Contextual Considerations for the Neuropsychological Assessment of Pediatric mTBI

Abstract

Mild traumatic brain injury (mTBI), also known as concussion, is a common injury in the pediatric population. In 2014, children aged 0 to 19 made up 32% (812,000) of the 2.5 million TBI-related emergency department visits in the United States, which does not reflect the much higher number of children with a brain injury who do not present to medical centers (Black & Zablotsky, 2021). Similar to psychiatric diagnoses, a diagnosis of mTBI/concussion is made using clinical features and symptoms that are classified under cognitive, affective, and somatic domains, with none of the symptoms pathognomonic for TBI. Symptoms secondary to a mTBI are time limited and show a typical trajectory, and in a majority of cases, lead to full resolution. When this expected pattern is not observed, contributing comorbid and premorbid factors need to be considered for a thorough understanding of etiology. Accurate psychoeducation and prompt intervention, which begin with early screening (e.g., vulnerabilities, comorbidities, risk factors), are needed to empower the systems that support a child. Although comorbid factors are many and a thorough review is outside the scope of this case series, the three cases presented represent a common constellation of factors (e.g., neurodevelopmental, environmental, and adverse/traumatic experiences) that interplay with contextual factors in a diagnostic workup and treatment planning. This case series will also present relevant literature to briefly introduce various social and cognitive outcomes following mTBI relative to more severe injuries, define aspects that differentiate mTBI from more severe injuries, and discuss the influence of environment and other contextual factors across the severity spectrum.