Student concussion symptoms and tailored accommodations during use of a return to learn program in 13 public high schools.

Background: Youth concussion is common but there is a paucity of information on symptoms students report to school personnel and a gap in understanding what accommodations schools can provide.

Objective: To examine symptoms and provision of temporary accommodations in schools for students reporting concussion symptoms.

Design: Secondary data analysis of a trial implementing an evidence-based student-centered return to learn (RTL) program.

Setting: Thirteen public high schools during the 2021-2022 academic year.

Participants: Sixty-two students diagnosed with concussion who reported symptoms to school personnel.

Interventions: The school-based RTL program, which consists of up to four weekly check-ins with an RTL champion who evaluates symptoms and recommends symptom-tailored accommodations.

Main Outcome Measures: Symptom profile, accommodation type, and accommodation duration.

Results: A total of 46 (74.2%) students received accommodation for ≤2 weeks and 16 (25.8%) students received accommodation for 3 (21.0%) or 4 (4.8%) weeks. Sixty-two students experienced an average of 11.2 unique symptoms during week 1. Compared to students whose symptoms resolved within the first 2 weeks, students who received accommodation for 3 or 4 weeks reported higher initial total symptom severity score (p = .02), and higher initial average severity per symptom (p = .01) at week 1. Physical symptoms were most common and received corresponding accommodations most often (75/90 reports: 83.3% of occurrences). In total, 674 (nearly 11 accommodations per student) weekly accommodations were offered.

Conclusions: Students with concussion report a large number and type of symptoms that necessitate symptom-tailored academic accommodations. High school implementation of an evidence-based RTL program may aid in identifying and addressing many RTL needs after concussion, including potential identification of students with concussion who will require longer-term support.