Special Considerations
We know that about 70% of students recover from a concussion within 4 weeks with regular classroom (Tier 1) support.
However, around 30% of students still have symptoms—like physical problems, trouble thinking, emotional changes, or sleep and energy issues—after 4 weeks. In these cases, parents/guardians should look into extra support programs at school. Programs like Response to Intervention (RTI) or Multi-Tiered System of Support (MTSS) provide more help for students who have challenges that affect learning.
Even though concussions usually get better quickly, some students may need extra academic support if symptoms last longer. These programs focus on giving students more tailored teaching and reasonable classroom accommodations to help them succeed.
For weeks 1-4 of a concussion, schools give academic “adjustments” in the general education classroom. Beyond 4+ weeks, schools may give academic "accommodations".
Weeks 1–4 after a concussion: The main goal is to help the student recover by making strong academic adjustments in the regular classroom. This could mean slight flexible and informal adjustments in the classroom like reducing work, giving more breaks, or changing how assignments are done.
After 4+ weeks: If the student still has symptoms, we shift to academic accommodations. These are more targeted supports at Tier 2, which might be more formalized through an Individualized Health Plan (IHP) or 504 Plan under the American with Disabilities Act (ADA)/Office of Civil Right (OCR). These accommodations are usually temporary but may take months, not just weeks, to show progress. At this point, schools are helping to find ways to accommodate ways for the student to better access the typical curriculum.
Rare cases: In very few students, a concussion may lead to a long-term disability affecting learning. In that situation, the student could qualify for Specially Designed Instruction (special education) under Individuals with Disabilities Education Act (IDEA) for a traumatic brain injury and get an IEP (Individualized Education Program) at Tier 3. An IEP allows for modification of the curriculum.
For Tiers 2 and 3:
Teachers, parents/guardians, and healthcare providers need to keep working together.
Students should continue to get medical care for ongoing symptoms.
School staff should keep the student safe from high-risk physical activities.
Because repeated concussions can add up over time, schools should track how many concussions a student has had and how each one affected them throughout their school years.
Concussion Management Guidelines Pyramid Diagram
A triangular pyramid diagram showing the Multi-Tier System of Support (MTSS)/Response to Intervention (RTI) framework for concussion management with three tiers:
Pyramid Structure
Tier 3 (Top - Yellow)
Intensive Intervention for FEW students
Includes Special Education/IDEA Modifications/SDI
Tier 2 (Middle - Green)
Targeted Intervention for SOME students
Includes Formalized Academic Accommodations Plan (504)
Tier 1 (Bottom - Pink)
Universal Core Instruction for ALL students
Includes Informal Classroom Adjustments
Blue arrows between tiers indicate movement between levels of support based on student needs. The diagram is labeled "Interdisciplinary Concussion Management Guidelines" at the top and "Multi-Tier System of Support (MTSS)/Response to Intervention (RTI)" at the bottom.
Words Matter: Use these terms intentionally: Adjustments vs. Accommodations vs. Modifications
Days to Weeks – Academic Adjustments:
These are short-term, flexible adjustments in the regular classroom for the first 4 weeks after a concussion.
Teachers can give or remove them easily, without meetings or special permission.
This is called Tier 1 support in MTSS/RTI.
Weeks to Months – Academic Accommodations:
These are longer-lasting supports if recovery takes more than 4+ weeks
They help with things like creative grading or extra time for schoolwork (accommodating access to typical learning)
This is called Tier 2 support in MTSS/RTI.
Months to Years – Academic Modifications:
These are major changes to what or how a student learns, like changing (or modification of) curriculum or class placement.
The student must qualify for Specially Designed Instruction (SDI) under Individuals with Disabilities Education Act (IDEA).
This is called Tier 3 support in MTSS/RTI
Medical Note
If a student already had underlying issues like headaches, migraines, learning/attention problems, or emotional challenges, a concussion can make those problems worse during recovery. That's because the brain, which was using much of it's energy before the concussion working on those issues, is now (temporarily) using a lot of energy to recover from the concussion.
New research also shows that a concussion can cause or increase depression, anxiety, or emotional/behavior problems in kids and adults.
Students who have had multiple concussions or who get symptoms more easily after a hit may be at risk for long-term problems. Having one concussion also makes it more likely to get another one in the future.
Stopping sports: If a concussion (or repeated concussions) is causing serious problems, the family, school, and medical team should talk about whether the student should stop playing sports to stay safe.