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Brain damage and football: what parents should know
Young players tackle Pee Wee football game at Big Bear Park in Sandy in October 2009. With professional football players willing to walk away from millions of dollars in income because they fear football's long-term effects, parents of children getting ready to suit up for the fall season may be considering pulling their children out of school and community programs. - photo by Jennifer Graham
The quarterback of the Pittsburgh Steelers is questioning whether he should continue to play football and a Baltimore Ravens lineman has already quit after the publication of a new study that showed brain damage in 110 out of 111 deceased NFL players.

The study, published July 25 in the Journal of the American Medical Association, has been construed by some analysts as the death rattle of football. "Could football ever end?" a columnist in The Wall Street Journal asked, while Forbes headlined an article on the research "The CTE study that could kill football."

With professional football players willing to walk away from millions of dollars in income because they fear football's long-term effects, parents of children getting ready to suit up for the fall season may be considering pulling their children out of school and community programs.

But is an occasional concussion in high school as worrisome as the decades of violent hits that professional football players endure? Another recent study suggests not.

In that study, also published in July in the same medical journal, researchers found no risk of later cognitive problems or depression among Wisconsin men who had played football in high school in the 1950s. Those findings may reassure parents, although the researchers acknowledge that football in the 1950s was different from football as it is played today.

Also, some analysts have said the findings of the study of deceased NFL players were skewed and overhyped because most of the brains were donated by families who were worried about brain damage while the men were alive.

In other words, we shouldn't necessarily be shocked that 110 men who had shown signs of cognitive decline had brains that appeared to be devoured by chronic traumatic encephalopathy, also known as CTE.

As striking as the pictures are, they don't prove that every NFL player faces the same fate, let alone everyone who plays football in high school or in a community youth league. But there are other reasons to worry.

Here's what we know about the latest research on football and its implications for the youngest football players.

What CTE does

Football has always carried the risk of physical injury, but it wasnt until 2002 that it was first implicated in chronic traumatic encephalopathy, a degenerative condition first identified in the 1920s. CTE can cause problems in thinking, regulation of emotions, and other physical problems, according to the Centers for Disease Control and Prevention. Like Alzheimer's disease, it can only be definitively diagnosed after death.

Dr. Bennet Omalu diagnosed CTE in Mike Webster, the former Pittsburgh Steelers center who died of a heart attack in 2002 at age 50. Their story was told in the movie Concussion, in which Will Smith played Omalu, and in the book League of Denial.

For years, the NFL would not acknowledge any link between professional football and brain damage, but a senior NFL official conceded the connection at a congressional meeting on concussions in 2016.

The official, Jeff Miller, the NFL's senior vice president for health and safety, said he was convinced by the work of Dr. Ann McKee, a Boston University neurologist and neuropathologist, who has studied the brains of former NFL players.

McKee is also one of the authors of the study published last month.

In that study, McKee and other researchers examined the brains of 202 deceased former football players, and interviewed relatives to compile histories of the players football careers, military service and known head trauma.

The median age at death was 66, and they averaged 15 years of playing football.

CTE was diagnosed post-mortem in 177 players, or 87 percent, a figure that McKee said researchers found shockingly high.

The greatest incidence and severity was found among the 110 NFL players in the study. CTE was also found in the majority of men who played football after high school. It was present in 48 of 53 college players (91 percent); 9 of 14 semi-professional players (64 percent); and 7 of 8 Canadian Football League players.

And in what may or may not be a relief for parents, it was least prevalent in men who had only played football in high school. Three of 14 high school players, or 21 percent, had CTE, the researchers said, and in those three cases, the symptoms were mild compared to that of the NFL players.

Among the high school players and others diagnosed with mild CTE pathology, 96 percent had behavioral or mood problems; 85 percent had cognitive symptoms, and 33 percent showed signs of dementia.

In contrast, of those with severe cases, 89 percent had behavioral or mood issues, 95 percent had cognitive symptoms, and 85 percent had signs of dementia.

Because many of the brains were donated for study by families who suspected their loved one had CTE, researchers said people should not assume the disease is prevalent in those percentages across all football players.

They also said that the presence and severity of CTE may be affected by other factors, including the amount of play, number of hits, the players position and the age at which the men first started to play football.

Implications for parents

A previous small study, published in the journal Neurology in 2015, found that memory problems were more prevalent in NFL players who first started the sport before age 12.

Only 42 players were part of this research, and all had already experienced some problems with memory and thinking at the time of the study. But the half who had started playing football before age 12 performed 20 percent worse on cognitive tests, the researchers found.

The players who had started earlier in childhood were less able to recall words from a list they had studied 15 minutes earlier, and they made more errors on a test of mental flexibility.

Such studies have caused some parents not only to reconsider whether they will let their sons play football, but also ponder whether it's ethical to even watch a sport in which people may be sustaining long-term damage to their brains.

In mulling the issue, Austin Meek, a sports columnist for the Register-Guard in Eugene, Oregon, noted that most NFL players started football years before they're mature enough to thoughtfully consider the risks. He interviewed one California ethicist who said she's a huge football fan but has decided not to let her 11-year-old son play.

If other mothers are coming to the same conclusion, not only the NFL, but Pop Warner youth leagues may be in trouble. The Los Angeles Times reported Aug. 1 that participation in high school football has declined for the second straight year in California. But even with 3,000 fewer students playing, football still remains the most popular sport for boys, Eric Sondheimer wrote.

Among those most at risk for CTE men who have already been playing professional football for years some say that they will allow their sons to play football later when they are teens, but will restrict them to flag football before then. In flag football, players don't tackle each other, but instead pull off a flag attached to the uniform to stop the other team from advancing.

"It's one of the ways to learn the fundamentals and technique of playing contact football and doing everything right without the contact," Jordy Nelson, a wide receiver for the Green Bay Packers and a father of two, told ESPN.

New England Patriots quarterback Tom Brady, however, has said that he would have no problem with his sons playing football or any other contact sport. "I think contact sports teach you certain levels of discipline that other sports maybe dont teach you. I have no problem with my kids playing football," Brady said in June. He noted, however, that his wife, model Giselle Bundchen, might not agree with him about that.

As for the American Academy of Pediatrics, the leading group of pediatricians said in 2015 that youth football players and their families must decide for themselves whether the benefits of football are worth the risk. The group said delaying tackle football until after age 12 could actually increase the risk of injuries among teens because of their inexperience. It stressed the importance of proper tackling technique and neck-strengthening programs.

Ironically, this was a departure from the group's position in the 1950s, when it said that tackle football, like boxing and hockey, "had no place" for children 12 and younger.

While making a decision about football, parents should also keep in mind that all sports carry some risks. In fact, among adults, it's horseback riding that accounts for the greatest number of emergency room visits for head injuries, according to an analysis of ER visits between 2003 and 2012.

Among children, however, football is the No. 1 cause of ER visits for boys; for girls, it's soccer.
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