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Concussion effect on academics may require accommodations

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An important study

This study is important, as it sought to investigate what many of us have anecdotally encountered: Students with higher symptom levels (and their parents) are more stressed about their academics, high school students are often more stressed and concerned by their injury and its effect on academics, and specific classes (e.g., math and language arts) are perceived as causing more trouble than other classes.

As expected, subjects in the unrecovered group had higher symptoms than at baseline. The unrecovered group also had significantly more subjects with impaired objective performance on neurocognitive measures; however, only 55% of unrecovered subjects had objectively impaired performance. This means that 45% had normal performance, even with higher symptom ratings. Interestingly, school problems were positively correlated with parent report of mood or emotional symptoms in the student, but there was no correlation with the student report.

For whatever reason, these students do not feel back to normal, and their symptoms are interfering with academic work. Perhaps the work also is interfering with return to normal. That point remains largely unstudied.

The authors make excellent points in their discussion regarding proactive counseling for students with high symptom burdens from concussion. This study shows support for identifying those students likely to have difficulties (actively symptomatic students, high school and perhaps middle school students) and providing specific, individualized academic support to them. The role of the school in this support is crucial. Good (and frequent) communication between the family, medical team, and school is essential to support the student, as symptoms change, so academic stress can be reduced. Often, this step is overlooked, even though it may be the most important.

Dr. Kelsey Logan is a pediatrician who is director of sports medicine at Cincinnati Children's Hospital Medical Center.


 

FROM PEDIATRICS

References

A concussion can affect a child’s or teen’s ability to focus at school and keep up with schoolwork, according to a recent study.

Concerns about keeping up with grades and concentrating on work mean that those who have had a concussion may require accommodations until their symptoms have fully subsided, Danielle Ransom, Psy.D., of the George Washington University, Washington, and her associates reported online (Pediatrics 2015 May 11 [doi:10.1542/peds.2014-3434].

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“The high level of concern about post-injury school performance implies the need to deliver early reassurance to students and families that their academic needs will be met,” Dr. Ransom and her team wrote. “Furthermore, the range of reported post-injury school problems (e.g., increased time spent on homework, headaches interfering with learning) suggests the need to provide actively symptomatic students with targeted supports during the post-injury recovery period.”

Among 349 youths, aged 5-18 years, who were undergoing evaluation and neurocognitive assessments within 28 days of concussion, 240 remained symptomatic or had impaired performance on testing while 109 had recovered from their concussion (had no elevation of symptoms and no impairments on neurocognitive tests). The researchers gave questionnaires about academic concerns to 239 student-parent pairs and 110 parents of students. The questions asked about concern over how the concussion affected the student’s school learning or grades and new or worsening academic problems since the concussion.

More of the students (59%) and parents (64%) from the unrecovered group had higher levels of concern about school than the students (16%) and parents (30%) in the recovered group. Concerns were highest among older children. Among those not yet recovered, 67% of high school students, 52% of middle school students, and 38% of elementary school students reported feeling moderately or very concerned about the concussion’s effect on their schoolwork.

In addition, 88% of unrecovered students reported having at least one problem at school as a result of symptoms such as headaches, fatigue, or concentration difficulty, compared with 38% of recovered students. Further, 77% of unrecovered students and 44% of recovered students said that they had trouble taking notes, were spending more time on homework, had difficulty studying, or had other problems with academic skills.

“Adverse postinjury academic effects (e.g., failure to complete schoolwork, problems keeping pace with an expanding workload, perception of poorly controlled symptoms) with no supports may be linked to the onset of depression and anxiety,” Dr. Ransom and her associates said.

The study did not receive external funding, and Dr. Ransom and her associates reported no relevant financial disclosures.

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