8.1

Assess existing and new mental health symptoms and disorders. 

Level of Evidence:

Experienced and trained healthcare professionals should use appropriate screening tools to assess the child/adolescent. These assessments should be considered for children/adolescents with a history of mental health problems or with prolonged post-concussive symptoms. 

Use Tool 8.1: Post-concussion mental health considerations algorithm and refer to a mental health specialist using clinical judgment.

Assessment screening tools to consider (direct website links):

• Link:  PHQ-SADS (somatic)
• Link: Severity Measure for Depression- Child Age 11–17 (adapted from PHQ-9 modified for Adolescents [PHQ-A])
• Link: Severity Measure for Generalized Anxiety Disorder-Child Age 11–17 (adapted from GAD-7)
• Link:  HEADS-ED Tool—Screening for Pediatric Mental Health (online interactive tool)
• Link:  PROMIS Anxiety (pediatric and parent versions are available via HealthMeasures.net)
• Link:  PROMIS Depression (pediatric and parent versions are available via HealthMeasures.net)
• Link:  PROMIS Profile (25 questions, 37 questions, 49 questions versions are available via HealthMeasures.net)

8.2

Assess the child/adolescent’s broader environment, including family and caregiver function, mental health, and social connections. 

Level of Evidence:   

• Ask about socioeconomic status (caregiver education, family income, occupation).
• Ask about social impacts and life stressors (school setting, friends, teammates).
• Ask the child/adolescent and parents and/or caregivers to complete the following, as appropriate:
  • Link:  PROMIS Family Function (pediatric and parent versions are available via HealthMeasures.net)
  • Link:  Patient Health Questionnaire (PHQ-9) (Self-administered screen for depression in adults) 
  • Link:  Generalized Anxiety Disorder scale (GAD-7)

8.3

Treat mental health symptoms or refer to a specialist in pediatric mental health. 

Level of Evidence:   

Base the mental health treatment on individual factors, patient preferences, the severity of symptoms, and co-morbidities.

Tools to assist healthcare professionals to make treatment decisions:

• Tool 8.1: Post-Concussion Mental Health Considerations Algorithm. 
• Tool 8.2: Management of Prolonged Mental Health Disorders Algorithm.
• Tool 6.2: General Considerations Regarding Pharmacotherapy.
• Tool 6.3: Approved Medications for Pediatric Indications.

Consider referring to a local healthcare professional, specialized pediatric concussion program or to a specialist with experience in pediatric mental health if child/adolescent has prolonged or urgent mental health symptoms. Provide the name of a specialist with experience in pediatric mental health.

For deciding when to refer a child/adolescent to a specialist, use Tool 8.1: Post-Concussion Mental Health Considerations Algorithm.