Year: 2023
Type: editorial
Abstract: In this issue of Pediatrics, Ware et al 1 find that intellectual functioning is not affected as early as 3 to 18 days postconcussion and up to 3 months later.Their methodologically rigorous approach from 2 large samples accounted for factors such as socioeconomic status and has an orthopedic injury control group.Variability in the concussion outcomes literature has in large part been due to inconsistency in study methods and rigor, including heterogeneity of the clinical sample, inclusion and choice of control groups, and variability in how the outcome of interest is defined and measured.There is considerable difference in traumatic brain injury outcomes on the basis of the nature and severity of the injury.Also important is not only whether there is a control group but its comparability.For example, it is insufficient to use an age-and sex-matched healthy cohort alone.Other considerations should include factors associated with outcome of interest, in this case intellectual ability, such as parent education, parenting practices, and environmental influences that enrich or disadvantage cognitive development.2 It is equally important to distinguish between a healthy cohort and one that has undergone an orthopedic injury, the latter of which can more accurately account for the disruptions to a young nervous system that has experienced an injury to a body part other than the brain, or personal or environmental factors that may predispose one to an injury.3 Anytime we reduce a complex human behavior to a single number, we must consider the operational definition of the numerical construct and the error variance associated with its measurement.Although various dimensions of intelligence have been described in the scientific literature and colloquially, the term IQ in the current context refers to a quantifiable, relative cognitive intelligence of a person.Some measures of cognitive IQ only encapsulate conceptual ability, whereas others are more comprehensive in approach and will encompass a broader range of skills such as attention span and speed of information processing.IQ scores have also been parsed into fluid versus crystallized skills, the former of which is more susceptible to injury and fluctuation by external influences, such as sleep, medication side effects, emotional status, and pain, all relevant factors in concussion.Fluid intelligence refers to one's ability to problem solve and learn and process new information.Crystallized intelligence represents an accumulation of information over time, such as vocabulary knowledge and knowledge of facts.The conclusions of this article address intellectual functions and it is important to distinguish this higher-level conceptual skill from other cognitive functions that may be more susceptible to a concussion, particularly in the early period postinjury.These other functions include processing abilities, such as attention/concentration, thinking/processing speed, and learning and memory.Although these cognitive findings may be secondary to the acute and subacute pathophysiology of concussion itself, more often than not in the postacute period, they are symptoms secondary to a number of other factors 4,5 such as deconditioning, persistent pain (including headaches/migraines), 6 posttraumatic stress, poor sleep, 7,8 anxiety and/or depression, somatization, 9 catastrophizing
Source: PEDIATRICS
Author: Talin Babikian
Institution: University of California, Los Angeles
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4384493276