Your Teen's Concussion: Talking, Thinking and School Changes to Watch For
Written by Mariya Kika, M.H.Sc., Reg. CASLPO, Speech-Language Pathologist
Table of Contents
What is a concussion?
How long does concussion recovery take, and who is involved?
What does Rowan's Law mean for student athletes?
When can a speech-language pathologist help after a concussion?
When should you get medical help right away?
FAQs
Your teen came home from practice with a headache. A week later the headache has eased, but something still seems off. They reread the same page of a novel three times. They lose the thread halfway through a story about their day. The noise at the dinner table, which never used to bother them, now sends them to their room.
Changes like these are easy to attribute to stress or a bad week. But, if they persist, and if your teen still doesn’t feel well despite their best efforts, then a visit to the doctor may be in order. Within the context of their athletic life and the demands of sport, you want to ensure that these are not signs of a concussion, which can affect how your teen thinks and communicates.
In plain language: A concussion can affect how a teen thinks, communicates and learns, even after the headache fades. Common signs include losing track in class, struggling to find words, and tiring quickly in conversation. Ontario's guideline recommends a return to school within days, with supports in place. If your teen isn't improving after two to four weeks, go back to the doctor and ask about a referral to a concussion care team.
What is a concussion?
A concussion is a brain injury caused by the brain rapidly moving within the skull. You do not always have to have been physically hit to get a concussion, and your teen doesn’t have to have been knocked out mid-game for it to be considered “serious”.
Symptoms can appear right away or over the following days. Headache, dizziness and nausea tend to be the most apparent. Changes in thinking and communication are not always obvious and can sometimes be attributed to difficulties with managing their other symptoms. But, one can look fine while having to now work much harder to do the things they used to.
What are the signs of a concussion in a teenager?
Beyond headache and dizziness, concussion symptoms in teens often show up in thinking and communication. Many teens describe it as brain fog. After a concussion, a teen may:
Lose track of conversations, especially in groups or noisy places
Pause to find words, or use a word that's close but not quite right
Take longer to respond, or ask people to repeat themselves
Have memory difficulties, such as forgetting what they just read or what was said in class
Struggle to start homework, or to plan the steps of a longer assignment
Become tired, irritable or overwhelmed after talking, reading or screen time
Teens don't always share these changes. Some haven't noticed them. Others worry about losing their spot on the team or falling behind their friends. Specific questions tend to get better answers. Instead of "How are you feeling?” try "Is it harder to follow what the teacher says right now?". Let them know that they are not at fault and that these questions are meant to help, not punish.
How long does concussion recovery take, and who is involved?
Concussion recovery is different for every teen, but rest only helps briefly. The guideline recommends relative rest for the first one to two days, and warns that resting longer can delay recovery. After that, teens can gradually return to daily activities, even with some symptoms. Keeping screen time low at home helps.
Remember, symptoms are meant to be managed, not ignored. Ask your doctor about recommendations for an interdisciplinary concussion team. Ideally, treatment begins within the first two weeks after the injury, if clinically indicated.
Teachers may see slower work, missed instructions, more errors than usual, or a student who needs to put their head down partway through class. Busy, noisy spaces like the cafeteria or gym can be harder to manage. They may prefer to take their lunch outside, or skip it altogether.
The Living Guideline for Pediatric Concussion Care (applied to anyone under 18) states that missing more than a week of school is not generally recommended. Evidence shows that a steady return to activities is recommended over rest in a dark room. Your teen doesn't need a doctor's note to return to school after a concussion, but they do need a plan.
A good return-to-school plan starts with one point person, such as a teacher, guidance counsellor or principal. Supports might include rest breaks, a quieter place to work and extra time on tests, adjusted as your teen recovers. Every Ontario school board also has a concussion policy that includes a Return to School Plan, so ensure that you ask the school about theirs.
What does Rowan's Law mean for student athletes?
Under Rowan's Law, Ontario's concussion safety legislation, schools and sports organizations across the province follow mandated concussion protocols and return-to-school and return-to-sport guidelines. Ultimately, though, school is demanding and recovery time often overlaps with the expectations of keeping up in the classroom.
Three parts matter most for parents:
Removal from sport: An athlete with a suspected concussion must be taken out of practice or play immediately.
Medical clearance: Only a physician or nurse practitioner can clear an athlete to return to competitive sport.
Annual review: For athletes under 18, the athlete and a parent confirm each year that they've reviewed concussion awareness information and the organization's Concussion Code of Conduct.
School comes first. The guideline says full-contact sport should wait until your teen is back at school full-time with a full workload.
When can a speech-language pathologist help after a concussion?
A speech-language pathologist (SLP) can help when thinking and communication changes don't ease with time, or when they get in the way of school, friendships or a part-time job. For many teens, these changes settle as they recover.
An SLP looks at the communication and thinking skills that school and social life depend on, and works on them directly. That can include:
Following lessons and group conversations
Finding words and explaining ideas clearly, in speech and in writing
Remembering and organizing what they read and hear
Planning assignments and pacing energy across the school day
Explaining to teachers and coaches what helps
Speech therapy usually works alongside the rest of the concussion team, which may include a doctor, physiotherapist and occupational therapist. For more on where it fits, see the role of speech therapy in concussion management. Virtual sessions can fit around the school day.
When should you get medical help right away?
Call 9-1-1 right away if your teen has any of these after a hit to the head or body:
• Severe or worsening headache
• Neck pain or tenderness
• Double vision
• A seizure, or passing out
• Increasing confusion, restlessness or aggression
• Repeated vomiting
• Slurred speech
Concussion Frequently Asked Questions
Should my teen rest in a dark room until the symptoms are gone?
No. Research recommends relative rest for the first one to two days only, as longer rest can delay recovery. After that, it is recommended that teens gradually begin returning to daily activities and school, with breaks and accommodations as needed to support their progress.
Does my teen need a doctor's note to go back to sport?
For competitive sport, yes. Under Rowan's Law, only a physician or nurse practitioner can clear an athlete to return, and full-contact sport should wait until your teen is back at school full-time.
Is speech therapy for a teen covered by insurance?
Many work health plans cover speech-language pathology for dependents, usually up to a yearly limit. Check your plan's coverage for details.
About the author
Mariya Kika is a registered speech-language pathologist and the founder of Cognicare Speech Therapy, operating virtually across Ontario. She holds a Master of Health Science from the University of Toronto. She has previously worked in hospital settings providing intensive outpatient neurorehabilitation support. She is a member of the Canadian Concussion Network, Ontario Brain Injury Association, Toronto Brain Injury Association, and Canadian Telerehab Community of Practice.
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Related Reading & Resources
How speech therapy can help adults with cognitive-communication disorders
Ontario Neurotrauma Foundation, Living Guideline for Pediatric Concussion Care. Parent handout and How do I get back to school?
Government of Ontario. Rowan's Law: information for sports organizations and schools.