How A Girl’s Brain Changes After a Traumatic Brain Injury

Girls who suffer traumatic brain injuries (TBIs) may be more susceptible to behavioral problems like psychological distress and smoking compared to boys, according to a new study.

Each year, TBIs cause 2.5 million emergency room visits, and so far research has consistently shown that they’re more common among boys than girls. Girls still get them, though, and often in sports like soccer, basketball and cheerleading. A new study published in the journal PLOS ONE that surveyed 9,288 Ontario students in grades 7 through 12 reports that girls who suffered brain injuries—in sports, most commonly—were more likely to report having contemplated suicide, experienced psychological distress, been the target of bullying and having smoked cigarettes.

Overall, the new study reports that one in five adolescents had sustained a TBI that resulted in their loss of consciousness for at least five minutes or hospitalization at some point in their lifetime. Boys experienced them 6% more than girls. These young people who had experienced a lifetime TBI also reported behaviors in the last year like daily smoking, binge drinking, using marijuana, cyberbullying and poor grades.

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Since the results were self-reported, the researchers could not determine causation, nor could they provide a definitive explanation for the gender differences. In the study, they speculate that it could have to do with a variety of factors that include hormonal differences, treatment differences, differences in cognitive abilities or some combination.

Dr. Geoffrey Manley, vice chairman of neurological surgery at the University of California, San Francisco, was not involved in the study but has another theory. According to his own research, women tend to be more forthcoming about their concussion symptoms than men. “Currently, we don’t have a clear idea of what exactly a concussion is,” he says. “We are really limited to self-reporting, and women are more honest about their symptoms than boys.”

Girls get TBIs most often playing soccer and basketball, but other sports—cheerleading, in particular—have very high risk for injuries. The American Academy of Pediatrics has called for more safety regulations for the cheerleading, even though it tends to not be included in national high school sports injury research.

There’s still a lot we don’t know about TBIs and concussions, including the best way to diagnose them. So far there is not a reliable imaging or biomarker test. But understanding who is at a risk, and for which reasons, helps bolster the collective knowledge of the issue. “No matter how you slice this, a subset of these folks are going to go on and have long-term disability,” says Manley. “We can try to predict who these people are going to be, and gender may be part of this.”