Understanding the neurodevelopmental effects of youth tackle football participation

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ABSTRACT Potential long-term effects of tackle football and other contact sports have created significant public health concerns about the risk of childhood participation. Considering the retrospective and cross-sectional nature of prior work, there are critical knowledge gaps regarding the causality of youth tackle football participation and subsequent clinical outcomes that preclude decision-making at the patient and policy level. Further, modifiable risk factors (e.g., neuromuscular control) may influence exposure to and thus, outcomes from football-related neurotrauma, but prevention remains understudied. Here we overcome some of the previous barriers to progress in this field by acquiring a “true baseline” for athletes before they begin their first season of tackle football and following them longitudinally across the first year of participation. We received funding from Ohio State’s Chronic Brain Injury Program and successfully collected pilot data on 50 youth tackle football players (ages 8-12 years); these data form the basis of our current proposal. Aim 1 will identify risk factors for higher exposure to football- related neurotrauma. We will measure football-related neurotrauma exposure in first-year youth tackle football players during all practices and games using instrumented mouthguards. We will use handheld dynamometry to measure neck strength and will measure neuromuscular control through visual, vestibular, and reaction time testing. Aim 2 will determine the effects of football-related neurotrauma exposure on neurodevelopment in children with no previous tackle football exposure. We will enroll children who are registered for, but have not yet begun participating in youth tackle football, as well as children registered for non-contact sports and children not playing any sports. Aim 2a will determine short-term changes in cognitive function and brain structure and function caused by football-related neurotrauma exposure from pre-season to post-season. Aim 2b will determine longer-term changes across the first year of participation by examining players during the off-season just prior to the start of the next season. Aim 2c will determine what factors (e.g., football-related neurotrauma exposure, exposure to adverse childhood events, pre-existing neurodevelopmental disorders) contribute to differences from typical development. We hypothesize that youth tackle football exposes children to repetitive neurotrauma during a period of rapid neurodevelopment, resulting in observable cognitive impairments and structural and functional changes in the brain, most likely in attentional control networks. Our proposal combines a state-of-the-art approach to determining the effects of football-related neurotrauma on neurodevelopment, a productive collaboration with youth sports programs in Ohio, community engagement and outreach, and a multidisciplinary team of experts. The societal and clinical impact of these findings cannot be overstated. In quantifying football-related neurotrauma exposure (Aim 1) and its effects on neurodevelopment (Aim 2) across the first year of youth tackle football participation, our expected outcomes will inform community stakeholders and policy-makers in their appraisal of the cost and benefit of children participating in youth tackle football.