Domain 9: Cognition



Evaluate a child/adolescent for cognitive symptoms that interfere with daily functioning following the acute injury. 

Level of Evidence:   

For symptoms that interfere with daily functioning for more than 4 weeks following acute injury, further evaluation by experienced professionals to assess cognitive problems may be required. 

Depending on the nature of the cognitive symptoms, examples of professionals may include:

  • Experienced educational professionals.
  • Pediatric neuropsychologists.
  • Occupational therapists.
  • Speech language pathologists.

Other assessments may be required to determine the underlying cause(s) and any pre-existing contributing factors that can be managed:

  • Use a risk score to assess any modifiers that may delay recovery (Recommendation 2.1b).
  • A mental health assessment and a closer look at the family may be recommended (Domain 8: Mental Health).
  • Vision, vestibular, and hearing assessments may be recommended (Domain 10: Vision, Vestibular, and Oculomotor Function).
  • Physical examination (Tool 2.1: Physical Examination).
  • As per usual pediatric clinical practice, broad clinical history taking is recommended to understand the youth’s developmental, medical, social, academic, and family histories. Particular consideration should be given to the interplay between these pre-existing factors and current cognitive profile/presentation/symptoms.


Manage cognitive symptoms that interfere with daily functioning for more than 4 weeks following acute injury.

Level of Evidence:   

See Domain 3: Medical Follow-up and Management of Prolonged Symptoms.

See Domain 12: Return-to-School and Work for suggestions to guide an initial discussion about the best pathways for the student in school, employment, sports, social, and home environments. Tools and tests should be used in conjunction with an examination of previous school records such as marks and teacher observations.