A-29 To report or not to report: A review of adolescent decision-making theories following sports-related concussion

Abstract

Abstract Purpose Sports-related concussion (SRC) is a prevalent concern among adolescent athletes. If SRC is suspected, athletes are usually removed from play for assessment and symptom monitoring. Return-to-play decisions heavily rely on athlete self-report of SRC and associated symptoms. Social pressures and attitudes related to symptom reporting influence an athlete’s decision of whether to disclose symptoms; not reporting increases risk for subsequent injury and delayed recovery. Therefore, it is important to understand the adolescent decision-making process following SRC. In this review, prevailing theories that explain symptom reporting and decision-making following SRC will be evaluated from a clinical lens. Data Selection Literature was reviewed using Google Scholar, PubMed, and SCOPUS. Search terms included “concussion” AND “sport” AND “symptom reporting” OR “reporting” OR “self-report”. Other terms included “decision-making”, “disclosure”, “adolescent”, “high school”, and “college”. Articles from 2004-2023 were included. Data Synthesis Three prevailing theories have been proposed to explain symptom underreporting among adolescent athletes: the Theory of Reasoned Action and Planned Behavior, the Bandura Social Cognitive Theory, and the Disclosure Decision-Making Model. These theories will be critiqued and the lack of research on neurodevelopmental components of decision-making will be highlighted. Conclusions The decision-making process following SRC is complex, multi-factorial, and state-dependent. While these theories provide critical insights into symptom reporting following SRC, they do not consider important neurodevelopmental factors such as the imbalance between cognitive control and reward processing in adolescence. When educating parents and coaches about symptom reporting following SRC, it will be important for clinicians to consider socioemotional, cultural, environmental, and neurodevelopmental factors.