Medical Professional Publications

Children Who Are "Wishful Thinkers" Report More Lingering Symptoms after Mild Concussion

Study Investigates Link between Coping Strategies and Post-Concussive Outcomes

The type of coping strategy a child uses may impact his/her interpretation of symptoms after experiencing a mild traumatic brain injury, according to research published in the Journal of the International Neuropsychological Society.

Mild traumatic brain injuries (TBI), also commonly termed concussions, are characterized by loss of consciousness, confusion, or disorientation lasting less than 30 minutes. Although recent reviews have suggested that mild TBI have little effect on children, few studies have focused specifically on what are commonly referred to as “post-concussive symptoms,” which include a range of somatic, cognitive, affective and behavioral complaints.

Although symptoms typically characterized as “post-concussive” are not specific to mild TBI and occur frequently in the general population and in individuals with injuries not involving the head, research has repeatedly demonstrated that they are more common and severe in children with mild TBI  

“The reasons why some but not all children with mild TBI display post-concussive symptoms are unclear,” said Keith O. Yeates, PhD, director of the Center for Biobehavioral Health and one of the study authors. “Injury severity accounts for some of the variability in post-concussive symptoms.  However, psychological factors such as coping strategies are also likely to play a role.”  

In children and adolescents, coping involves deliberate actions to manage one’s environment, thoughts, and emotions when presented with a stressor.  Research in adults suggests that coping strategies are related to post-concussive symptoms and psychosocial outcomes in both mild and severe TBI.

To determine whether coping strategies may moderate the occurrence of post-concussive symptoms following mild TBI, investigators at Nationwide Children’s Hospital and Rainbow Babies and Children’s Hospital in Cleveland, compared coping strategies and post-concussive symptom reports of children with mild TBI to reports of children who experienced an arm or leg fracture, over the first year after their injury.

They found that effects of mild TBI on children’s post-concussive symptoms are most pronounced when children endorse higher levels of problem-focused disengagement as their coping strategy. Problem-focused disengagement involves managing stress by passive avoidance and wishful thinking.

“Clinically, the results suggest that interventions designed to prevent or alleviate post-concussive symptoms should focus on identification of children with mild TBI who use maladaptive coping strategies and help them develop strategies that encourage problem-focused engagement,” said Dr. Yeates. “Overall, our study demonstrates that injury-related factors alone are not likely to be sufficient in accounting for post-concussive symptoms following mild TBI, but that child characteristics such as coping strategies also contribute to injury outcomes.”  

Did You Know?
On March 11, Nationwide Children’s hosted a panel discussion on community reintegration after traumatic brain injury.

Woodrome SE, Yeates KO, Taylor HG, Rusin J, Bangert B, Dietrich A, Nuss K, Wright M. Coping Strategies as a Predictor of Post-concussive Symptoms in Children with Mild Traumatic Brain Injury versus Mild Orthopedic Injury. J Int Neuropsychol Soc. 2011 Mar;17(2):317-26.

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