Study: No link between youth football head impacts, cognitive outcomes

Press Staff Writer

        When children are considering playing contact sports, parents/guardians and medical providers must weigh the risks and benefits. One of the major concerns is the possibility of negative short- and long-term effects of repetitive head impacts. Most studies evaluating the relationship between head impacts and neurocognitive function have been retrospective, conducted in adults.
        “The current evidence is very conflicting,” says pediatric neurologist Sean Rose, MD, who is co-director of the Complex Concussion Clinic at Nationwide Children’s Hospital in Columbus. “Many factors can affect cognition and behavior, making it difficult to tease apart the effects of head impacts during sports and other confounding factors, such as pre-participation cognitive ability.”
        Dr. Rose and colleagues collaborated with MORE Foundation, the Complex Concussion Clinic at Nationwide Children's, and other researchers to prospectively follow youth tackle football players in real time across four seasons, which can account for confounding factors.
        The study, recently published in JAMA Network Open, was conducted from July 2016 through January 2020, and enrolled players from four football teams. A total of 70 male players, 9-12 years of age, who were in fifth and sixth grade, volunteered to participate, with 18 completing all four years of the study.
        The researchers measured subconcussive head impacts using helmet-based sensors during practices and games, and then calculated a cumulative measure of head impacts per season. They also evaluated 10 cognitive and behavioral measures in players before and after each football season.
        In the final analyses, no consistent associations between cumulative head impacts and cognitive and behavioral outcomes were observed, and no changes became more prominent over the years.
        However, at multiple time points across the study, other medical diagnoses – premorbid attention deficit hyperactivity disorder, anxiety and depression – were associated with worse cognitive or behavioral scores, while premorbid headaches or history of concussion was less frequently associated with outcomes.
        “These findings shouldn’t be used to withhold kids with these medical conditions from playing contact sports,” says Dr. Rose. “More research is needed to determine if there is a subset of kids who are more at risk from playing contact sports.”
        The data from the first three seasons of the study were published from 2019-2021 in Journal of Head Trauma Rehabilitation, Journal of Neurotrauma, Journal of Child Neurology, and Annals of Biomedical Engineering.
        “This is the longest study that has measured head impacts and assessed neurocognitive outcomes over time in kids of this age group, and it is currently the only such study,” adds Dr. Rose. “It would be valuable if other studies that have followed players over one or two seasons would add on multiple years to be able to compare with our results. This would provide additional evidence that providers can use when discussing the risks and benefits of youth contact sports with families.”
        MORE Foundation funded the study and provided staff and administrative support, Riddell, and ElMindA provided grants and equipment for the study.
        More information is available at


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