INTRODUCTION. Children with concussive brain injuries often exhibit impaired executive functioning that can lessen quality of life and impede cognitive development. Research also demonstrates that there may be important sex-based differences in outcomes following concussion. However, few studies have sought to go beyond symptom reports, leaving our understanding of sex differences in executive functioning unknown in this population. Therefore, we sought to not only evaluate clinical symptoms but also executive functioning in a multi-faceted manner through computerized testing and parental reports of cognitive-behavioral functioning in daily life. We hypothesized that females would exhibit more severe clinical symptoms and greater executive dysfunction following concussion compared to males.
METHODS. During the 2017-2019 academic years, data were collected from a local pediatric sports medicine clinic. Thirty males (M = 15.00, SD = 1.44 years) and twenty females (M = 15.30; SD = 1.38 years) who sustained concussions were examined. All participants were evaluated at two timepoints, an average of 2- and 5-weeks post-concussion. Clinical symptoms were measured using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Executive function was measured using the parent-reported Behavioral Rating Inventory of Executive Function (BRIEF), as well as a modified CogState Brain Injury Test Battery.
RESULTS. Females reported a greater number of somatic and cognitive symptoms on the RPQ at 2 weeks and 5 weeks post-injury (p’s < .05). In addition, a significantly greater proportion of females (16 of 20) reported persistent clinical symptoms at 5-week follow-up when compared to males (5 of 30; p < .05). Further, parents of female participants reported significantly greater difficulties with their child’s behavioral regulation than parents of male participants (p’s < .05). Females also performed more slowly on the One Back Condition of the CogState Brain Injury Test Battery relative to males (p < 0.05). No correlations between injury characteristics (time since injury, concussion history) and clinical symptoms or executive functions were observed. 
CONCLUSIONS. Our findings corroborate evidence that females report greater clinical symptoms following concussion than males. In addition, females not only demonstrated slower cognitive performance, but their parents also reported greater impairment in executive functioning. Thus, our findings indicate that females may exhibit significantly poorer cognitive outcomes than males. Future longitudinal research incorporating baseline evaluations is necessary to gain a more accurate understanding of sex differences before-and-after concussion.

Sex Differences in Executive Functions following Pediatric Concussive Brain Injury