Postconcussion Syndrome

Postconcussion syndrome is a controversial construct currently included in DSM-IV-TR (American Psychiatric Association 2000) as a disorder proposed for further study. This proposed disorder includes a variety of postconcussive symptoms, which in adults have been characterized as consisting of somatic complaints (e.g., fatigue, headache, dizziness), cognitive difficulties (e.g., attention and memory disturbances), and emotional problems (e.g., mood and anxiety problems).

Mittenberg et al. (1997) examined the occurrence of postconcussion syndrome in children and found that children who experienced TBI showed more postconcussive symptoms than a control group of children with orthopedic injuries. Injury severity and self-report of child anxiety were related to the expression of symptoms. In addition, the rate of postconcussive symptoms was similar to that found in a group of adults matched for injury severity. Yeates et al. (1999) studied the incidence of post-concussive symptoms in children following mild TBI and found that these children showed elevated levels of certain symptoms, such as inattention and fatigue, when compared with uninjured siblings. In addition, children who displayed these symptoms also showed neuropsychological deficits in attention and executive functions as well as increased behavioral dysfunction and reduced motivation. Yeates et al. (2009) examined longitudinal trajectories of postconcussive symptoms in children with mild TBI as compared with children with orthopedic injuries. They found that children with mild TBI, particularly those with more severe injury, were more likely to demonstrate trajectories showing high acute levels of symptoms, as well as persistent increases in post-concussive symptoms, in the first year postinjury.

Medical practitioners need to understand the possible expression of postconcussive symptoms following concussion or mild TBI, because children of ten present to medical professionals for advice following sports-related concussions. Unfortunately, our knowledge of the medical complications following mild TBI in children is incomplete, making it difficult to offer empirically supported guidelines for the clinical care of these children (Homer and Kleinman 1999). Medical professionals need to be aware of several issues regarding the management of multiple concussions in children (Kirkwood et al. 2006) and the relevant guidelines for disposition, including return to play (Committee on Quality Improvement et al. 1999; Kamerling et al. 2003).

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