If your child plays a contact or collision sport, whether at the youth, middle school or high school level, odds are that at some point in their athletic career they will suffer a concussion. How well they recover depends a lot on how quickly their concussion is identified so they can be removed from practice or game action. 

A lot of student-athletes - a declining percentage, fortunately - don't appreciate precisely when they have suffered a concussion. There are a lot of reasons:

• the symptoms may not appear right away (as one recent study of college athletes  (1) found, 23% of diagnosed concussions were delayed, on average, 17 hours, and another 27% had unspecified onset (1,2), or  
• they don't know the symptoms, or
• they are not functioning at their cognitive baselines and do not recognize they have suffered an injury (2) or 
• because they don't appreciate that concussions, however mild, are traumatic brain injuries (3,4,5), or 
• because they still believe that a  loss of consciousness (LOC) is required for a concussion (again, the message that a concussion doesn't require LOC, and that, in fact, the vast majority of concussions - 90-95% of all concussions in high school sports - do not involve LOC, seems to be sinking in). (6)

Code of silence

Unfortunately, the problem is that, even for athletes who realize that they have suffered a concussion, there is still a very good chance (more than 50% in one oft-cited 2004 study (4) but probably much higher) they won't self-report symptoms to sideline personnel, much less voluntarily remove themselves from the game.  

Why?

For a variety of reasons, it seems, but mostly, I think, because the very culture of the contact or collision sport they are playing, and their own self-concept as invincible, strong adolescents, encourages them to remain silent:

• to avoid jeopardizing their spot in the starting lineup or letting their teammates down; (3)
• to avoid being seen as weak or cowardly by their coach or teammates, or even their parents; (3)
• to demonstrate to the coach and their teammates that they can "take a hit like a man,"
• to show that they can be as tough as their professional heroes;
• because they fear they will be held out of play; (7) 
• because they want to win the game at all costs; or
• because they believe that the glory of individual and team success, the promise of a college scholarship, or the lure of a lucrative professional career, is somehow worth the risk of lifetime impairment from continuing to play with concussion symptoms.

That all of these forces conspire to prompt kids to be reluctant, indeed, unwilling to self-report concussion symptoms was driven home to me during the filming of MomsTEAM's PBS documentary, The Smartest Team.  Nearly every football player I interviewed for the film freely admitted that they would not self-report concussion symptoms.  Here is just a sampling of what they told me:

• "If I can get up and walk away from it, yeah, I'll probably keep playing."
• "You see some dots and they go away ... so you just keep playing through it. It's my senior year."
• "As long as I can still see and keep my balance, as long as I'm not feelin dizzy, head injuries are all right."

I have been hearing and reading a lot lately about how we need to "change the culture" of football and encourage honest self-reporting by athletes of concussion.  It is seems clear from the research that if players don't tell anyone that they or a teammate are experiencing concussion symptoms and continue to play, they are increasing the chances their recovery will take longer, and, worse, expose them to increased risk of an even more serious brain injury, or, in very rare circumstances, catastrophic injury or even death from second impact syndrome.

Several years ago, HBO's Real Sports did a segment on high school sports concussions featuring the tragic story of Ryne Dougherty, a Montclair, New Jersey football player who died in 2008, likely from second impact syndrome, when he suffered a blow to the head when he returned to play, despite having confided to teammates that he was still experiencing headaches from an earlier concussion.

As needless as Ryan's death was, even more shocking was that his teammates, when asked if, knowing what they knew now about the dangers of playing with concussion symptoms, they would still hide their concussion symptoms in order to play, they still all answered without equivocation, "Yes."

Indeed, an ESPN poll of players, coaches, parents and athletic trainers in 23 states (8) found that players  - the ones whose brains are being rattled and who are putting themselves at risk of adverse long-term health consequences from concussions - are still the group least concerned about concussions. (Again, it's not surprising: teenagers all think they are invincible, which leads them to engage in a lot of risky behaviors)

When asked whether, if a star player got a concussion, they would rather lose the state title game as he sat out than win it because he chose to play with a concussion, more than half (54.1%) of the 300 players in the ESPN survey said they would play the star compared to 9% of athletic trainers, 6.1% of parents, and 2.1% of coaches. A majority of players (55.4%) also felt that a headache - far and away the the number one reported symptom of concussion - shouldn't disqualify them from returning to the same game.

The survey results were consistent with my anecdotal experience in talking to players for The Smartest Team.  Typical was what one player told me: "There was a time that I've gotten a concussion. I didn't think much of it, you know, just a headache, move on with it, keep playing. ... Got hit pretty hard, helmet to helmet, couldn't see, saw stars everywhere, just went back on the field, started playing again. Didn't, didn't need to tell anyone. I mean it's not like I was laying down, couldn't get up or anything. But I thought I was fine."   (He wasn't, of course, and should have told someone and removed himself, or been removed, from the game)

Yes, it is critically important that all athletes playing a contact or collision sport (including not only football, hockey and lacrosse, but soccer, basketball, cheer, and baseball), understand the symptoms of a concussion (things they feel) and appreciate the range of damaging health consequences they can suffer if they don't report them and keep playing, from making another concussion much more likely to long-term cognitive (concentration, memory, reasoning) and emotional difficulties (e.g. depression) to, in rare instances, catastrophic injury or death (e.g. second impact syndrome).  We should do everything we can to encourage honest self-reporting.  

We also need to encourage reporting by players about concussion symptoms being experienced by their teammates (One of the things I stressed at the players meeting back in June 2012 before the season began was the need for a "buddy system.")  My experience in Oklahoma gave me some reason to be cautiously optimistic that, by educating players and parents, and by enlisting the help of coaches, we can increase the number of athletes who are willing to self-report and use the buddy system.  

One of the players on the Oklahoma team we followed in the fall of 2012 appears in the documentary telling me that he had a friend on the line who seemed really "out of it" at practice one day.  When he told the coach, his teammate "got really mad."  But he was undeterred, because he "knew it was going to help [his teammate] in the long run." Another player told me that, "As far as the buddy system goes, I know that we need to keep each other's backs, like me and Matt have each other's backs as far as like, if I get a concussion or he had gotten a concussion, then you know, make sure he's OK. If he's out of it, you know, can't answer simple questions, go alert the coaches."

But while I saw some progress in terms of self-reporting and use of the buddy system during my time in Oklahoma, I don't think we can count on changing overnight a deeply entrenched culture as a panacea in solving the chronic problem of under-reporting.

In fact, the evidence continues to be that athletes are resistant to such culture change, despite increased education.  Two studies [reported after this blog originally appeared] (13,14)  by researchers at Cincinnati Children's Hospital (2) of 120 high school football players, 30 of whom had suffered a concussion,  found that, while three-quarters had received concussion education, and 9 out of 10 recognized the risk of serious injury if they returned to play too quickly:

• an astounding 91 percent felt that it was okay for an athlete to play with a concussion
• 75 percent said they would play through any injury to win a game
• 53 percent said they would "always or sometimes continue to play with a headache sustained from an injury,"
• Only 54 percent would "always or sometimes report symptoms of a concussion to their coach," and
• Only 4 in 10 would tell their coach immediately if they had concussion symptoms. 

Are impact sensors the solution? 

One possible way around the problem: to avoid relying on athletes themselves, game officials and/or sideline observers to call for a concussion assessment, but to instead employ real-time monitoring of head impact exposure (e.g. number, severity, location, and cumulative impact) at all levels of football, and other helmeted and non-helmeted contact and collision sports where practical, to allow for early recognition and management of brain injury. (9,11,12)  

Benefits of real-time hit monitoring  

While monitoring will not eliminate brain injuries altogether, the benefits of early identification and prevention of further injury are numerous:

• Sideline personnel will benefit from objective data that might inform their medical decisions; ^[9,11,12]
• Parents will benefit from reduced reliance on honest self-reporting of concussion symptoms by athletes and of the observational skills of sideline management in spotting signs of concussion;
• Teams will benefit by having healthy, unimpaired athletes on the field more often; and
• The student-athlete and professional athlete will benefit the most from reduced exposure to potentially injurious blows and from the "conundrum of having to self-report an injury that they may not recognize as being potentially injurious or dangerous in the moment of competition."  

As co-founder of Simbex, LLC, the Lebanon, New Hampshire company that makes the HITS (Head Impact Telemetry System) - a peer-reviewed, scientifically-validated technology used by researchers in biomechanical studies to measure head impacts on the playing field - Greenwald knows a thing or two about the technology of head impact exposure monitoring.  That his company might benefit from the widespread monitoring he and his colleagues at Simbex propose in the editorial, however, does not make their recommendation any less important. 

Writing about head impact sensors in the March 2013 issue of the British Journal of Sports Medicine (11) Jeffrey S. Kutcher, MD, of the Department of Neurology and Michigan Neurosport at the University of Michigan, observes that the "development of easily deployable sport equipment-based accelerometer systems ... provide[s] two unique and potentially useful, clinical opportunities:

The first is the ability to monitor impacts during the course of an athletic event for the purpose of screening for potential injury. Although many researchers have analyzed impact counts and characteristics across a variety of settings in the hopes of establishing force 'thresholds' for injury, no such threshold has been discovered.  As efforts to improve impact-monitoring accuracy continue, however, so will the search for the 'concussion threshold.'  At the same time, there may be a separate, but similar role for the real-time tracking of impact forces.  Although an on-board accelerometer system may not be able to accurately predict injury, it may have utility as a screening device by alerting sideline personnel of an impact that has occurred above a predetermined magnitude that triggers either observation or clinical evaluation of an athlete.  Although there are currently no published studies to support the use of impact sensor systems in this manner, and a 'concussion threshold' is unknown, the potential clinical utility should be carefully considered.

The second potential clinical benefit of impact monitoring systems stems not from the idea of monitoring impacts for the presence of an acute injury-generating hit, but from the potential advantage of acruately cataloguing the number of hits and post-impact head acceleration being experienced by an athlete over time.  Some have suggested that the idea of a 'hit count' that is kept for athletes over the course of a game, practice, week, month, season or career.  This concept is fairly new and, as yet does not have published data to suggest that any particular level or number of hits has significant clinical meaning for any particular sport or position.  Nonetheless, individual athletes may feel there is a benefit to having an estimate of forces their brain experiences over time. 

Head impact monitoring systems 

The day when monitoring of head impact exposure in football and other helmeted sports becomes commonplace may be closer at hand than one might think, as a number of helmet sensor products are already on, or about to come on, the market designed to capture the kind of data that not only Greenwald and his colleagues, but other concussion experts say is needed as a way around the underreporting/under-identification problem.

Watch this space. 

October 24, 2015 update: While the number of impact sensor products on the market or in development has grown exponentially since I wrote this blog back in February 2013, my direct, first-hand experience working with a host of sensor manufacturers and teams at both the high school, and for the past two years, at the youth football level, leads me to believe that, cost, reliability, specificity and sensitivity hurdles have pushed the day when widespread use of impact sensors as what one sensor company CEO called another "tool" in the concussion toolbox, or "another set of eyes" for an athletic trainer on the sports sideline to help him or her spot athletes who should be checked out for possible concussion, can be realistically achieved.  

While MomsTEAM and I continue to see sensors as holding out the promise of a technological solution to chronic under-reporting (which preliminary data collected during the 2014 season and presented to the American Academy of Pediatrics' 2015 Annual Meeting in Washington, D.C. suggests has not gotten better over the past ten years), our primary focus in the coming months and years to develop, under a NCAA-Department of Defense "Mind Matters Challenge" grant, a multi-media program designed to change the culture of sports from one of resistance to one of safety, and fight chronic under-reporting by working with coaches, athletic trainers, parents, and players to create an environment in which athletes feel safe in honestly self-reporting concussion symptoms.

1.  Duhaime A, Beckwith J, Maerlender A, McAllister T, Crisco J, Duma S, et. al. Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets. J Neurosurg. 2012; 117(6):1092-1099 (epub ahead of print October 2, 2012. DOI: 10.3171/2012.8.JNS112298).

2.  Ellenborgen R. Sports and Concussion. J. Neurosurg. 2012;117:1089-191.

3. McGrath N. Supporting the Student-Athlete's Return to the Classroom After a Sport-Related Concussion. J Ath. Tr. 2010:45(5):492-498.

4. McCrea M, Hammeke T, Olsen G, Leo P, Guskiewicz K. Unreported concussion in high school football players - Implications for prevention. Clin J Sport Med 2004;14:13-17.

5. Tomei KL, Doe C, Prestigiacomo CJ, Gandhi CD. Comparative analysis of state-level concussion legislation and review of current practices in concussion. Neurosurg Focus 2012; 33 (6):E11 (published online ahead of print)(accessed December 10, 2012).

6. Meehan W, d'Hemecourt P, Comstock D, High School Concussions in the 2008-2009 Academic Year: Mechanism, Symptoms, and Management. Am. J. Sports. Med. 2010; 38(12): 2405-2409 (accessed December 2, 2010 at http://ajs.sagepub.com/content/38/12/2405.abstract?etoc)

7. Echlin PS, Skopelja EN, Worsley R et al. A prospective study of physician-observed concussion during a varsity university ice hockey season: incidence and neuropsychological changes. Part 2 of 4. Neurosurg Focus 2012;33(6):E2. 

8. "Concussion Confidential"ESPN The Magazine (http://sports.espn.go.com/espn/news/story?id=5925876)(accessed December 21, 2010).

9. Greenwald R, Chu J, Beckwith J, Crisco J.  A Proposed Method to Reduce Underreporting of Brain Injury in Sports.  Clin J Sport Med2012; 22(2):83-85.

10. Kaut KP, DePompei R, Kerr J. Congeni J. Reports of head injury and symptom knowledge among college athletes: implications for assessment and educational intervention.  Clin J Sport Med 2003;13:213-221. 

11. Kutcher J, McCrory, Davis G, et al.  What evidence exists for new strategies or technologies in the diagnosis of sports concussion and assessment of recovery?  Br J Sports Med 2013;47:299-303. 

12. Broglio SP, Eckner JT, Surma T, Kutcher JS. Post-Concussion Cognitive Declines and Symptomatology Are Not Related To Concussion Biomechanics in High School Football Players.  J Neurotrauma 2011;28:1-8. 

13. Anderson B, Pomerantz W, Mann J, Gittelman M. "I Can't Miss the Big Game": High School (HS) Football Players' Knowledge and Attitudes about Concussions. Paper presented at the Annual meeting of the Pediatric Academic Societies, Washington, D.C. May 6, 2013.

14. Wall Street Journal (2013). Study Raises Concerns That Teen Athletes Continue to Play with Concussion Symptoms (http://online.wsj.com/article/PR-CO-20130506-904595.html)(accessed May 7, 2013)  

Note: this blog was updated on May 9, 2013 to reflect the new Cincinnati Children's Hospital study and to include information about impact sensors as a technological end-around the problem of chronic under-reporting.

Participation in youth sports in general, and in youth football in particular, is on the decline in some parts of the nation.  One of the biggest factors driving the decline is a concern about injuries. 

Lots of youth sports programs say they want to improve safety, but how many are actually making the effort to implement best health and safety practices?

I can't speak for every program, but I know one that is definitely walking the talk: the youth tackle and flag football and cheer program in Grand Prairie, Texas, where I spent the first week of August in 100 degree heat (the first thing I did when I arrived was to buy a pallet of water at a local big box store!) working with a group of leading experts I invited in to help educate and train 2,500 young tackle, flag and cheer athletes, parents, coaches, and administrators in the program on ways to make football and cheer safer as part of our MomsTEAM Institute of Youth Sports Safety's SmartTeams^TM | UNICEF International Safeguards of Children in Sports project. 

What are some of the ways to make youth football safer? Here are ten specific steps I encouraged the Grand Prairie program, as an independent youth football program not affiliated with USA Football or Pop Warner, to take to provide a safer and more enjoyable experience for its players:

1. Adopt and periodically practice a comprehensive Emergency Action Plan: As I emphasized in my meetings with the Grand Prairie board, one of the most important steps it could take to protect the safety of athletes, spectators, coaches, and officials in case of a medical (serious head, neck or spine injury, heat stroke\ or weather emergency (e.g. lightning, excessive heat) was to develop, implement, and practice an emergency action plan (EAP). To emphasize the point, we ran a mock emergency drill my last day in Texas.  Because many youth sports programs, such as Grand Prairie, lack the resources of school-based programs to pay a certified athletic trainer to be at games and practices, I emphasized the need for Grand Prairie to look for volunteers such as school nurses, RN's, LPN's, EMTs, or nurse practitioners or  medical doctors (either parents with kids in the program or from the community) to help fill the gap.
2. Strongly encourage parents to make sure their child has a pre-participation physical evaluation.  In his presentation to the Grand Prairie parents, Dr. Jim McDonald, a pediatric sports medicine medical doctor at Nationwide Children's Hospital and  Ohio State, encouraged them to make sure their child had a pre-participation physical examination, including the taking of detailed cardiac and concussion histories, even though a PPE is usually not required for participation in community-based sports.  Experts agree that a PPE is the primary means of identifying athletes at risk of sports injury and initiating preventative measures.
3. Teaches  proper tackling and limit player-to-player contact during practices. As I did in 2012 while I was working with the high school football program in Newcastle, Oklahoma during the filming of my PBS documentary, The Smartest Team: Making High School Football Safer, I flew in Coach Bobby Hosea, the inventor of a revolutionary heads-free tackle training system now being used at all levels of the game, to teach safe tackling to the Grand Prairie players.  To the naysayers who believe teaching kids to tackle without using their heads, or that sensible limits on full-contact practices at the youth level, can't make the game safer, a new study in the Orthopaedic Journal of Sports Medicine shows that they can significantly reduce the number of concussions, not just in practices (where, in contrast to other levels of football, most concussions occur at the youth level), but also in games. 
4. Makes sure that all helmets fit properly, and that used helmets have been properly reconditioned. An important part of my week in Grand Prairie, as was the case in 2012 in Newcastle, was a helmet fitting session in which an expert made sure that every player in the Grand Prairie youth football program started the pre-season with a properly fitted helmet and reminded coaches to check helmet fit periodically during the season.  I also made sure that all helmets were reconditioned prior to the season in accordance with the helmet manufacturers' recommendations, and also supplied thirty of the younger, smaller players with brand new, lightweight helmets to  evaluate  (citing a lack of data, the National Operating Committee on Standards for Athletic Equipment ("Nocsae") said in June 2015 that it had no current plans to issue a separate performance standard for youth football helmets; look for a future blog on that subject).
5. Requires safety training. Most youth sports coaches are parent volunteers with little or no safety training.  To fill that safety gap, I arranged for an instructor from the local chapter of the Red Cross to hold training sessions for Grand Prairie parents and coaches in first-aid, CPR and the use of an AED. 
6. Mandates comprehensive concussion education.  As I discussed in a previous blog, state laws requiring concussion education do not always cover community- based and independent sports programs.  I encouraged parents and coaches to take the free 30-minute online CDC Heads Up Concussion training courses, which MomsTeam Institute has endorsed. As a longtime advocate for mandatory concussion education meetings before every sports season, I walked the talk by flying in from Chicago a top sports concussion neuropsychologist. Dr Elizabeth Pieroth, to talk to the Grand Prairie parents and coaches about concussions, not just knowing the signs and symptoms but the importance of creating an environment in which players feel safe in reporting concussion symptoms to increase the likelihood that they will be immediately removed from games and practices.
7. Has adopted conservative return to play guidelines.  As required by law in every state for school-based sports, independent and community-based programs should require players to obtain written clearance by a medical professional with concussion training and expertise before returning to play.  Many experts recommend that, because their brains are still developing, younger players should be held out of play longer than older athletes, some suggesting a minimum of three weeks after a concussion before returning to sports.
8. Regularly inspects practice and game facilities. All programs should designate a parent or coach to regularly inspect practice and game facilities to make sure they are safe, including the cleaning of locker rooms to minimize the risk of communicable diseases (such as community-acquired MRSA.  Athletes, parents, and officials should be encouraged to immediately report any unsafe conditions.
9. Conducts detailed background checks of all volunteers and paid staff. It is every parent's nightmare that their child might be a victim of a sexual predator while participating in youth sports. Unfortunately sexual abuse of young players has occurred in youth sports leagues of all kinds, as well as with individual coaches in individual youth sports.  Performing background checks on all volunteers is a powerful tool for protecting each player in your league. This safety measure is so important it needs to be required in all youth sports leagues.
10. Follows the International Safeguards for Children in Sport. Adopted at the Beyond Sport summit in South Africa in 2014, the Safeguards are designed to help create a safe sporting environment for children wherever they participate and at whatever level, provide a benchmark to assist youth sports organizations and sports stakeholders to make informed decisions about safety, promote best practices and challenge practices that are harmful to children, and provide clarity on safeguarding children to all involved in sport.  As the head of a pioneer organization designated by UNICEF UK to help implement the Safeguards in the U.S, I will be working with the Board of Directors of the Grand Prairie youth football and cheer program on an ongoing basis to implement the holistic and process-oriented approach to youth sport safety the Safeguards recommend. 

I firmly believe that the best way to protect our children in sports is for an independent non-profit serving the interests of all youth sports stakeholders, not any special interest or group, to develop a program, such as we are doing with SmartTeams^TM,  free to incorporate best practice recommendations from a wide variety of sources, including UNICEF, leading medical societies, and governmental agencies such as the CDC, adapted, where appropriate, for use by youth sports programs that lack the resources of school-based programs.

If more sports programs, like Grand Prairie, were to implement these kinds of safety measures, I am convinced that the safety concerns of parents would be assuaged and the decline in youth sports participation could be stemmed, even reversed.

During the next few weeks I will have more to say about youth sports best safety practices and what weare doing with SmartTeams , but, in the meantime, remember that to play safe, we need to be smart!

Note: This blog was first published on Huffington Post 

On July 12, UNICEF's Innocenti Research Center in Florence, Italy released an important report on violence against children in sport in industrialized countries, including the United States.

The report found a troubling lack of awareness of and education on child protection issues among youth sports coaches, parents, and other stakeholders. To combat the problem it recommends improvements in data collection and knowledge generation about violence to children in sport, development of structures and systems for eliminating and preventing such violence (including promotion of ethical guidelines and codes of conduct), and education, awareness-raising and training.

Yet the UNICEF report received absolutely no media attention in this country. Nada. Zippo. Zilch. Zero.

Which begs the inevitable question: Why not?

It can't be because children playing sports in this country are immune from violence, because they are not. It's just that the violence either isn't reported or makes it in to the local or national news only in the most egregious cases. The sad fact is that youth athletes are victims of violence in its myriad forms every day: forced to participate in physically injurious or sexually degrading initiation rituals (e.g. hazing), required to run extra laps in 90 degree heat for being late to practice, allowed to return to the playing field too soon after a concussion, sexually assaulted by coaches (as alleged in a new lawsuit by a former elite swimmer that was the subject of a long article in USA Today), psychologically degraded or humiliated based on gender, body shape or performance, or required to follow nutrition and weight loss regimes that lead to eating disorders such as anexoria or other health problems.

The lack of media attention can't be because youth sports organizations, whether they be at the national, regional or local level, are doing all they can to protect children against such violence. As the UNICEF study reports, while some other countries (most notably, the United Kingdom) have enacted child protection programs in sport, they are virtually non-existent in the United States.

Scott Blackmun, C.E.O. of the U.S. Olympic Committee, admitted to USA Today that it was only as a result of the recent lawsuits against USA Swimming and club-level coaches (at least five are pending), that officials somehow finally became "sensitized ... to the fact that they may have issues in their own sport that they didn't know about or didn't think about in the past."

Come on, Scott! The fact of the matter is  that the problem of sexual abuse of athletes in this country has existed in the shadows but largely swept under the rug for decades.

It is "beyond shocking," said the lawyer for 28-year old Jancy Thompson, the plaintiff in a lawsuit alleging abuse by her former coach at a Northern California swim club over a five-year period beginning when she was fifteen, that USA Swimming did not have better protection, reporting or response procedures in place before now.

"It's mind boggling to me," said Robert Allard. "The more I look into this, the more appalled I am that little, if anything, has been done to protect children."  Critics claim that even child-protection policies which have been adopted - such as the one passed by USA Swimming's board in 2004 - have not been fully implemented.

I couldn't agree more.

Children first, athletes second

A major part of the problem, in my view, is that instead of defining youth athletes in a way appropriate to their needs - as children first and athletes second - organized youth sports in the United States and other industrialized countries all too often treat children with exceptional athletic potential as adults, with potentially serious adverse consequences to their physical and emotional health.

The United Nations Convention on the Rights of the Child - which only the United States and Somalia have failed to ratify - spells out the basic human rights that children everywhere should enjoy, among them the right to survival, to develop to the fullest, and to protection from harmful influences, abuse and exploitation. The UNICEF report views the Convention as providing "the overarching framework that can guide those who provide and supervise sport for children."

While some Olympic sports organization have started to take action, it is up to each sport organization to putting safeguards in place, when what is needed is a coordinated, national effort to stop the abuse.

The recommendations of the UNICEF study deserve serious consideration. The report should be required reading for every member of every board of directors of every national youth sports organization in this country. Unless and until all the stakeholders in youth sports - coaches, parents, administrators, athletic directors, and the athletes themselves - recognize that violence and abuse in sports is a problem, it will continue to be yesterday's news.

Brooke de Lench is Founding Executive Director of MomsTEAM Institute, Inc., Director of Smart Teams Play Safe, Publisher of MomsTEAM.com, author of Home Team Advantage: The Critical Role of Mothers in Youth Sports (HarperCollins), and Producer/Director/Creator of the PBS documentary, "The Smartest Team: Making High School Football Safer." Brooke is also a founding member of the UN International Safeguards of Children in Sports coalition.

She can be reached by email delench@MomsTeam.com, and you can follow her on Twitter @brookedelench.  

NOTE: This article is from an earlier  blog, yet remains important.

Earlier this spring  I had the honor of being invited to speak at the "Safe to Compete: Protecting Child Athletes from Sexual Abuse" summit in Washington, DC, sponsored by the National Center for Missing and Exploited Children and the Cal Ripken, Sr. Foundation.  

The summit brought together over fifty of the nation's largest youth-serving and youth-sports organizations, as well as child development, youth sports and prevention experts, to discuss strategies for protecting children from sexual abuse while playing sports.

Unfortunately, like many of the speakers, much of my contact with parents on the issue of sexual abuse in sports has been after their children have been victimized, but all of us also work with school boards and national sports organizations to enact policies designed to prevent such abuse from occurring in the first place.

A crowded police blotter 

The need to redouble our prevention efforts has been driven home over the past couple of weeks, which has seen a sharp spike in reports in the media about youth sports coaches accused and convicted of, and sentenced to probation or jail for sex crimes against young athletes, from sending them inappropriate text messages and emails to sexual assault and statutory rape.  

The first was a story in the May 23, 2013 Washington Post reporting on a 7-year sentence handed down against a prominent ex-swimming coach, Rick Curl, who plead guilty in February to one count of child sexual abuse.  It is a story MomsTEAM had been following closely since last summer.

A host of stories of alleged sexual abuse by youth sports coaches soon followed in rapid succession:

• May 30: a Sacremento-area youth basketball coach, Troy Hensley, is arrested for allegedly carrying on a 3 and 1/2 month sexual relationship with a 17-year-old girl; 
• June 4: a 30-year old Mississippi high school Spanish teacher and soccer coach, Marco Suarez, is arrested for having sex with a female student who had allegedly come to his house at an invitation he sent via text message and Facebook;
• June 5: At least six separate incidents of alleged sexual abuse by coaches make the news:  
  • a Gastonia (NC) teacher and wrestling coach is charged with fifteen felony counts of child sex crimes spanning the five-year period from 1999 to 2004; 
  • a former Corvallis (OR) cheerleading coach, David Chatman, 38, pleads guilty  to a charge of second-degree sexual abuse for having sex at his apartment with an underage student rendered unconscious by a presciption medicine she had been taking (the worst thing about this one is that Chatman was already a registered sex offender after being convicted of touching a sleeping 16-year-old cheerleader on an airplane in 2007 while he was the head coach for an all-star cheerleading team on its way home from a competition on the East Coast);
  • A former Viera High School (FL) assistant football coach is sentenced to three years probation after pleading guilty to three misdemeanor counts of contributing to the delinquency or dependency of a minor for sending questionable text messages and emails to a female student last year.
  • A Gastonia (NC) science teacher and wrestling coach is arrested on 14 felony counts of indecent liberties, six with a student, and eight with a child, and one felony county of statutory rape of a minor 6 years of age or older which allegedly took place between May 1, 1999 and June 15, 2004.
    
  • A 41-year-old Orange County (FL) boxing coach, James Lyons, is arrested after a 17-year-old girl he was teaching to box said he forced her to have sex with him on four separate occasions.  The victim's mother told Orange County Sheriff's deputies that she "felt like Lyons was a father figure." The victim has been training with Lyons for four years about six times a week. She started meeting Lyons at his home to conduct video training lessons to prepare for a match this summer and that's where they had sex, the report said.
    
  • A Harpeth Hall (TN) middle school soccer coach, George "Rico" Laise, 46, is arrested on two counts of statutory rape by an authority figure and two counts of rape involving a victim with a mental incapacity stemming from charges that he had an unlawful sexual relationship with an underage student suffering from the results of a concussion suffered in 2012 at a tournament in Las Vegas while playing on a travel soccer team he coached. Police say the girl, who was 16 at the time, Laise began having sexual conversations her after the concussion. That March, she later told police, their sexual relationship began, which lasted through April of this year and occurred mostly at his home, while she was still suffering from the concussion; and
  • An inquest in the United Kingdom into the February death of  popular athletics coach learns that he killed himself three days after he was arrested on suspicion of engaging in sexual activity with a child.

What explains this sudden rash of news reports of sexual abuse of young athletes? Is it that our children are more willing to report such crimes, the vast majority of which go unreported? Is it that parents are getting better at identifying some of the warning signs of sexual abuse? I would like to think that both are at least partially responsible. 

One thing of which I am sure is that a number of national organizations, including the National Center for Missing and Exploited Children and the United States Olympic Committee, are taking leadership roles in this area by implementing new programs specifically targeting sexual abuse by coaches of young athletes, the NCMEC with its Safe to Compete program, and the USOC with its Safe Sport initiative.

Former elite athletes speak up and out 

Another promising development is that more and more elite athletes are joining the fight against sexual abuse in sports.  At the summit in March I  spent time with three former elite athletes who are standing up against sexual abuse, each of whom added to my knowledge of sexual abuse and the havoc it creates.

Former NFL defensive lineman Joe Ehrmann is an inspirational dynamic speaker who only recently began publicly speaking about his abuse. He told me that after more than fifty years since he was abused, "I want to make sure this ends and that no other child has to go through the hell I went through. At my age it just doesn't make sense to keep it a secret." 

Another high profile athlete who speaks bravely about his own abuse is former NHL player Sheldon Kennedy (pictured with Ehrmann at right). Sheldon is known for his courageous decision to charge his Major Junior Hockey league coach with sexual assault for the abuse he suffered over a five year period while a teenager under his care.  As the co-founder of the Canadian group Respect Group, Inc., Kennedy's focus is on empowering people to recognize and prevent abuse, bullying and harassment in sports and schools through interactive, online certification. 

After the first day of the summit, I took a long walk with Katherine Starr, a former member of the British Olympic swimming team for the 1984 and '88 Summer Games, during which I learned just how much the sexual abuse to which she was subjected as a teenager continues to seep into everything she does in life. Little things - like when a new acquaintance innocently touches her shoulder or arm - still evoke an immediate and visceral negative reaction.  To help fellow abuse victims, Katherine has established a non-profit organization, Safe4Athletes, to advocate for a safe and positive environment for all athletes free of sexual abuse, bullying and harassment. (that's me with Katherine in the picture at right)

I strongly encourage you as a parent to visit each of these websites to which I have linked in this blog, and consider inviting Joe, Kathleen or Sheldon to come to speak to the youth sports organizations in your community. The best way to prevent abuse is to be proactive, to become educated.  There are ways to reduce sexual abuse by coaches.  It takes commitment from every stakeholder: parents, athletes, coaches, administrators, and national organizations such as NCMEC and the USOC.  Together we can make a difference in the lives of children so that they don't end up scarred for life like Kathleen, Joe, Sheldon and the victims of the abusers in the horrible stories that have made the past few weeks so difficult.

Related articles and resources:

Some of my recent blogs on sexual abuse: 

Warning Signs of Sexual Abuse by Coach of Child

Penn State Sex Abuse Scandal: What Happens When Media Spotlight Fades?

For more prevention tips, visit Sexual Abuse Center on MomsTEAM's Health & Safety Channel.

Other resources: 

To download the NCMEC's Safe To Compete materials, click here. 

To join the USOC's 12-month safe sport campaign, Make the Committment: Stop Abuse in Sport, click here. 

To visit Katherine Starr's excellent website, Safe4Athletes.org, click here. 

If the book seems to be losing steam at this point, Kutcher and Gerstner end it on a high note, returning one last time to a discussion of the outsized influence the media has had, and continues to play, in the messaging about concussion.

Regardless of whether the early sports concussion landscape is seen as being defined by the 2008 New York Times article headlined, "Dementia Risk Seen in Players in NFL Study", as Kutcher and Gerstner argue, or the 2007 Times article, "Expert Ties Ex-Player's Suicide To Brain Damage," as Jean Marie Laskas argues in her outstanding book, Concussion, the influence of messaging in the discussion about head injuries in sports is a constant.

The reality, as they point out, is that the "multitude of voices across the different media formats, speaking about sports and concussion, whether it is a sports fan with no medical knowledge on Twitter, a former NFL player doing color commentary on ESPN, a sportswriter with Sports Illustrated, or even a TMZ tabloid reporter, all lend to a confusing cacophony. But the idea is always the same: driving traffic, gaining a following, and if a business, making money."

The result, unfortunately, is that alleged "truths" are established - whether it be that playing football causes dementia or causes CTE, or that CTE causes players to commit suicide - which are not, at least not yet, supported by actual science in peer-reviewed studies or published in the medical literature. Instead, they are "supported" (if that's even the right word) by something much less reliable, in the case of the 2008 Times article, by a phone survey commissioned by the NFL.

As Kutcher correctly observes, "whether in the media or in the political process, medical science very typically does not make for good storytelling. ... There must be a highly charged and emotional narrative attached to any research or science for it to significantly capture the public's attention." The problem in the case of sports and brain trauma is that, as I know all too well, the public has been mostly been hearing the last decade, not from respected scientists like Kutcher, but from those who have the "loudest megaphones and get in front of the most cameras." That they have little scientific knowledge or training, whether their message is based on facts or not, has, as he points out, often been beside the point: when they "take to social media in force to put out their ideas - mostly unchallenged- about their own personal conclusions" the result is "critical thought takes a backseat while emotional narratives play the starring role."

As distressing as this all may be, and despite the troubling concussion = dementia narrative that has gained so much traction in recent years from anecdotal reports spread in the media without any context, Kutcher isn't giving up hope that, somehow, the public will come to understand that just because something is in print or broadcast doesn't make it the truth, and that journalists themselves will begin to "question assumptions, [and] dig a little harder to understand the more difficult concepts," so as to be able to "craft a clear and nuanced message for public consumption." I would like to share Kutcher's optimism, but, after so many years fighting the battle for truthful, objective reporting about head injuries in sports, I'm afraid I'm not as sanguine about the chances of that ever happening.

In the meantime, though, one thing is clear: thoughtful, informative, factually accurate books like Back in the Game, books which help all those with a stake in sports to carefully assess the risks of sports against its benefits; books which see critical thought and a comprehensive approach as the keys to maximizing brain health over a lifetime, books which see it as a responsibility which all sports stakeholders must share as a team, will always have a honored place on my bookshelf.