Anxiety and closed head injury in young people

The direct, subtle, complex, and even illusory relations between anxiety and closed head injury (CHI) in young people are frequently depreciated by professionals in paediatric rehabilitation settings. Neglecting these relations can slow recovery and complicate rehabilitation. As a brief clinical primer, this paper reviews evidence for 10 possible pathways by which closed head injury (CHI) can directly or indirectly cause, or appear to cause, anxiety in young people: (1) damage to brain structures that regulate emotion; (2) neurological damage that exacerbates pre-injury anxiety; (3) the trauma of sustaining and/or recovering from the CHI; (4) awareness of impaired cognitive functioning; (5) sustaining a CHI does not alter the progression of pre-injury anxiety; (6) emergence of anxiety is coincident but unrelated to the CHI; (7) parental stress caused by caring for an injured child transfers to the child; (8) parental stress caused by a child's disinhibited behaviour transfers to the child; (9) increased dependence/loss of functioning; and (10) impaired social cognition. Working to understand these pathways is critical to improving neuropsychological testing, rehabilitation, assessment of psychopathology, and provision of psychological services to paediatric rehabilitation patients and their families.