Dove-Hawk Model of Allostatic Load for Youth With Persistent Concussion Symptoms

This model aims to contextualize challenges that youth with persistent concussion symptoms face during recovery by considering the person, occupation, and environment factors that influences occupational performance. The model suggests that the relationship between the amount of allostatic load and occupational performance is represented as a normally disturbed curve. Allostatic load is the cost of returning to pre-injury occupations due to a lack of resources (e.g., no access to information on the safe return to activity) or insufficient management of resources (e.g., attempting to return to school too soon despite evidence-informed recommendation). The center area of the model, optimal recovery zone, depicts that the allostatic load is being managed appropriately (i.e., the youth displays a good understanding of strengths and challenges and approaches returning to occupation gradually), where the youth is at the optimal status of his/her occupational performance. Outside this area, there are variations of passive-dove and active hawk profiles, where both depict decreased occupational performance. The ends of this spectrum are represented by passive-dove or active-hawk profiles. The passive-dove profiles, the doves, are individuals who use a passive approach to manage allostatic load. They are more detail-oriented and cautious. Their expected behavioral profile might include a conditioned fear response; that is, easy activities are now associated with a risk of failure. Therefore, the individuals who use a passive approach to manage allostatic load may not engage in tasks even if the tasks are safe. On the other hand, the active-hawk profiles, the hawks, are individuals who have an active approach to allostatic load. They are active and may not consider the consequences in dangerous activities. Their expected behavioral profiles might include a rigid approach in returning to meaningful activities. They may have high expectations on themselves to return to pre-injury occupations, but not in a gradual manner. Therapists use activation approaches to promote reengagement for doves and use censoring approaches to create personal boundaries and make realistic expectations for hawks. The goal of rehabilitation is to facilitate management of allostatic load while engaging in meaningful activities.