Concussion Symptom Treatment and Education Program: A Feasibility Study

Abstract

OBJECTIVE: To evaluate the feasibility and potential benefits of a manualized, brief cognitive-behavioral therapy-based intervention program for children and adolescents with persistent postconcussive symptoms. SETTING: Two outpatient pediatric concussion programs in the United States. PARTICIPANTS: Patients aged 8 to 17 years who sustained concussions between 2 and 12 months prior to enrollment. DESIGN: Pre-/postretrospective study. MAIN MEASURES: SCAT-3; HBI; PedsQL 4.0 Generic Core Scales; and RCADS. RESULTS: Thirty children and adolescents completed the treatment program. Self- and parent-reported postconcussive symptoms, quality of life, and internalizing symptoms significantly improved with treatment. Mixed-effects models revealed a significant decline in self-reported postconcussive symptoms across treatment sessions, a = -2.07, SE = 0.25, P < .001. The largest change occurred between sessions 2 and 3, following the session focusing on concussion psychoeducation and sleep hygiene (estimated mean change between sessions 2 and 3 = -4.72, P < .0001). CONCLUSIONS: Our findings indicate that a 6-session manualized cognitive behavioral intervention is feasible to initiate in an outpatient clinic 1 to 12 months following a pediatric mild traumatic brain injury. With a manualized format, clinicians at most levels of training should be able to implement this treatment manual and flexibly adapt as needed when working with children and adolescents who are experiencing delayed symptom recovery following concussion.