When it comes to concussions, the biggest question, especially on the minds of parents of student-athletes, is whether and when their child should get back in the game. But researchers at the Children’s National Health System say that there’s potentially bigger question that parents and educators aren’t asking: how concussions affect children’s performance in the classroom.

In a study published in the journal Pediatrics, Danielle Ransom, a postdoctoral fellow in neuropsychology, and her colleagues found that children who had concussions may experience more problems concentrating, keeping up and paying attention in school. The symptoms are worse for students who have recently been injured, but remained significant even for those who had recovered.

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“My colleagues and I have been hearing for years that kids with concussions have problems in school, but there was no evidence to show what the problems are, and how frequently they are occurring,” she says.

So she focused on 349 students ages 5 to 18 years old who had all been diagnosed with concussion. Some were still recovering, and experiencing symptoms, while others were no longer feeling any effects from their injury. Of the students who were still recovering, 88% reported more than one symptom including headaches, fatigue, difficulty understanding lessons or problems concentrating. And 77% said they had more trouble taking notes and spent more time completing homework assignments.

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Students who experienced more-severe head injuries were also more likely to have the most trouble in school. But Ransom admits that diagnosing the severity of concussions is still a challenge. “At this point we really don’t have tools to clinically say, this is what you can expect in your kid’s recovery,” she says.

Still the results highlight the need to pay attention to the extra support that children with concussions need in order to recover. That may include, at least in the first days back from a head injury, a shorter school day, since students may feel more tired and overwhelmed by a full day, and even breaks throughout the day so they can rest when they feel headaches or symptoms occurring.

“Instead of trying to get the kid back to school doing things 100% as they usually would, we need to allow the symptoms to ebb and flow in a more natural way,” says Ransom. “Kids should be paying attention to their bodies, and teachers need to be attuned to their symptoms.”

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Such strategies could not only help to ease the transition back to school, and but also potentially lessen the effects of the concussion, says Ransom. There is evidence that children who push themselves to return too quickly to their normal workload can slow recovery and even make symptoms worse.

Unfortunately, she says, there is no magic threshold for when students can handle working at their full capacity; it varies with each child and with the injury. But recognizing that concussions can affect how children do in school could lead to better ways of helping them to return to their normal workload sooner. “We really think the findings in our study highlight the importance of targeting specific problems, and can ease the transition back for kids,” says Ransom.

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