Parents and coaches are well-versed in recognizing headaches as a sign of concussion in student-athletes. However, the symptoms of mood and emotional disturbance are more difficult to identify and harder for teens and those around them to understand.
With the exception of the patient’s primary care provider, most physicians don’t know an individual’s baseline of brain function and mood before they were injured, making it important for parents, siblings, coaches and friends to corroborate their symptoms, according to Dr. Rory Tucker, a sports medicine physician with Penn State Bone and Joint Institute and Penn State Health Medical Group – Camp Hill.
“Parents may notice a change in their teen’s sleep patterns,” he said. “He or she may be more withdrawn, socializing less with friends or family members, more emotional or tearful. They may have anger outbursts or be more nervous than they were before.”
It is important to bring these symptoms to the attention of the student-athlete's medical provider who may be able to recognize these symptoms early on. In some cases, medication may help.
“Medication is rarely necessary in the long term, but while a concussion is healing, it can sometimes be beneficial to take medication to control moods,” Tucker said. “We also use medications to assist with sleep. Impairment of sleep can have a detrimental impact on emotional health and how people interact with others.”
One important consideration, said Dr. Craig DiGiovanni, a postdoctoral fellow with the Department of Psychiatry and Behavioral Health at Penn State Health Milton S. Hershey Medical Center, is the overlap between the diagnostic criteria for depression and concussion symptoms, such as difficulty with processing information quickly, impaired concentration and fatigue.
“The same can be said for anxiety,” he said, adding that kids who have had anxiety and depression before their injury are more at risk for a reoccurrence. “Parents should look out for more concerning symptoms of depression that are outside the scope of common concussion symptoms, like loss of interest in activities, significant weight gain or loss, feelings of worthlessness and suicidal thoughts.”
For children and teens who have cognitive and emotional symptoms that persist for weeks and even months, DiGiovanni will refer them for a comprehensive neuropsychological evaluation.
“It compiles information from a variety of tests to help us get a sense if there are specific cognitive concerns that need to be addressed or if anxiety and depression are coming to the forefront,” he said. “These evaluations can recommend additional school supports, helpful strategies to use at home and other therapies.”
Resuming daily life
Each child requires a unique approach to treatment to help them get back to school and back to play, according to DiGiovanni.
“It’s hard for athletes to temporarily give up their primary activity, and it’s important to provide them a sense of purpose in other forms,” he said. “Establish a routine and give them tasks to do around the house, like walking the dog if they are able. Sometimes we even suggest that the athletes go to practice to be with their team, even though they can’t participate. It’s a way for them to feel like they are still part of the experience.”
For those who find that too difficult, Tucker suggests asking your provider about participating in a support group.
“No matter what their injury, they are not alone. There is help,” he said. “Young people can get help from those who came before them and help those who come after them. They can gain a lot of strength in believing they still have purpose.”
The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.