New Approaches to Assessment and Monitoring of Concussion in Children

Abstract

A “mild” traumatic brain injury (TBI) constitutes the overwhelming majority of brain injury cases in children and adolescents. This article focuses on cerebral concussion, which can be viewed as a subset of mild TBI, which, until recently, has received limited attention in the pediatric assessment literature. Few extant measures appropriate to this condition in the developing child are available. A “broadband” approach to the assessment and management of concussion in children is presented, stressing the unique goals of the pediatric postinjury evaluation and treatment process in returning to home life, school, and sports/recreation. This approach calls for standardized assessment using diverse methods that tap multiple domains of the child's functioning, gathering input from key respondents across settings. Neuropsychological testing, together with structured symptom rating scales, provides a multilevel view of the effects of the concussion on the child. Structured data obtained with standardized methods from multiple sources provide more reliable and ecologically valid information to facilitate interventions in the child's key home and school environments. New pediatric assessment measures are presented, providing clinicians with tools to assess and manage this injury effectively. Two clinical cases highlight the use of the battery in guiding recovery. Continued research on the broadband concussion assessment model is needed.