other appropriately designed studies on the management of concussion and on post-concussion syndrome in youth are needed in order to develop empirically based clinical guidelines, including studies to determine the efficacy of physical and cognitive rest following concussion, the optimal period of rest, and the best protocol for returning individuals to full physical activity as well as to inform the development of evidence-based protocols and appropriate accommodations for students returning to school. Prospective studies to delineate individual differences in concussion symptomatology and course as well as the predictors of recovery and persistence in children and adolescents with sports-related concussions are also needed in order to identify individuals who are likely to have persistent symptoms and therefore to be in need of intervention.

Recommendation 2. The National Institutes of Health and the Department of Defense should support research to (1) establish objective, sensitive, and specific metrics and markers of concussion diagnosis, prognosis, and recovery in youth and (2) inform the creation of age-specific, evidence-based guidelines for the management of short- and long-term sequelae of concussion in youth.


  • Epidemiological studies of the neurocognitive effects of repetitive head impacts (i.e., head impacts that do not result in symptoms of concussion) and multiple concussions in high school and collegiate athletes have had mixed results, and many are limited by small sample sizes and methodological weaknesses. There are limited data from imaging research indicating that repetitive head impacts result in changes to the integrity of brain white matter. Research involving retired professional football players provides preliminary evidence of a positive association between the number of concussions an athlete has sustained and the risk of depression; however, data on the relationship between the number of concussions and the risk of suicide are not available. Whether repetitive head impacts and multiple concussions sustained in youth increases the risk for long-term neurodegenerative diseases, such as chronic traumatic encephalopathy (CTE) and Alzheimer’s disease, remains unclear. Additional research is needed to determine whether CTE represents a distinct disease entity or is part of a spectrum of disease manifestations that share a common finding of tau pathology, as well as to identify biomarkers for the in vivo diagnosis of CTE

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