The intersection of concussion management and neurodiversity

Here in Texas, vibrant autumn foliage and a decrease in temperatures is a sign fall has arrived. However, an increase in the number of concussions is a reliable indicator of the changing season—at least for those that work in health care. ¹

While concussions can happen at any time of the year, the fall season brings with it its own unique opportunities for head-related injuries. From fall sports to accidents on the schoolyard playground, this time of year can bring new, challenging cases for pediatric practitioners.

Overlapping symptoms

Any person who sustains a concussion can find themselves experiencing a number of symptoms ² impacting their:

• Physical health
• Cognitive abilities
• Mood/Emotional regulation
• Sleep functioning 

These concussion symptoms overlap with many other developmental conditions or baseline behaviors. ³ As such, it makes sense that individuals presenting with impairment in any of the above symptom categories at baseline (e.g., history of migraine, learning disabilities, anxiety, insomnia, etc.) may experience exacerbated symptoms in these areas following a concussive injury. Furthermore, research has shown that people diagnosed with certain premorbid conditions can be at risk for experiencing more severe concussion symptoms, and/or a more complicated and prolonged recovery experience, compared to those with no significant histories prior to injury. ⁴

Because most assessment tools and intervention models were focus on healthy, neurotypical individuals, treating patients with pre-existing conditions can be complex.⁵

Hitting close to home

These findings should be thought-provoking for any clinician that works with patients diagnosed with chronic health illnesses, neurodevelopmental disorders, psychiatric conditions and/or sleep-related issues—just as the team does in the Jane and John Justin Institute for Mind Health at Cook Children’s.

Even when the patients have not experienced a “bump, blow or jolt to the head or body,” ⁶ their diagnoses often result in dysfunction of these same systems that are involved with concussions.

The Cook Children’s staff works tirelessly for (and alongside) all of the patients to promote their overall functioning and help them reach their personal potentials. If any of these patients—with already complex histories—have the unfortunate (but very possible) experience of sustaining a concussion, how will that disrupt ongoing treatment progress? How will this further complicate matters for these families? How do we keep these already vulnerable patients from falling into the vicious cycle of “Persisting Symptoms after Concussion (PSaC),” the proposed new terminology for the previously used “Post-Concussion Syndrome”? ⁷

Managing concussions in neurodiverse patients

Lindsey Carnes Dalby, Ph.D., is passionate about providing compressive concussion management and working with patients who have neurodevelopmental conditions. Even with her years of expertise, the overlap of these two “worlds” has been tricky to navigate at times. The level of care involved in these situations requires a more nuanced and sometimes time-consuming, person-centered approach.

Over the years, she has fielded a number of compelling questions from families, educators/coaches and fellow providers, such as:

“How exactly do I know if my child who engages in head banging has finally hit hard enough to get a concussion?”

“How do we ‘gradually return’ to ABA Therapy?”

“If my child with an intellectual disability struggles to engage in their special education evaluation at school, how are they going to be able to complete this computerized neurocognitive assessment?”

Working with these comorbid concussion cases has created some unique professional challenges, but also opportunities for creative problem solving. For much of Dr. Dalby’s career, she has relied solely on clinical intuition and gut instinct in working with these special cases—until recently. 

Advancing health equity in concussion care

A few months ago, The Concussion in Sport Group (CISG) held its first ever Clinical and Educational Symposium (outside of the usual quadrennial Consensus Conferences). Dr. Dalby attended and represented Cook Children’s at this historical, inaugural meeting. During the sessions, experts highlighted important prevention initiatives, clinical advances and significant research findings in concussion care, including a panel devoted to special populations.  

This group of presentations examined current research on the impact and treatment of concussions in unique populations and shared new tools for providers working in the intersection of concussion and neurodiversity.

The neurodiversity concussion toolkit

One individual and organization worthy of special recognition is Catherine McGill, Ph.D., and the Virginia Concussion Initiative, who created the neurodiversity toolkit. This toolkit is available free of charge and provides a number of strategies to help quickly recognize concussions and support recovery, with the primary goal of accessibility and inclusivity for every patient.

The toolkit aids clinicians working with neurodiverse patients to 1) reduce risk for prolonged recovery, 2) recognize changes in presentation, 3) respond with individualized care, 4) recover gradually and 5) return to baseline safely.

Some of the resources found in the toolkit library include:

• Clinical management considerations infographic to support concussion management with neurodiverse individuals
• Baseline concussion assessment tool
• Concussion assessment cards (with images and ASL prompts for symptoms and injury characteristics)

·         Social stories to educate on concussion recognition and recovery (for varying levels and needs)

·         Concussion education video with ASL interpretation

You can read more about Dr. McGill’s work, learn more about the Virginia Concussion Initiative, and find the neurodiversity toolkit and other helpful resources here: https://vci.gmu.edu/home

Neuropsychological assistance

The Neuropsychology Department is a proud and dedicated member of the Jane and John Institute for Mind Health team and is available to assist with concussion care (both acute and chronic) for patients and their families.

The team is passionate about empowering equitable concussion management for all individuals, and patients deserve the gold standard management that is right for them.

REFERENCES

1. Daugherty, J., Yuan, K., Sarmiento, K., Law, R. (January, 2024). Are there seasonal patterns for emergency department visits for head injuries in the USA? Findings from the National Electronic Injury Surveillance System-All Injury Program. Injury Prevention, 30, 46-52.

2. Harmon, K.G., Drezner, J.A., Gammons, M., Guskiewicz, K.M., Halstead, M., Herring, S.A., ... & Roberts, W.O. (2013). American Medical Society for Sports Medicine position statement: Concussion in sport. British Journal of Sports Medicine, 47 (1), 15-26.

3. Maietta, J. E., Kuwabara, H. C., Cross, C. L., Flood, S. M., Kinsora, T. F., Ross, S. R., & Allen, D. N. (2021). Influence of autism and other neurodevelopmental disorders on cognitive and symptom profiles: Considerations for baseline sport concussion assessment. Archives of Clinical Neuropsychology, 36 (8), 1438-1449.

4. Leddy, J.J., Baker, J.G., & Willer, B. (2016). Active rehabilitation of concussion and postconcussion syndrome. Physical Medicine and Rehabilitation Clinics of North America, 27 (2), 437-454.

5. Korcsog, K. H. (2024). Back to baseline: Understanding the complexities of estimating premorbid cognitive functioning in sport-related concussion assessment. [Doctoral dissertation, University of Windsor].

6. Center for Disease Control and Prevention. (2025). Heads up: Concussion basics. Retrieved from https://www.cdc.gov/heads-up/about/index.html

7. Broshek, D.K., Pardini, J.E., & Herring, S.A. (September, 2022). Persisting symptoms after concussion: Time for a paradigm shift. PM & R, 14 (12), 1509.