Managing Persistent Head Injury Symptoms in Autistic Adults

One of the most challenging scenarios in workers’ compensation brain injury claims occurs when the diagnostic workup looks reassuring, but the injured worker continues to report significant symptoms.

Now add another layer: the injured worker is an autistic adult.

A question submitted by an attendee at MTI America’s recent Brain & Spine CEU captured the challenge well:

“I had a closed head injury claim involving an autistic adult. It becomes very difficult to manage when the diagnostics show everything is good, but the injured worker remains symptomatic. Where do you go from there?”

It’s an important question because a “normal” test result does not necessarily mean the injured worker has returned to their pre-injury level of function.

Normal Imaging Is Not the Same as No Symptoms

CT scans and MRIs are essential tools for identifying structural abnormalities such as bleeding, fractures, swelling, or other significant pathology. But persistent symptoms following a concussion or mild traumatic brain injury may occur even when conventional imaging does not reveal an obvious structural explanation.

The injured worker may continue to experience:

• Headaches or dizziness
• Sensitivity to light or sound
• Fatigue
• Sleep disturbances
• Problems with concentration or memory
• Balance or vestibular issues
• Changes in mood or behavior
• Difficulty tolerating environments or activities that were manageable before the injury

For the claims professional, this creates a difficult situation: How do you move a claim forward when the objective testing and the injured worker’s reported experience do not seem to match?

The answer may be to shift the question from “What does the scan show?” to “What has changed functionally?”

Autism Adds Another Layer to the Clinical Picture

Every autistic adult is different. However, autism can affect communication, sensory processing, routines, emotional regulation, and how discomfort or changes in function are expressed.

That makes establishing the injured worker’s pre-injury baseline particularly important.

For example, an injured worker may have had sensory sensitivities before the accident. Following a head injury, those sensitivities may become more pronounced. A worker who previously tolerated a busy workplace may now struggle with noise, fluorescent lighting, multiple conversations, or changes in routine.

Similarly, communication differences can make symptom assessment more complicated. The injured worker may have difficulty describing whether something is new, worse, or simply different after the injury.

Rather than assuming every symptom is related to the head injury—or assuming ongoing symptoms are unrelated because diagnostic testing is normal—the care team needs to understand what the individual could do before the injury compared with what they can do now.

Start With the Baseline

When a claim becomes difficult to reconcile clinically, a detailed functional history can be extremely valuable.

Questions may include:

What was the injured worker’s normal level of independence before the injury? What job duties could they perform? What sensory environments could they tolerate? How did they communicate pain or discomfort? Were headaches, sleep problems, dizziness, anxiety, or sensory sensitivities present before the accident? What has objectively changed since the injury?

Input from family members, caregivers, employers, therapists, and other individuals who knew the injured worker before the injury may also help establish that baseline when appropriate and authorized.

This gives the clinical and claims teams something meaningful to measure beyond an imaging result.

Look at the Whole Clinical Picture

Persistent symptoms may warrant a coordinated, multidisciplinary evaluation rather than simply repeating the same diagnostic testing.

Depending on the symptoms and medical direction, the treatment team may consider areas such as:

• Neuropsychological evaluation to assess cognitive functioning and changes from baseline
• Vestibular therapy for dizziness, balance problems, or motion sensitivity
• Vision assessment or rehabilitation when visual symptoms persist
• Speech-language therapy for cognitive-communication difficulties
• Occupational therapy to address daily activities, sensory demands, and functional independence
• Physical therapy for balance, cervical issues, conditioning, or related physical limitations
• Behavioral health support when emotional or psychological factors are contributing to recovery
• Sleep evaluation when disrupted sleep may be worsening headaches, cognition, fatigue, or mood

The goal is not to order more services simply because symptoms continue. It is to identify the barriers preventing functional recovery and match the appropriate intervention to those barriers.

Avoid the “All Medical” vs. “All Behavioral” Trap

Complex brain injury claims can sometimes drift toward two extremes.

On one side is the assumption that every ongoing symptom must be caused by an undetected physical brain injury. On the other is the assumption that normal imaging means the remaining symptoms must be psychological or behavioral.

Neither approach serves the injured worker—or the claim—well.

Recovery can involve overlapping neurological, vestibular, musculoskeletal, cognitive, psychological, environmental, and social factors. For an autistic injured worker, sensory and communication differences may further influence how those challenges appear.

The better question is not necessarily “Is this symptom medical or behavioral?”

It may be:

“What is preventing this person from functioning at their pre-injury level, and what evidence-based intervention can help address that barrier?”

Give the Claim Measurable Functional Goals

When symptoms persist, claims can easily become centered around repeated appointments and subjective symptom reports.

Functional goals can create a clearer path forward.

Instead of only tracking whether the injured worker still reports headaches, for example, the team might also evaluate whether the worker can tolerate screen time for progressively longer periods, complete specific cognitive tasks, travel independently, tolerate a workplace environment, maintain a consistent sleep schedule, or perform defined activities of daily living.

That creates measurable markers of progress.

Symptoms matter. Function matters too.

The Claims Professional Can Help Connect the Dots

Adjusters and nurse case managers are not responsible for diagnosing persistent neurological symptoms. But they can play an important role in recognizing when a claim needs a more coordinated approach.

When diagnostics appear normal but recovery has stalled, consider asking:

Do we understand this injured worker’s pre-injury baseline? Are we measuring functional improvement or only reviewing diagnostic results? Are the right specialties involved based on the actual symptoms? Are providers communicating with one another? Is there a defined treatment goal and return-to-function plan?

Those questions can help turn a frustrating claim into a more structured recovery pathway.

The Takeaway: Treat the Person, Not Just the Scan

A normal CT or MRI can be reassuring, but it does not automatically answer every question about an injured worker’s recovery after a head injury.

For an autistic adult, understanding pre-injury function, communication patterns, sensory needs, and existing supports can be particularly important when evaluating what has changed following the injury.

When symptoms persist, the next step may not be another scan.

It may be a better understanding of the injured worker’s baseline, a multidisciplinary assessment of the barriers to recovery, and clearly defined functional goals that give everyone—the injured worker, provider, nurse case manager, and adjuster, a path forward.

Because in complex brain injury claims, moving the claim forward starts with understanding what “recovery” actually looks like for that individual.

MTI America | Complex Care Support

Complex brain and spine claims often require coordination across multiple specialties, providers, therapies, and support services. MTI America helps claims professionals coordinate the services injured workers need throughout the recovery journey helping connect the pieces, reduce delays, and keep the focus on function and progress.

People Who Care. Solutions That Move Claims Forward.