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Mild head injury in children and adolescents: A review of studies (1970–1995).
Abstract
In this article, the authors provide a comprehensive review of the research of mild head injury in children and adolescents from 1970 to 1995. Because of marked variability in methodologies across studies, a preliminary box-score tally was computed, without regard to studies' scientific or methodological merit. These results revealed 13 adverse, 18 null, and 9 indeterminate findings related to neuropsychological, academic, or psychosocial outcome. When studies were classified based on methodological merit, the stronger studies were generally associated with null outcomes across domains. However, a few of the less stronger neuropsychological studies (5 of 40) reported subthreshold and transitory alterations during the early postinjury period. At the present time, cautious acceptance of the null hypothesis is recommended until more definitive studies are conducted that address the problems raised in this review.
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“This investigation was limited to patients who had at least complicated mild or moderate TBI (as evidenced by the presence of intracranial lesions on neuroimaging), because uncomplicated mild TBI is typically not expected to be associated with significant lasting cognitive impairment in children who do not have compromised psychosocial backgrounds (Ponsford et al., 1999; Satz et al., 1997).”
From Criterion validity of the Wechsler Intelligence Scale for Children–Fourth Edition after pediatric traumatic brain injury (2008) · cites this paper as Satz et al., 1997
Citations
Cites
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Pathobiology of traumatically induced axonal injury in animals and man
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“A review of studies from 1970–1995 on MTBI-related neuropsychological or academic-psychosocial outcome pointed out that the sequelae of MTBI remains unclear [12].”
A prospective, population-based, follow-up study of mild traumatic brain injury in children
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Do Postconcussive Symptoms Discriminate Injury Severity in Pediatric Mild Traumatic Brain Injury?
Moran, L. M., Taylor, H. G., Rusin, J. A., Bangert, B. A., Dietrich, A. M., Nuss, K. E., Wright, M., & Yeates, K. O. (2011) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0b013e3181f8d32e · Cited by 24
Do Concussive Symptoms Really Resolve in Young Children?
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“However, clinicians should be cautious not to assume that post injury symptoms simply reflect individual’s pre-injury characteristics [44] and recognize that behavioural and emotional problems may also be a potential consequence of TBI.”
BackgroundCrowe, L., Hearps, S. J. C., Anderson, V., Borland, M., Phillips, N., Kochar, A., Dalton, S., Cheek, J., Gilhotra, Y., Furyk, J., et al. (2018) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2017.12.026 · Cited by 23
Pediatric traumatic brain injury and abusive head trauma
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Social support, coping, and psychological adjustment among caregivers of head-injured patients
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Neuropsychological evaluation and management of sport-related concussion
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The accuracy of adult recall for early mild traumatic brain injury
McKinlay, A., & Horwood, L. (2017) · Disability and Rehabilitation · doi:10.1080/09638288.2016.1193905 · Cited by 17
“or their family.[8,9] The lack of recognition of an earlier mTBI event may also result in ineffective interventions and treatment plans for those who do present with persisting problems.”
BackgroundThree-Month Psychiatric Outcome of Pediatric Mild Traumatic Brain Injury: A Controlled Study
Max, J. E., Judd, N., Bigler, E. D., Wilde, E. A., Patterson, J. E., Edwards, T. M., Calahorra, A., De-la-Garza, B. G., & Vaida, F. (2021) · Journal of Neurotrauma · doi:10.1089/neu.2021.0324 · Cited by 18
“12,13 The present study aims to clarify the controversy regarding behavioral outcomes in pediatric mTBI with a comprehensive psychiatric investigation to overcome the methodological problems of previous studies.”
Prigatano, G., Gray, J., & Gale, S. (2008) · Clinical Neuropsychologist · doi:10.1080/13854040701440501 · Cited by 16
“The present investigation also highlights the potential importance of separating out levels of mild TBI when studying cognitive and psychiatric sequelae, as originally suggested by Satz and colleagues ( 1997 ).”
BackgroundMild Head Injury in Children and Adolescents
Satz, P. (2001) · Current Directions in Psychological Science · doi:10.1111/1467-8721.00127 · Cited by 39
“Other definitions vary somewhat in the criterion duration of unconsciousness and the status of length of retrograde and posttraumatic amnesia (Satz et al., 1997).”
InfluentialSelf-citationIverson, G. L., & Lange, R. T. (2010) · Springer eBooks · doi:10.1007/978-0-387-76978-3_24 · Cited by 34
Case Study: Bipolar Disorder After Head Injury
Sayal, K. S., Ford, T. J., & Pipe, R. (2000) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200004000-00023 · Cited by 21
Management of Mild Head Injury in the Pediatric Patient
Mami, A. G., & Nance, M. L. (2008) · Advances in Pediatrics · doi:10.1016/j.yapd.2008.07.011 · Cited by 9
Julien, J., Tinawi, S., Anderson, K., Frenette, L. C., Audrit, H., Ferland, M. C., Feyz, M., & de Guise, É. (2017) · Brain Injury · doi:10.1080/02699052.2017.1346289 · Cited by 15
Kirkwood, M. W. (2015) · Neurorehabilitation · doi:10.3233/nre-151232 · Cited by 16
Serum Biochemical Markers for Brain Damage in Children with Emphasis on Mild Head Injury
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Attention Deficit Disorder: Practical Coping Methods
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“that postinjury behavioral deficits such as ADHD may not simply reflect preinjury characteristics or developmental trajectory but instead result from the injury event itself.(15) Indeed, a recent meta-analysis in both pediatric and adult populations, however, showed strong evidence for the association between ADHD and…”
BackgroundOlsson, K. A., Kenardy, J., Brown, E., Charlton, E., Brown, F., Lloyd, O., & McKinlay, L. (2014) · Brain Impairment · doi:10.1017/brimp.2014.22 · Cited by 8
Skull Fracture During Infancy: A Five-Year Follow-Up
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“In a review of studies relating to neuropsychological, academic, or social outcome following mild TBI in children and adolescents, Satz et al. (1997) point out that the methodologically stronger studies are generally associated with a null outcome.”
BackgroundAviv, I., Shorer, M., Fennig, S., Aviezer, H., Singer‐Harel, D., Apter, A. S., & Peleg, T. P. (2022) · Child Neuropsychology · doi:10.1080/09297049.2022.2072823 · Cited by 6
“factors and an assessment of performance validity (Satz et al., 1997).”
BackgroundMethodEvans, E. A., Asuzu, D., Cook, N. E., Caruso, P. A., Townsend, E. L., Costine, B. A., Fortes, C., Hotz, G., Duhaime, A., Ramon, D., et al. (2018) · Journal of Neurotrauma · doi:10.1089/neu.2017.5408 · Cited by 6
Adult cognitive outcomes following childhood mild traumatic brain injuries
Yumul, J. N., & McKinlay, A. (2017) · Developmental Neurorehabilitation · doi:10.1080/17518423.2016.1259273 · Cited by 7
“ceeding injuries, as well as to personal life experiences.(48) On the whole, while long-term cognitive deficits may exist in the mTBI group, cumulative effects are not necessarily associated with multiple childhood mTBI.”
BackgroundHalldórsson, J., Arnkelsson, G., Tomasson, K., Flekkoy, K., Magnadottir, H., & Arnarson, E. (2013) · Brain Injury · doi:10.3109/02699052.2013.765599 · Cited by 7
Concussion in Children and Adolescents
Clayton, G. H., Kirkwood, M. W., Laker, S. R., & Wilson, P. E. (2013) · Current Physical Medicine and Rehabilitation Reports · doi:10.1007/s40141-013-0008-z · Cited by 7
“The most rigorous studies indicate that by 2–3 months after injury, and often much sooner, deficits are no longer apparent when measured in group analyses using standardized performancebased neurocognitive or academic tests [28–30].”
BackgroundMinimal and mild paediatric brain injury: A 3-year cohort of consecutive presentations
Russo, R., Rice, J., Chern, P. M., & Raftos, J. (2012) · Developmental Neurorehabilitation · doi:10.3109/17518423.2011.625558 · Cited by 7
Isn't everything in forensic neuropsychology controversial?
Lees-Haley, P., & Fox, D. D. (2001) · NeuroRehabilitation (Reading, MA) · doi:10.3233/nre-2001-16411 · Cited by 6
“As noted in recent reviews, even the highest quality empirical research studies use different definitions of MTBI (e.g. [5, 6,12]).”
Developmental Considerations in Pediatric Concussion Evaluation and Management
Gioia, G. A., Vaughan, C. G., & Sady, M. (2011) · Springer eBooks · doi:10.1007/978-0-387-89545-1_12 · Cited by 3
Leonard, B., Shuvaev, V. V., Bullock, T. A., Dona, K. N. U. G., Muzykantov, V. R., Andrews, A. M., & Ramirez, S. H. (2024) · Bioengineering · doi:10.3390/bioengineering11030200 · Cited by 6
“TBI is particularly common in young adults and children, making it the leading cause of death and disability in the United States among these age groups [2,3].”
BackgroundA targeted neuropsychological examination of children with a history of sport-related concussion
Moore, R. D., Sicard, V., Pindus, D. M., Raine, L., Drollette, E., Scudder, M., Decker, S., Ellemberg, D., & Hillman, C. H. (2018) · Brain Injury · doi:10.1080/02699052.2018.1546408 · Cited by 5
“Analysis revealed an effect of level, t(29) = 5.”
BackgroundTraumatic Brain Injury Across the Lifespan: A Neuropsychological Tutorial for Attorneys
Richards, P. M., & Kirk, J. W. (2010) · Psychological Injury and Law · doi:10.1007/s12207-010-9065-0 · Cited by 5
“, complicated by positive neuroimaging findings); however, the majority of studies still favored no significant neuropsychological findings by 6 to 12 months postinjury (Satz et al. 1997; Satz 2001).”
BackgroundInfluentialVersorgungsbedarf von Kindern und Jugendlichen mit einem Schädel-Hirn-Trauma
Petersen, C., Scherwath, A., Fink, J., & Koch, U. (2008) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-008-0536-3 · Cited by 5
Predicting Postconcussive Symptoms After Mild Traumatic Brain Injury in Children and Adolescents
Yeates, K. O. (2014) · Springer eBooks · doi:10.1007/978-1-4939-0295-8_15 · Cited by 4
“Although neurocognitive deficits typically resolve within a few weeks after mild TBI [15–18], neuropsychological testing can be used to identify children who show acute decrements in their cognitive functioning and those who have low cognitive reserve capacity, and both types of children may be at risk for PCS.”
BackgroundAcute and Long-Term Outcomes Following Pediatric Traumatic Brain Injury
Howarth, R., Blackwell, L., & Ono, K. E. (2016) · Journal of Pediatric Neuroradiology · doi:10.1055/s-0036-1584285 · Cited by 4
Impact of mild traumatic brain injury understanding on intended help-seeking behaviour
Feary, N., & McKinlay, A. (2018) · Journal of Child Health Care · doi:10.1177/1367493518799617 · Cited by 3
“, 2008); 90% of which is classified as mild TBI (mTBI) (Satz et al., 1997).”
BackgroundTraumatic brain injury in children part 2: Recovery process and outcomes
Braine, M. E. (2013) · British Journal of School Nursing · doi:10.12968/bjsn.2013.8.7.330 · Cited by 4
Mild Traumatic Brain Injury in Children: Ringing the Alert Bell
Menascu, S., & Tshechmer, S. M. (2011) · doi:10.4021/jnr.v1i1.16 · Cited by 3
“Accidents, including severe head injuries, are the leading cause of death in infants and children between the ages of 1 to 14 [1, 2].”
BackgroundStockbridge, M. D., & Newman, R. S. (2017) · Translational Issues in Psychological Science · doi:10.1037/tps0000091 · Cited by 4
“…discrete commitment in the young, plastic brain allowed it to adapt more readily to damage than the adult brain (Eisele & Aram, 1996; Reilly, Bates, & Marchman, 1998), this notion has largely been disproved (Daneshvar et al., 2011; Lloyd, Wilson, Tenovuo, & Saarijärvi, 2015; Satz et al., 1997).”
BackgroundBehavioral Disorders Associated with Central Nervous System Dysfunction
Castellon, S. A., Hinkin, C. H., & Satz, P. (2002) · Springer eBooks · doi:10.1007/0-306-47377-1_29 · Cited by 3
Self-citationMax, J., Judd, N., Bigler, E. D., Wilde, E. A., Patterson, J. E., Edwards, T. M., Calahorra, A., Zimmerman, E., Hesselink, J., Huang, M., et al. (2025) · Journal of Neurotrauma · doi:10.1089/neu.2024.0460 · Cited by 2
“9,10 However, these conclusions are challenged by fi ndings of two large prospective studies of mTBI.”
Saarinen, M., Himanen, L., Raukola-Lindblom, M., Erkinjuntti, N., Vahlberg, T. J., Rinta-Rahko, A., Wiklund, J., Karrasch, M., Tenovuo, O. S., & Lähdesmäki, T. (2025) · European Journal of Paediatric Neurology · doi:10.1016/j.ejpn.2025.02.002 · Cited by 3
Lidzba, K., Afridi, Z., Romano, F., Wingeier, K., Bigi, S., & Studer, M. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1359566 · Cited by 2
“However, data on neuropsychological outcome after pediatric mTBI are less consistent: Systematic reviews have concluded that children after mTBI have very few, if any, long-term neurocognitive impairments (Satz et al., 1997; Babikian and Asarnow, 2009).”
BackgroundBehaviour outcomes three months after mild TBI in preschool children
Yumul, J. N., McKinlay, A., Anderson, V., & Catroppa, C. (2023) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2023.2224030 · Cited by 2
Theadom, A., Barker-Collo, S., Parag, V., Caspi, A., Moffitt, T., Hogan, S., Ramrakha, S., & Poulton, R. (2023) · The journal of head trauma rehabilitation · doi:10.1097/htr.0000000000000875 · Cited by 2
“33,34 The findings from this study that age of first injury was not associated with cognitive functioning in mid-adulthood supports these findings.”
BackgroundDetect mTBI in pediatric populations using a tablet-based software BrainCheck
Ye, S., Ko, B., Phi, H. Q., Eagleman, D., Flores, B., Katz, Y., Huang, B., & Ghomi, R. (2020) · medRxiv · doi:10.1101/2020.04.29.20085274 · Cited by 2
Familial Intelligence as an Estimate of Expected Ability in Children
Joel, R. (2001) · doi:10.1076/clin.15.4.446.1879 · Cited by 2
“behavioral problems (Gerring et al., 1998; Satz et al., 1997); failure to account for this history could result in erroneously attributing preexisting”
BackgroundPediatric and Adolescent Concussion
Apps, J. N., & Walter, K. D. (2011) · Springer eBooks · doi:10.1007/978-0-387-89545-1 · Cited by 10
Rozbacher, A., Selci, E., LeiterPhD, J., Ellis, M., Frcsc, & Russell, K. (2017) · Journal of Neurotrauma · doi:10.1089/neu.2016.4765 · Cited by 1
Anderson, C. M., Rausa, V. C., McKinlay, A., Schuster, T., Lloyd, M., Huang, A., Chau, T., Morawakage, T., Anderson, V. A., & Takagi, M. (2026) · Neuropsychology Review · doi:10.1007/s11065-026-09702-z · Cited by 1
The impact of adolescent traumatic brain injury on health risk behaviors
Bammel, A. C., Hohman, Z. P., Littlefield, A. K., & Schmidt, A. (2025) · Child Neuropsychology · doi:10.1080/09297049.2025.2476682 · Cited by 1
“…preexisting differences between individuals likely to sustain significant injuries (e.g., poor executive functioning; Kennedy, Cohen, et al., 2017; Satz, 2001); and many studies evaluate health risk behaviors separately which can obscure relationships between predictors and negative health…”
Alghamdi, A. M., Fallatah, M., Almansour, A. S., Aljohani, A. N., Ashqar, A., & Lary, A. (2025) · Cureus · doi:10.7759/cureus.80426 · Cited by 1
“This definition can be vague because of the lack of a globally accepted single definition of concussion [1].”
Blaabæk, E. H., Andersen, L. H., & Fallesen, P. (2023) · Social Science & Medicine · doi:10.1016/j.socscimed.2023.116524 · Cited by 3
Psychische und neuropsychologische Folgen von Schädel-Hirn-Traumen im Kindesalter
Lehmkuhl, G., & Melchers, P. (2001) · doi:10.1026//0942-5403.10.2.70 · Cited by 1
Cumulative Effects of Concussion/Chronic Traumatic Encephalopathy
Taylor, A. M., & Blackwell, L. S. (2015) · Contemporary pediatric and adolescent sports medicine · doi:10.1007/978-3-319-23549-3_6 · Cited by 2
Chapter 24 – Central Nervous System Injuries
Jea, A., & Luerssen, T. (2012) · Elsevier eBooks · doi:10.1016/b978-0-323-07255-7.00024-6 · Cited by 1
Chapter 21 – Central Nervous System Injuries
Luerssen, T. (2006) · Elsevier eBooks · doi:10.1016/b978-0-323-02842-4.50024-3 · Cited by 1
The implications of head injuries for higher education: Evidence from psychology students
Richardson, J. T. E. (2005) · Psychology Teaching Review · doi:10.53841/bpsptr.2005.11.1.64 · Cited by 1
“Indeed, one review has concluded that any effects of mild injuries typically resolved within six months and were not associated with long-term changes in either academic attainment or behavioural functioning (Satz et al., 1997).”
Backgroundde Souza, N. L., Meng, W., Vaida, F., Jacobus, J., Wilde, E. A., Dennis, E. L., Bigler, E. D., Yang, X., Cheng, M., Troyer, E. A., et al. (2025) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617725101537
“Several methodological limitations may contribute to these inconsistencies (Goh et al., 2021; Hacker et al., 2023; Satz et al., 1997).”
Suskauer, S. J., & Yeates, K. O. (2025) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000001127
Glendon, K., Pain, M., Hogervorst, E., Belli, A., & Blenkinsop, G. (2023) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2023.12.005
Saddique, S., Av, R., & Dutta, G. (2019) · International Journal of Scientific and Research Publications (IJSRP) · doi:10.29322/ijsrp.9.07.2019.p91104
Le traumatisme crânien de l’enfant: troubles cognitifs et comportementaux
Chevignard, M., Touré, H., Brugel, D., & Laurent‐Vannier, A. (2009) · La Lettre de médecine physique et de réadaptation · doi:10.1007/s11659-009-0137-z · Cited by 2
Fletcher, J. (1999) · Evidence-Based Mental Health · doi:10.1136/ebmh.2.2.59
Exploring Psychological Outcomes of Sport Concussion in Elite Athletes and their Parents
Borza, C. (2016) · ERA: Education and Research Archive (University of Alberta) · doi:10.7939/r39w0943k
The Psychosocial Impact of Sports-Related Concussion in Elite Youth Ice Hockey Players
Jubinville, A. (2015) · ERA: Education and Research Archive (University of Alberta) · doi:10.7939/r3348gt36
Chipchar, E. N. (2015) · ERA: Education and Research Archive (University of Alberta) · doi:10.7939/r37p8tj8x
Cognitive therapy: Looking backward, looking forward
Dobson (2000) · doi:10.1002/1097-4679(200007)56:7
Self-citation
Metadata
- Authors
- Satz, P., Zaucha, K., McCleary, C., Light, R., Asarnow, R., & Becker, D.
- Affiliations
- University of California, Los Angeles (US)
- Venue
- Psychological Bulletin
- Published
- 1997
- Volume
- 122
- Issue
- 2
- Pages
- 107-131
- ISSN
- 0033-2909 (ISSN-L)
- 1939-1455
- OpenAlex
- W2039083624
- Cited by
- 245
- References
- 0
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 3 · 2019: 3 · 2018: 57 · 2017: 8 · 2016: 11 · 2015: 10 · 2014: 10 · 2013: 9 · 2012: 5
- FWCI
- 4.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Bulletin (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (P50NS030308, R01 NS26801, P50 NS30308-02, R01NS026801)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Physical Sciences › Engineering › Biomedical Engineering › Automotive and Human Injury Biomechanics
- Keywords
- mild traumatic brain injury, concussion, children, adolescents, neuropsychological outcomes, educational outcomes, psychosocial outcomes, methodological quality, null hypothesis
- MeSH terms
- Achievement, Adolescent, Brain Damage, Chronic, Child, Follow-Up Studies, Humans, Neuropsychological Tests, Social Adjustment, Head Injuries, Closed
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