33. Evaluating the Children’s Exertional Effects Rating Scale (ChEERS) in Anxious and Depressed Youth with Concussion

Abstract

Symptom exacerbation (i.e., exertional effects) is a core feature of concussion. Youth with pre-existing anxiety and depression may experience higher exertional effects. The Children’s Exertional Effects Rating Scale (ChEERS - 7 item) measures changes in headache, fatigue, concentration, irritability, fogginess, sensitivity to light, and dizziness after cognitive activity. The purpose of this study is to evaluate differences in exertional effects among concussed youth with and without anxiety and depression. Participants included concussed youth 8 to 18 years old (female 79.2%) with pre-existing anxiety and depression (n = 72), anxiety only (n = 90), and no pre-existing mental health conditions (n = 615). Participants completed pretest ChEERS prior to engaging in neurocognitive testing, followed by posttest ChEERS. The exertional effects index (EEI) was created by summing the subtraction of posttest from pretest scores for all 7 items. Anxious and depressed youth had higher EEI for concentration (F = 3.85, p = .05), fogginess (F = 10.71, p = .001), and dizziness (F = 5.34, p = .02) compared to those without pre-existing mental health symptoms. Furthermore, anxious and depressed youth had higher EEI for concentration (F = 8.99, p < .01), irritability (F = 12.01, p = .001), and dizziness (F = 10.59, p = .001) compared to youth with only anxiety. Youth recovering from concussion with pre-existing anxiety and depression experience higher exertional effects after cognitive activity. Having both pre-existing anxiety and depression may present unique considerations for recovery compared to youth with anxiety alone.