In the past few years, research about concussions and their link with depression, even suicide, in pro football players has understandably concerned parents of young athletes.

Should they fear that their active young athletes may be jeopardizing their future health and setting themselves up for depression?

In most cases, no, says Keith Yeates, PhD, professor of psychology, pediatrics and clinical neurosciences at the University of Calgary in Alberta. “The vast majority of kids do recover pretty much on their own from concussion,” he says. While the recovery period varies from person to person, ”most people talk about four weeks to twelve” as a recovery timetable, says Dr. Yeates, who has researched the problem extensively.

Concussions ”don’t impact the kids as much as you [may] think,” says Tim McGuine, PhD, ATC, a distinguished scientist at the University of Wisconsin School of Medicine and Public Health. He has a large database of 2,000 high school athletes he is following to study the impact of concussion on quality of life, including depression. So far, he has not found differences in depression between athletes who suffer a concussion and those who do not.

Although long-term ill effects from concussions are not common, parents should should arm themselves with some facts.

What is a Concussion?

A concussion is a mild traumatic brain injury, caused by a blow, bump or jolt to the head that disrupts the brain’s normal function. Not all blows or bumps cause a TBI, however. And a TBI, when it does occur, can be mild.

According to the Centers for Disease Control and Prevention, TBI, as concussions are known medically, was the diagnosis in more than 282,000 hospitalizations and 2.5 million emergency department visits in 2013 (for people of all ages). From 2001 to 2012, the CDC says, the rate of ED visits for injuries related to sports or recreation related concussion more than doubled among children ages 19 and younger, the agency says.

Another study, by FAIR Health, found that the increase in youth concussion grew 500% from 2010 to 2016.

As to which sports are most likely to lead to concussions? Surveys and studies have come up with different results. But a study released in 2017 by the American Academy of Orthopaedic Surgeons has found that girls’ soccer teams suffered more concussions than even boys’ football. Boys’ baseball and girls’ volleyball had the greatest increase in concussions during the 10 years studied.

What Are the Symptoms?

Symptoms vary, and not all are present in each person. The symptoms can be grouped as physical, cognitive, emotional and sleep-related, according to experts at Nationwide Children’s Hospital.

Physical include headache, dizziness, problems with balance, vomiting and nausea, fatigue and light sensitivity.

Cognitive include feeling foggy mentally, a feeling of being slow and difficult with concentrating, remembering or focusing.

Emotional issues include irritability, sadness, nervousness and being more emotional than is usual.

The emotional issues occur only occasionally, Dr. Yeates says, and are less likely to occur immediately. Instead, they can increase or become more noticeable with time. “The usual timeline, frankly, doesn’t involve significant emotional issues. Physical symptoms are much more common and more frequent, as are cognitive symptoms.”

Sleep problems include difficulty falling asleep or sleeping more or less than is usual.

The symptoms sometimes come on right with the injury, but in other youth can take up to 48 hours or more. That’s why it is crucial to monitor your child for up to 48 hours, looking out for danger signs that signal the concussion might be more serious.

These include: a severe or increased headache, double vision, unequal pupils, convulsion, drowsiness that increases, clear fluid or blood discharge from the nose or ears, vomiting that is projectile or frequent, neck stiffness, severe personality changes, weakness in the arms or legs, numbness in extremities or the face.

What the Research Shows

While the research about pro athletes is scary, Dr. Yeates says worry about suicide occurring after youth concussion is usually unfounded. “I wouldn’t be worried about suicide unless you have a kid with a previous history of depression and suicidal ideation [thoughts],” he says. “I wouldn’t be worried about clinical depression unless there is a previous history of psychiatric problems [such as depression].”

With his colleagues, Dr. Yeates evaluated 30 previously published studies on outcomes after traumatic brain injuries, including concussion, in youth. They found that both psychological and psychiatric problems were more common after the concussion if the child had to be hospitalized, in those youth with previous psychiatric illness and with previous concussions.

While some previous research has found that concussion in youth increases their risk overall of depression, Dr. Yeates says the studies have flaws in their methods.

For their own research, Dr. Yeates’ team had a reassuring conclusion: for most, evidence suggests that problems don’t persist beyond the typical recovery period.

In one study, McGuine polled 973 high school athletes on quality of life and depression symptoms. Of the total, 261 reported they had had at least one concussion in the past two years or so. He found no differences in depression or quality of life between the groups.

While a small percentage do have problems, he says by and large most don’t. And, he adds, it isn’t just athletes with concussion who may get ”down” after the injury. He sees it, too, for instance, with athletes who have ankle sprains and can’t return to play.

What’s the Best Course of Action?

If you suspect a concussion, your child should be seen by a health care provider. Don’t try to assess the injury yourself. Be sure the provider is up to date on concussions, as practices on how to manage them have evolved based on research, Yeates says.

Many practices, such as keeping children in a dark room, are outdated, he says. In fact, Dr. Yeates says, that could have contributed to emotional issues after the injury.

McGuine agrees. He recommends light activity as tolerated, usually four or five days later. “The idea of no screen time, no school, not activity, that is going away.”

However, your child should not return to sports until cleared by a health care provider, experts agree.

Dr. Yeates tells parents not to expect instant recovery. Some youth have symptoms that persist for two, three, even four weeks or longer.

Management of concussion has changed as research has evolved, so it’s important to find a health care provider who has kept up, experts agree.

If symptoms don’t resolve in four weeks, get a referral to a neuropsychologist, a neurologist or a sports medicine doctor, Dr. Yeates says, ”someone who knows about concussions.”

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Last Updated: Mar 11, 2019