By Kathryn Doyle
(Reuters Health) - Kids and teens who suffer a concussion worry about their academic skills in the weeks afterward, and older kids and those with more severe symptoms seem to worry the most, according to a new study.
Studies in the last five years have focused largely on the athletic side of the equation - "taking them off the field, not putting them back on the field with symptoms, but this is really looking at the student side of the equation," said senior author Gerard A. Gioia of Children's National Health System in Rockville, Maryland.
A toolkit called HEADS UP to Schools, from the Centers for Disease Control and Prevention, already advises school professionals that after a concussion, kids may need to spend fewer hours at school, take more time for tests or assignments, or may feel frustrated at being unable to keep up with schoolwork. Students should be seen by a health care professional, who can make decisions about school readiness based on symptoms.
The new results "support what we thought was happening," Gioia told Reuters Health by phone.
He and his coauthors surveyed 239 pairs of kids and their parents, plus another 110 kids' parents, after the kids were treated at an outpatient concussion clinic within 28 days of the injury, after they had returned to school. The youngsters ranged in age from 5 to 18.
Kids and parents reported post-injury academic experiences and concerns.
Based on neurocognitive tests at the clinic, only 109 of the 349 students, or 31 percent, were recovered from their concussion and no longer had symptoms.
Almost 60 percent of kids with symptoms, and 64 percent of their parents, said they were moderately or very concerned about the concussion affecting school learning and performance, compared to 16 percent of recovered kids and 30 percent of their parents.
More high schoolers than middle school or elementary school students said they were concerned about their schoolwork, the researchers reported in Pediatrics.
More symptomatic kids reported having headaches interfere with school, problems paying attention or feeling too tired than kids without symptoms.
More than half of symptomatic kids said they were now spending more time on homework, compared to one-fifth of those without symptoms. They also reported more difficulty studying and taking class notes.
"The persistence of symptoms clearly is the most significant factor in academic impact," said Susan Saliba, a physical therapist, athletic trainer and associate professor at the Curry School of Education at the University of Virginia in Charlottesville.
The results reinforce that symptoms should be the guide in return to learn programs, Saliba, who was not involved in the new study, told Reuters Health by email.
"Anxiety, sleeplessness and moodiness are symptoms of concussion, but are strongly associated with adolescent behavior and any external stress," she said. Having a plan in place helps alleviate stress, she said.
"The academic impact does differ depending on the kind of demand that a student experiences," Gioia said. "High schools students were reporting significantly greater concern, and a higher number of problems in school relative to middle school and younger students."
High school tests and timelines have implications for graduation and college, which could be a source of concern, he said.
"Concussions vary widely, generally speaking we want kids to get back into school as soon as they can tolerate it," Gioia said.
Most are ready by two to three days of restful downtime after the injury, he said.
"School systems need to be prepared to accept and support these kids heading back into classrooms before full recovery," which requires collaboration between medical professionals and school staff, he said.
SOURCE: http://bit.ly/1zSHBu1 Pediatrics, online May 11, 2015.