Andrée-Anne Ledoux, PhD Children’s Hospital of Eastern Ontario Research Institute Ottawa, Ontario, Canada

Girls Recover From Concussions More Slowly Than Boys Interview with:

Andrée-Anne Ledoux, PhD Children’s Hospital of Eastern Ontario Research Institute Ottawa, Ontario, Canada

Dr. Ledoux

Andrée-Anne Ledoux, PhD
Children’s Hospital of Eastern Ontario Research Institute
Ottawa, Ontario, Canada What is the background for this study?

Response: The natural recovery processes from a pediatric concussion remains poorly characterized throughout childhood. Children’s brains go through many phases of growth during development and sex differences exist. Therefore a 6-year-old child may not have the same recovery trajectory as an adolescent because of biopsychosocial differences. Thus, this study explored symptom improvement after concussion while considering these two key demographic factors. Understanding symptom improvement at different stages of development is important in order to provide the best possible care.

The study examined data from 2,716 children and adolescents who had presented at nine emergency departments across Canada and were diagnosed with concussion. We examined the natural progression of self-reported symptom recovery following pediatric concussion over the initial three months after injury. Participants in the study were aged 5 to 18 years old with acute concussion, enrolled from August 1, 2013, to May 31, 2015. We examined different age cohorts – 5 to 7 years of age, 8 to 12 years of age, and 13 to 18 years of age, and investigated how sex is associated with recovery.

Our study represents the largest study to evaluate symptom improvement trajectories in concussed pediatric population. What are the main findings?

Response: The greatest gains in recovery occurred primarily in the 1st week, with some gains in the 2nd week. Beyond two weeks, the rate of recovery significantly slowed. The duration of symptoms was longer the older the concussed child. What stands out in the study is the recovery rates between adolescent girls and boys. We found that girls recovered more slowly than boys. In fact, more than 50 percent of adolescent girls still exhibited post-concussion symptoms twelve weeks after the injury. There are thought to be many potential explanations for the sex differences. Physiological differences exist between boys and girls such as neck strength, pubertal stage and hormonal differences. Psychosocial differences between the sexes may contribute to differential perception and may influence symptom reporting (e.g., female athletes have a higher injury rate and report more symptoms with greater severity). What should readers take away from your report?

Response: The majority of symptom improvement will occur within the first 2-weeks post-injury, slowing down between 2 and 4 weeks. Sex and age differences exist throughout recovery processes and these should be taken into consideration when managing pediatric concussions.

This report providers and clinicians with more tools to make effective healthcare decisions for children based on the natural progression of symptom change and recovery from concussion. Health providers now have a guide to track whether a child is within expected normal range of recovery. We hope that this report will provide a better perspective to families and children on recovery status of their child. What recommendations do you have for future research as a result of this work? 

Response: As a result of this study, we recommend that future research consider age and sex when looking at children’s recovery after a concussion. Is there anything else you would like to add?

Response: This study only included self-rated symptom improvement scores. These scores are not representative of neurophysiological and neuropsychological recovery. Self-reported clinical symptoms assessments are subjective and therefore can be a source of bias.

This work was funded by the Canadian Health Research Institute. I have no conflicts of interest to declare. 


Ledoux A, Tang K, Yeates KO, et al. Natural Progression of Symptom Change and Recovery From Concussion in a Pediatric Population. JAMA Pediatr. Published online November 05, 2018. doi:10.1001/jamapediatrics.2018.3820

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Last Updated on November 5, 2018 by Marie Benz MD FAAD