The violent consequences of American football's concussion crisis run deeper—and younger—than expected.
Published in the Annals of Neurology, the study examined the brains of 246 tackle football players, 211 of which were diagnosed with chronic traumatic encephalopathy (CTE), the degenerative brain disease tied to long-term gameplay associated with team organizations like the National Football League. While age of exposure didn't change the severity of each player's CTE pathology, it did affect the timing: According to the study, playing tackle football before age 12 "predicted earlier cognitive and behavioral/mood symptom onset by 13.39 and 13.28 years, respectively."
The results corroborate the researchers' earlier findings on the impact of youth football on the long-term behavioral health of players: A previous survey of 214 living former football players published in Nature's Translational Psychiatry in September of 2017 revealed that picking the game up before the age of 12 "corresponded with worse behavioral regulation, depression, apathy and executive function." The earlier the body plays, the earlier the brain pays.
"Youth exposure to repetitive head impacts in tackle football may reduce one's resiliency to brain diseases later in life, including, but not limited to, CTE," Ann McKee, that study's co-author and the director of Boston University's CTE Center, told USA Today. "It makes common sense that children, whose brains are rapidly developing, should not be hitting their heads hundreds of times per season."
The new research is alarming not simply because it presents an apparent connection between observable neurobiological and behavioral problems, but because of what a former player burdened with those problems can actually look like.
Days after her 2017 research on youth football and behavioral problems appeared in Nature's Translational Psychiatry, McKee announced that Aaron Hernandez—the former New England Patriots tight end who committed suicide in prison after being found guilty of first-degree murder in April of 2015—suffered from a "severe" case of CTE at the time of his death. McKee's diagnosis appeared to offer something of a "CTE defense"; after years associated primarily with memory loss and mood swings, football-related CTE could now be linked to the violence that's marred the league for years.
It's not hard to read between the lines here: Tackle football in childhood, the research suggests, can lead to violence and instability in adulthood. At what point, then, does youth football rise to the level of public-health crisis? Consider, as a point of comparison, the issue of childhood poverty: Some public-health advocates have made the case that the adverse childhood experiences that accompany poverty or social instability can lead to long-term neurological deficits that keep kids locked in a near-permanent cycle of crime and punishment. Identifying childhood poverty as a public-health crisis necessitates a public-policy response; the same logic would apply to tackle football.
There are certainly existing mechanisms designed to help mitigate concussion-related issues: A July of 2015 analysis in the Journal of Law and the Biosciences notes that limiting contact practices and "high-risk formations" and disincentivizing aggressive helmet-to-helmet contact have been a feature of professional leagues for years. Indeed, it's been nearly a decade since the tragic brain injuries endured by middle school football player Zackery Lystedt spurred legislation on handling youth concussions during organized sports. When it comes to mandatory helmets, according to the Law and Biosciences study, "their salutary effect on public health is unquestioned."
But McKee's latest study will likely heighten the alarm for both lawmakers and parents. While a 2014 NPR poll found that Americans overwhelmingly supported high school football, more recent surveys find parents increasingly funneling their children toward different sports out of fear of long-term damage.
This wave of concern may prove the opportune the time for advocates to strike. Indeed, they already have: In February, the California state assembly members proposed legislation that would ban participation in organized tackle football leagues before high school; in March, an Illinois lawmaker proposed a similar age limit on tackle football.
Whether these bans are viable or enforceable on a nationwide scale remains to be seen. But one thing is clear: The growing body of research indicates that America's love of youth football is headed for a reckoning, whether the country is ready or not.