Additional issues in pediatric concussion: Premorbid functional considerations in pediatric concussion

Clinicians working with children with concussions and mild traumatic brain injury (TBI) can attest that substantial individual differences in functional outcomes exist even when injuries appear very similar. There is increasing interest in those factors that may moderate the negative impact of mild TBI in children, including greater awareness of the impact of the child’s preinjury functioning and the potential to positively or negatively impact functional outcome following concussion. This chapter focuses on preinjury variables that may influence neurocognitive and functional outcomes in individual children and adolescents following concussion and mild TBI. Specifically, research is reviewed on the influence of preinjury child characteristics (i.e., age, gender, cognitive and adaptive functioning, psychopathology, and genetic factors) and premorbid environmental characteristics (i.e., family psychosocial functioning, socioeconomic status, race/ethnicity, and family environment) on injury expression. By better understanding the impact of these factors on outcome from concussion, clinicians will be better equipped to provide targeted guidance and intervention to improve outcome by managing risk factors that have the potential to complicate recovery from this common injury.