  70. Morrongiello BA, Corbett M, McCourt M, Johnston N (2006) Understanding unintentional injury-risk in young children I. The nature and scope of caregiver supervision of children at home. J Pediatr Psychol 31:529–539

    Article  PubMed  Google Scholar 

  71. Morrongiello BA, Klemencic N, Corbett M (2008) Interactions between child behavior patterns and parent supervision: implications for children’s risk of unintentional injury. Child Dev 79:627–638

    Article  PubMed  Google Scholar 

  72. Damashek A, Corlis M (2017) The role of proximal maternal supervision in children’s risk for injury in a low-income sample. J Pediatr Psychol 42:727–737

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank the children, youth, and families, in addition to the trained assessors and clinicians in the field, for participating in the research process.

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Authors and Affiliations

  1. Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON, N6G 1G7, Canada

    Shannon L. Stewart, Abigail Withers, Alana A. Graham & Nicholas Donnelly

  2. School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G5, Canada

    Jeffrey W. Poss

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  1. Shannon L. Stewart
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Correspondence to Abigail Withers.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the University of Western’s ethics review board (REB#106415).

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Informed consent was obtained from all participants during standard of care assessments at each of the participating mental health agencies.

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Stewart, S.L., Withers, A., Graham, A.A. et al. Examining the Biopsychosocial Factors Related to Lifetime History of Concussion in Children and Youth. Child Psychiatry Hum Dev 55, 36–47 (2024). https://doi.org/10.1007/s10578-022-01384-x

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