Children's Hospital Colorado

Developmental and Psychosocial Impacts of Concussions

A teenage athlete sits with an athletic trainer.As a neuropsychologist in the Concussion Program at Children’s Hospital Colorado, my team and I are constantly researching the symptoms, impacts, treatment and management of concussions. In our new study, recently published in the journal Pediatrics, we found that some children and adolescents who continue to report symptoms weeks and months after suffering a concussion may be exaggerating or feigning symptoms in order to get out of schoolwork or sports or for other reasons unrelated to their injury.

For many decades, the main problem was that concussions were given too little attention. Nowadays, the pendulum has swung the other way, to a near overwhelming amount of attention. In this climate, the default for many people seems to be to assume that any problem after a head injury must be directly caused by the injury.

Caring for Patients after a Concussion

Many pediatricians and other primary care providers feel they lack the training or tools to adequately care for patients after a concussion or mild traumatic brain injury (mTBI). Our findings further complicate management because most medical providers do not routinely use objective methodology to detect exaggeration or feigning.

It is important to note that pediatric mTBI occurs frequently, with more than a half million children and teens seen annually through US emergency departments alone. The vast majority of kids recover spontaneously and completely within a few weeks. So, in my mind, having all injured youth undergo validity testing would be an inefficient use of health care resources.

We don’t want anyone to interpret the results of this study as implying that concussions aren’t serious or that we think any child with persistent concussion symptoms is “faking.” Children who display more persistent symptoms, lasting more than 3-4 weeks, should undergo proper specialty medical evaluation, as well as neuropsychological evaluation that includes validity testing. All concussions are types of brain injuries, and symptoms of any kind shouldn’t be dismissed.

Concussion Study Results

Below are a few additional points to share from our recent study:

  • If a child exaggerates memory problems after a concussion, and such exaggeration remains undetected, then health care personnel, caregivers, or school personnel might assume the injury reflects a more severe brain injury and pursue inappropriate treatment for the child.
  • Developmental and psychosocial factors such as underlying learning, attention and mood difficulties are too often neglected after a concussion. When this happens, management strategies often have negative effects including increased family anxiety about brain “damage” and unnecessary restrictions for the child from sports, schoolwork and social activities.
  • Exaggeration or feigning is one non-injury factor that needs to be considered in the face of persistent problems following a concussion. Neuropsychologists have led the way in identifying various non-injury factors as important in post-injury complaints and in establishing objective methods to detect when these factors play a role. So, the results highlight the importance of having a clinical neuropsychologist involved when symptoms persist.
  • The results from this study reinforce the need for understanding the roles that psychological and social factors may play, in additional to biological ones, in recovery after a concussion. Physical factors obviously influence a child’s clinical presentation after a concussion. But, psychosocial factors do as well, especially the further in time one gets from injury. 

Want to learn more about how we diagnose and treat concussions? Visit our website or call our Concussion Program Hotline: 720-777-2806

Written by: Michael Kirkwood, PhD Co-Director, Children's Hospital Concussion Program Children’s Hospital Colorado Dept of Orthopedics.