Exploring Human Potential

The AAP and Cognitive Dissonance: Sports vs. Traumatic Brain Injuries In Children.

Posted on | October 29, 2013 | 2 Comments

Mike Magee

When I sat down to view the Frontline “League of Denial” documentary, I already knew in advance it’s focus – head injuries in NFL players. I knew as well the long standing legal battle between NFL players, the players association, NFL owners and Riddell, the maker of football helmets. And like many other watchers of football, the connection between massive hits, concussions and brain injuries was a “no brainer” – of course there was a causal connection.

You’d have to suspend all judgement or be Paul Tagliabue, the Commissioner of the NFL, to deny it. In a sports panel discussion in 1994, he said, “Concussions I think is, you know, one of these pack journalism issues, frankly. There’s no increase in concussions. The number is relatively small. The problem is it’s a journalist issue.”

So when I pushed the play button, I was not prepared for the tease: The sound bite came from a woman physician. The Chyron identified her as  “ANN MCKEE, M.D., Neuropathologist, BU CTE Center”. CTE = Chronic Traumatic Encephalopathy. Her single sentence: “I’m really wondering if every single football player doesn’t have this.”

I was more than half way through the 113 minute program before I was reintroduced to Dr. McKee, a leading Alzheimer’s researcher at Boston University. In the lead up I had met players and families of former players who reinforced that there was clearly a tie between the the violent concussive blows that are NFL football and the depressing, and to this point, largely anonymous dead ends of many of these former Sunday performers.

And then came the shocker:

NARRATOR: By 2010, Dr. McKee had looked at the brains of 20 NFL players. She had found CTE  in 19 of them. It was during that time that a brain arrived that would dramatically raise the stakes.

ROBERT STERN, Ph.D., Neuropsychologist, BU CTE Center: Owen Thomas to me was a critical case. Here we have a 21-year-old who was a hard-hitting lineman from the age of 9 on.

CHRIS NOWINSKI: And then, seemingly out of nowhere, he decided to take his own life. Never been diagnosed with a concussion, never had a problem in the world.

NARRATOR: Owen Thomas had hanged himself in his off-campus apartment. Chris Nowinski secured his brain for Dr. McKee. without any history of diagnosed concussions, it seemed unlikely he had CTE.

Dr. ANN McKEE: I was fully prepared to see nothing. I remember late at night looking at the brain and thinking, “Just going to knock this one off.” And it just floored me. It just— I just couldn’t believe what I was seeing.

NARRATOR: Such an advanced case of CTE had never been found in such a young person.

Dr. ANN McKEE: In, like, 20 spots in his frontal lobe. He’s 21. He’s so young. You know, that changes the game to me.

ANNOUNCER: —wrapped up and brought down by Owen Thomas—

NARRATOR: Because he’d never had a diagnosed concussion, Dr. McKee suspected Thomas might have gotten CTE from the everyday sub-concussive hits that are an inherent part of the game.

ANNOUNCER: Another nice play by Owen Thomas—

Dr. ANN McKEE: Those sub-concussive hits, those hits that don’t even rise to the level of what we call a concussion, or symptoms, just playing the game can be dangerous…. I’m really wondering if every single football player doesn’t have this.

When I heard that last statement, I remember thinking, “What about the Pop Warner football program whose “Tiny Mite” kids begin at age 5 and at 35 pounds.” So after the program, I went to their home page, and under “Safety First” read the proud proclamation, “Did you know that Pop Warner football is safer than soccer? Pop Warner football has 12% fewer injuries per capita among 5-15 year olds than organized soccer in the same age range!”

I wasn’t reassured. In fact, I said to myself, “Well, what about soccer, and hockey, and…”. That was October 8, 2013.

This week I reviewed the early release of an American Academy of Pediatrics consensus statement published online on October 27, 2013 titled “Returning To Learning Following A Concussion.

In the paper, the authors avoid the value debate of “cause” and jump right to “effect” – and what to do about it. They state, “With an estimated 1.7 million traumatic brain injuries occurring annually, many of them concussions, the need for specific recommendations for returning a student to learning after concussion is necessary.”

They then elaborate in significant detail how best to “react” to the learning deficits known to accompany childhood sports-induced, brain injuries. But do they have a position on organized sports themselves and how to prevent injury (including the possibility of avoiding certain sports)?

Well, here’s what they say in another consensus paper penned on June 1, 2001 titled “Organized Sports For Children and Preadolescents”:

“To optimize the safety and benefits of organized sports for children and preadolescents and to preserve this valuable opportunity for young people to increase their physical activity levels, the American Academy of Pediatrics recommends the following:

1. Organized sports programs for preadolescents should complement, not replace, the regular physical activity that is a part of free play, child-organized games, recreational sports, and physical education programs in the schools. Regular physical activity should be encouraged for all children whether they participate in organized sports or not.

2. Pediatricians are encouraged to help assess developmental readiness and medical suitability for children and preadolescents to participate in organized sports and assist in matching a child’s physical, social, and cognitive maturity with appropriate sports activities.

3. Pediatricians can take an active role in youth sports organizations by educating coaches about developmental and safety issues, monitoring the health and safety of children involved in organized sports, and advising committees on rules and safety.

4. Pediatricians are encouraged to take an active role in identifying and preserving goals of sports that best serve young athletes.

5. Additional research and resources are needed to:

a. determine the optimal time for children to begin participating in organized sports;

b. identify safe and effective training strategies for growing and developing athletes;

c. educate youth sports coaches about unique needs and characteristics of young athletes; and

d. develop effective injury prevention strategies.”

Well, as the Frontline documentary demonstrates (and the most recent AAP learning piece tacitly affirms), time has run out on “reacting to” or “studying” the issue. The AAP recommendations this week create an odd dissonance almost begging for a more direct AAP approach to cause and effect.

For Health Commentary, I’m Mike Magee


2 Responses to “The AAP and Cognitive Dissonance: Sports vs. Traumatic Brain Injuries In Children.”

  1. SportsCAPP
    October 29th, 2013 @ 9:57 pm

    “learning deficits known to accompany childhood sports-induced, brain injuries.”

    Roughly 20-25% of children’s concussions are in organized sports based on a number of studies. A child is more likely to be taken to a doctor if they have a head injury in a sporting event than in an accident at home.

    Organized Sports are the focus of concussion education right now… But they far from the only way a child gets a concussion – and account for fewer than 20-25% of youth concussions. Due to adult supervision, rules and ref, improving coach training and media attention on concussions, parents should encourage their kids to play sports in programs with concussion and safety training.

  2. Mike Magee
    October 30th, 2013 @ 11:46 am


    Thanks for your important comment. Indeed you are correct in noting that many of the head injuries that children sustain occur outside of the confines of organized sport. That said, as an IOM report released today highlights, we are operating in a gray area when it comes to assessing the long term implications of repetitive head and neck impacts (direct and indirect) during the adolescent and teen years. Logic would dictate caution and advise against cavalier pronouncements or minimizing the potential harm that may be associated with daily and weekly major and minor insults associated with organized childhood contact sports. Mike

Leave a Reply

Show Buttons
Hide Buttons