Missing even two weeks of school has significant consequences.

Reintegration will take place in the athletic realm when the young person returns to the team. As in the classroom, social dynamics will play a part in the sports setting. The player who sits out with an mTBI is sometimes bullied or mocked as a "wimp". To ease adjustment, it can be helpful for the young person to spend time just being with the team before actually returning to play. Be aware of over-stimulation.

If ancillary therapy is available in the school, the team can incorporate it into the adjustment plan, if appropriate. Reintegration into the school environment is essential to successful recovery. An educational or work re-entry specialist can aid in this reintegration.

Common adjustment issues include:

• Maladaptive pain coping responses (e.g. activity avoidance due to fear of re-injury).


• Situational discouragement or depression.


• Return to Activity anxieties and fears.


• Normal human emotional reactions that accompany temporary disability, which must be handled appropriately to prevent the emotional response(s) from becoming permanent.


• Fear of driving.

Sometimes patients with concussion can develop diagnosable mental health conditions that require a comprehensive treatment approach, such as counseling with medication. These can be full-blown problems or lower-level issues. The point is, these emotional problems are real and need to be addressed. For example, being depressed about not being able to play is not the equivalent of clinical depression, but it still can affect recovery.

It’s essential to consider these problems in the context of everything else happening in the patient’s life. All are interwoven. The treatment team should look for symptoms of emotional problems that can exacerbate concussion symptoms. Some issues are higher level and must be treated first. Ignoring these symptoms may result in lack of treatment success.

It may help to describe to your patient what you are going to treat. Patients may respond more readily if they are told they are being treated for anxiety due to concussion complications, rather than for high level mood disorder. The concussion may be causing or compounding emotional issues.

In either case, it’s not enough to address these symptoms medically. As you would when treating full-blown mood and anxiety disorders, you should offer a combination of behavioral and medical treatments and referral to specialists, such as psychiatrists.