In-Depth Discussion of Concussions In The Age Of Twitter: Is It Possible?

One of my biggest gripes about the media in the age of Twitter and ever-shorter attention spans is that it doesn't lend itself well to an examination of issues in the depth they deserve.  

Recently, I was asked a series of questions by a newspaper journalist for a story on a concussed athlete who had decided to quit football despite being cleared by the team doctor to return to play.

Even though I knew that 95% of what I said in my emailed response would never make it into the story, I nevertheless spent the time formulating thoughtful responses, hoping that at least some of what I offered would avoid the cutting room floor.

I was wrong.

Here, for those of you out there who are interested in the full responses (with links for further reading) are the questions I was asked and the answers I gave: 

Question:  The player I'm writing about made the decision to quit football (even though a team doctor said he could still be cleared to return) due largely to the emotional and mental effects (rather than the physical ones) the concussion had on him. He found himself dealing with depression and struggling with his studies. How common is it for concussion sufferers to deal with such issues? Is this a part of concussion treatment that often goes overlooked in sports?

Answer: Depression is common after concussion, especially when the symptoms of concussion linger, but clinicians say it is often difficult to determine whether such depression is pathological or psychological. A 2013 study by researchers at the University of Washington also found that a history of concussion in teens was linked with a 3-fold increase in risk of depression. I'm not a psychologist, of course, so I'm not in a position to say how depression in a concussed athlete should be treated, but I do note that some experts criticize the symptom scales currently in use because some of the symptoms attributed to concussion, such as depression, can be the result of non-brain related conditions that were present before the athlete suffered his/her concussion. A 2014 study in the journal Pediatrics, for instance, found that some children and adolescents who continue to report symptoms weeks and months after suffering a concussion may be exaggerating or feigning symptoms in order to get out of schoolwork or sports, or for other reasons unrelated to their injury (a phenomenon called "secondary gain"), including underlying depression.  As Dr. Rosemarie Moser points out in that article, neuropsychologists "know that whenever symptoms do not improve and the recovery period is longer than expected, the possibility of emotional/psychological factors affecting symptoms should be considered."

Question: What role can or should a coach play in assisting a player in dealing with concussions -- both from a mental/psychological and physical standpoint?

Answer: Like the athlete's parents, treating physician, and athletic trainer, a coach should make sure the athlete understands that he or she should not try to rush back to play before they are symptom-free, and that he or she has not only completed the program of gradually increased exercise experts recommend without symptoms returning, but is psychologically ready. Coaches need create an environment in which athletes feel safe, not only in reporting concussion symptoms so that they can be removed from play to minimize the risk of further, potentially catastrophic injury but of a longer recovery, but in which athletes feel safe in telling the coach that they aren't ready to return, either because they are still experiencing physical symptoms or because they aren't ready from a psychological standpoint. In practical terms that means that the coach should never question a player's toughness, masculinity, competitiveness, or attitude, either directly or indirectly because doing so contributes to the prevailing "culture of resistance" to honest concussion symptom reporting by athletes that makes early identification of concussed athletes so difficult. Unfortunately, at least two studies has shown that athletes are not very good at assessing their own readiness to return to play after a concussion. A growing body of evidence suggests that psychological factors play an important role in determining whether an athlete makes a successful return to sport following injury. Clinicians, not the coach, need to take such considerations into account during injury rehabilitation and the period before an athlete returns to competition.  But even if a doctor or athletic trainer has cleared an athlete to return to play, if a coach has any doubt about the athlete's psychological or physical readiness to return to play, he or she should not let him play.

Question: Despite his situation, the player in question has no regrets and said he would encourage his own future children to play football. What kind of advice or counsel do you provide to parents whose children want to play football?

Answer: There is no simple answer to that question, but the most important thing a parent can do in deciding whether to allow their child to play football or any contact or collision sport is become educated: about the risk factors (including whether their child may be at greater risk of injury because of pre-existing neurological conditions, such as ADHD or a history of migraines, about what the program is doing, or not doing, to minimize the risk of concussion or repetitive brain trauma, to identify concussed athletes as quickly as possible, and to make sure they do not return to play before their brains are fully healed. A child may want to play football, but, ultimately, it is up to his or her parents to be ... well ... parents, weighing the individualized risks of participation versus the benefits and deciding whether football, when all of the pluses and minuses are added up, is right for their child.

Question: There's a perception in some places that concussions can only happen at the highest levels of football (NFL, college, competitive high school), and that young children can't hit each other hard enough to cause concussions or other injuries (an NFL QB made a fairly passionate speech to me making this very argument a year ago). Is there truth to that? What risk of concussions is there for children, and contact at a young age have a cumulative effect that could contribute to a player dealing with continued and chronic issues into adulthood? It is a myth that children can't and don't suffer concussions playing youth football or can't and don't hit each other hard enough to cause concussions.

Answer: A pair of studies by researchers at Virginia Tech, one in 2012, the second in 2013, found that young kids playing tackle football do indeed sustain hits just as heavy as high school, college and pro football players, although not as frequently, and that they do get concussed. One recent study of former NFL players found that those who started playing football before age 12 were more cognitively impaired later in life than players who started later, but the scientific literature on the cumulative effect of repetitive brain trauma, and whether children, because their brains are still developing, are at much greater risk, is in its infancy and there is still a lot we simply don't know. The evidence does seem to be clearly pointing in the direction of establishing that cognitive difficulties later in life are dose-related; in other words, that the more hits a player sustains over time, the greater the risk that he or she will suffer some form of early cognitive impairment or, worse, a degenerative neurological condition such as chronic traumatic encephalopathy (CTE). But there are many, many factors, including genetics, use of alcohol, recreational or performance-enhancing drugs, the number of concussions, the way in which they were managed, even playing position, that may affect that risk. Science is a long way from determining if there is a so-called hit count or threshold above which continuing to play a contact or collision sport such as football puts an athlete at substantially increased risk. Until then, caution, not panic, should be the byword.

Brooke de Lench is Executive Director of the MomsTEAM Youth Sports Safety Institute, a 501(c)(3) tax-exempt non-profit youth sports safety education and watchdog organization, Founder and Publisher of (now in its 15th year as a leading source of youth sports health and safety information for parents, coaches, and sports medicine professionals), producer of The Smartest Team: Making High School Football Safer (PBS), and author of Home Team Advantage: The Critical Role of Mothers in Youth Sports (HarperCollins). You can follow Brooke on Twitter @brookedelench. 



Power of the Permit: Improving Youth Sports Safety One Municipality at a Time


If you are involved in a private youth sports program which plays on publicly-owned fields, diamonds, rinks, or courts, or are in local government, you have probably been hearing a lot lately about what is being dubbed the "power of the permit": the authority municipalities and towns around the country are using to condition use of their athletic facilities by private programs on compliance with state concussion safety laws from which they would otherwise be exempt, or, in an increasing number of instances, to fill gaps in their state's law.

Contrary to what you may have been reading, however, the exercise by municipalities of the power of the permit to require private sports programs to comply with state-mandated concussion safety laws, or impose additional conditions beyond those required by state law, isn't an isolated or new phenomenon: it's been a growing trend for years.

I first recognized the power that a municipality has to control the use of its fields two decades ago when I started a new travel soccer program in my hometown and went looking for fields on which the teams could play. I soon learned that permits to the town's fields were given out by the director of the recreation department, whose practice had always been to simply hand over permits for all the town's fields en masse to the established travel soccer program, whose policy of exclusivity and lack of concern for player safety were the very reasons that led me to form my new program.

While my efforts to persuade the Board of Selectmen, the town manager, and the Rec Department director to allocate permits in a more equitable fashion, and to use their power to make sure that the programs using town-owned facilities met minimum standards for inclusiveness and safety, fell on deaf ears (we ended up being forced to use for our home games a dusty field the high school had essentially abandoned), I returned to a discussion of the "power of the venue permit" 10 years later in my 2006 book, Home Team Advantage: The Critical Role of Mothers in Youth Sports, where I suggested that one of the best ways for youth sports parents to improve the safety of privately-run sports programs in their communities was to lobby their elected officials to utilize that power to "reform youth sports by exercising public oversight over the use of taxpayer-funded fields, diamonds, tracks, pools, and courts, [and] deny permits to programs that fail to abide by a [youth sports] charter" covering such topics as background checks, and codes of conduct for coaches, players, and parents.

When I presented the next year in Atlantic City to recreational department directors gathered for the annual meeting of the New Jersey Parks and Recreation Directors' Association, I spoke to the critical role they could play in improving sports safety by proactively exercising the power of the permit to require youth sport coaches to receive more training in first aid, CPR, and the signs and symptoms of a concussion. It wasn't long after the speech that a rec director contacted me about using the Power of the Permit in his town.

All politics is local

Since then, a growing number of communities across the nation have utilized the power of the permit, not just to extend the reach of state concussion laws to private programs utilizing municipally-owned athletic facilities otherwise exempt from coverage (many of the concussion safety laws enacted by the states do not cover non-scholastic sports programs), but to impose additional requirements not mandated by state law. Here are just a few examples: 

  • In May 2011, the Recreation Department in Franklin Lakes, New Jersey became the first municipal recreation department in the area to mandate baseline neurocognitive testing for all athletes 11 and older playing rec football, and announced its intention to eventually extend the requirement to all 3,000 children participating in the borough's sports programs.
  • In March 2012, the Town of Ashland, Massachusettsenacted one of the most comprehensive concussion bylawsI have seen covering programs utilizing town-owned athletic facilities, imposing requirements going well beyond those required under Massachusetts law.
  • In May 2012, the Brookline (MA) Park and Recreation Commission enacteda policysettng standards for the prevention and management of sports-related head injuries for all organized youth sports programs offered by Brookline Recreation and those groups permitted to use its facilities, which, the director of parks and recreation, Lisa Paradis, told me in an interview, did not need the approval of the Board of Selectmen because she closely modeled it on Ashland's policy. The Brookline policy goes further than the Commonwealth's concussion safety law by requiring baseline neurocognitive tests at least once a year, and by requiring that concussed athletes be advised to get rest while symptomatic. A permit holder's failure to comply with the policy could subject the user to permit revocation.
  • In July 2012, two years before Virginia's concussion safety law wasamendedto cover non-interscholastic sports programs utilizing public school athletic facilities, the Town of Christianburg (VA) Parks and Recreation Department enacted its own Youth Sports Concussion Policy. Notably, unlike Virginia's law, the policy expressly empowers game officials to remove athletes from play if they are suspected of having suffered a concussion (a power that I have beenadvocating for many yearsgame officials be given, and a power conferred on game officials by laws at the state level in only 12 states, and by rule at the high school level by the National Federation of State High School Associations), and requires that coaches who disregard the safety and well being of a youth sports participant as it related to concussions be subject to indefinite suspension (only Pennsylvania and Connecticut have laws which penalize coaches for violating their statutes)
  • Most recently, in May 2015, the City of Norwalk, Connecticut enacted an ordinance requiring private sports programs using municipal facilities to comply with a comprehensive concussion risk management program, including a requirement that all coaches take a concussion education course, a requirement absent from Connecticut's concussion safety law, more concussion education of parents and athletes, including an oral presentation (I have been advocating for such concussion education meetings to be held before each sport season for the past fifteen years), and requiring that a concussed athlete complete the six-step exercise protocol recommended by most concussion experts before receiving written clearance to play (only a handful of state laws, including California's, expressly make this a requirement).

Filling gaps

As these local ordinances illustrate, even if private sports programs are covered by the state's concussion safety law, such laws often do not go far enough. For instance, many do not require that coaches receive training in recognizing the signs and symptoms of concussion, or require that parents be notified when their child is suspected of having suffered a concussion, and few penalize those who violate their provisions.

Especially at the youth level, where trained medical personnel such as certified athletic trainers are much less likely to be at games, and even less likely to be at practices, it is coaches and game officials who will most often have to make the initial remove-from-play decision in cases of suspected concussion. If no concussion education of coaches is required by state law, and if game officials are not empowered to remove athletes, I believe it is up to the municipality to use the power of the permit to mandate such training and confer such authority.

Even if a state's concussion safety law does cover community-based, private sports programs, very few states have enacted laws that cover all aspects of youth sports safety, such as requiring more broad-based safety training for coaches in first-aid, CPR, and the use of an AED, and the development and implementation of an Emergency Action Plan (EAP) to be triggered in case of medical emergencies, such as a cardiac event (e.g. sudden cardiac arrest), asthma attack, allergic reaction to a bee sting, or heat stroke, and environmental emergencies (lighting, tornado, or an excessively high heat index).

As a result, even if a private sports program that uses town fields, rinks, diamonds, or courts is required to comply with state mandates regarding concussion safety, I believe that there is a huge sports safety gap which, absent voluntary implementation by a private sports program of youth sports health and safety best practices, such as those we are pilot testing in Grand Prairie, Texas this fall as part of our SmartTeamsTM program, can and should be filled by a municipality by exercising its power of the permit.

"Safety Champions" Needed

As with legislation at every level of government, successful utilization of the power of the permit depends not so much on concerned citizens committed to making youth sports in their local community safer (although they are, of course, important) as on the willingness of governmental officials themselves to sponsor bylaw changes and push for enactment, in other words, to serve as "safety champions."

In the case of Norwalk, Connecticut, for instance, it was Diane Beltz-Jacobson, Assistant Corporation Counsel for the City, who, once a concerned mother brought the issue to the attention of governmental officials, spearheaded the effort which led to adoption of a concussion safety ordinance by the city. "Since my own son had just sustained a concussion and I was aware that there is a gap in the state laws that protect our youth athletes, I was motivated to draft the bylaw," Beltz-Jacobson told me in an interview, a bylaw which she modeled on the Brookline bylaw with her own enhancements. "Once I finished it and presented it to the common council, they took a number of passes to strengthen before they ultimately approved it."

For more on the Power of the Permit, including a video of a presentation by Professor Doug Abrams of the University of Missouri School of Law at a youth sports safety summit MomsTEAM Institute convened at Harvard Medical School in September 2014, click here.

Has your community used the Power of the Permit to make youth sports safer in your community? We want to know about it! Send your information to 

Brooke de Lench is Founding Executive Director of MomsTEAM Institute of Youth Sports Safety, Founder and Publisher of, producer of The Smartest Team: Making High School Football Safer, and author of Home Team Advantage: The Critical Role of Mothers in Youth Sports (HarperCollins).  You can follow Brooke on Twitter @brookedelench.

Note: This blog was originally published on Huffington Post on July 20, 2015. 



King-Devick Test: MomsTEAM Has Championed From The Start

In a  March 11, 2015  "Well" blog  New York Times health reporter, Gretchen Reynolds, reported on a new study by NYU researchers, including Laura Balcer, a member of MomsTEAM Institute's Board of Advisors, about the use of a simple, rapid, and inexpensive visual test called King-Devick as a sideline screen to help identify athletes as young as five with possible concussion so they can be immediately removed from play.

It was nice to see Ms. Reynolds jump on the K-D bandwagon, and especially gratifying because MomsTEAM has been reporting on and charting the progress of K-D since the very first 2011 study by Dr. Balcer - then at the University of Pennsylvania - of MMA (mixed martial arts) fighters showed that the test had promise in rapidly identifying athletes with concussion.*

Damon Glass administering King-Devick test

Every single K-D study conducted since then, a number by Dr. Balcer and her colleagues, and some by researchers in New Zealand involving rugby players, has shown that K-D can identify up to 75% of concussed athletes, and, when used in combination with other validated sideline screens, such as the Standardized Assessment of Concussion (SAC), is able to identify athletes subsequently clinically diagnosed with concussion with 100% accuracy. (Can't do any better than that!)

In 2012, as I getting ready to film "The Smartest Team: Making High School Football Safer," and was working with a group of world-class concussion experts on developing a concussion risk management program for the Newcastle, Oklahoma high school football program which we now call The Six Pillars,® I asked King-Devick to donate flashcards for all 160 players in the program.  I was pleased that the company agreed, and was excited that we were able to feature the school's certified athletic trainer, Damon Glass, demonstrating K-D on the football sideline in the documentary. (see photo at right)

MomsTEAM saw promise in the test when it first learned about K-D back in 2011, and we couldn't be more thrilled for Steve Devick and his company today, as study after peer-reviewed study has shown it fullfilling the promise we saw from the get-go: that a simple, rapid test that anyone, not just a medical professional, could use to identify on the sports sideline an athlete who likely suffered a concussion so that they could be removed from play and referred for a complete examination by a clinician to make a formal concussion diagnosis.

As MomsTEAM Institute works to launch its SmartTeamTM program around the country this fall, we are evaluating a number of emerging sideline concussion screening tools, just as we did with King-Devick for our documentary in 2012, and we hope to include King-Devick to provide additional data which researchers can use to evaluate its use by parent volunteers at the youth level with concussion education and training as a simple and easy to use tool t o identify athletes to remove from play for further evaluation, when trained medical professionals, such as certified athletic trainers, are unavailable.  Watch this space.

April 1, 2015 update:

The March 31, 2015 NBC Nightly News featured a report on the King-Devick test.  One important caveat, however: while the segment which appeared on air is accurate, the text accompanying the video on NBC's website needs to viewed with a clarification: in asserting that King-Devick is a "reliable way to quickly diagnose a concussion" (emphasis supplied), it may mislead parents and coaches into thinking that they can use the test to make a clinical diagnosis that an athlete has suffered a concussion. They can't and they shouldn't. The test is a remove-from-play tool, not one which allows non-medical personal to actually diagnose concussion. That diagnosis can only be performed by a health care professional with appropriate training and expertise in diagnosing and managing sport-related concussion. 

* July 12, 2015 update:  In a July 10, 2015 blog post for Huffington Post, sports journalist Ken Reed also touted the King-Devick test, suggesting that it be used by every high school in the country. Interestingly, Reed makes no mention of the fact that the Smartest Team and MomsTEAM have been making exactly that recommendation for three years, thereby suggesting to readers that he was the first to do so. Even more interesting is the fact that Huff Po declined to run a blog post I submitted several months ago advocating exactly the same thing.    


King-Devick article chronology 

February 8, 2011: King-Devick Test Promises More Rapid, Reliable Sideline Screening for Concussions (mixed martial arts fighters)

August 31, 2011: New Study Confirms Value of King-Devick Test in Sideline Assessment of Concussion (college athletes)

June 15, 2012 King-Devick Test Effective Sideline Concussion Screening Tool, New Study Finds (rugby)

August 26, 2012: King-Devick Testing Kits For Chicago Schools: Just One Tool In Concussion Tool Box (football)

June 11, 2013: King-Devick Test: An Important Part of Sideline Concussion Screening Battery

August 23, 2013: MomsTEAM Institute's documentary, "The Smartest Team: Making High School Football Safer" premieres on PBS; prominently features King-Devick Test. 

February 14, 2014: King-Devick: New Screening Tool May Dramatically Improve Concussion Detection Rate on Sports Sideline (rugby)

February 23, 2014: More Evidence That King-Devick Test May Help Identify Concussed Athletes On Sports Sideline (college men's and women's soccer, women's lacrosse)

Brooke de Lench is the Founding Executive Director of MomsTEAM Youth Sports Safety Institute, a 501(c)(3) sports safety watchdog, education, research, and advocacy organization, Founder and Publisher of, director of The Smartest Team: Making High School Football Safer (PBS), and author of Home Team Advantage: The Critical Role of Mothers in Youth Sports (HarperCollins).




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Brooke de Lench on the Today Show: Baby Goes Pro!


Earlier this week, I had the opportunity to talk to Lester Holt on NBC's Today Show about a subject I have been writing and talking about for the past decade - sports training for kids at earlier and earlier ages.  It was fitting to end the year and the last week of MomsTeam's first decade speaking to the nation about the tremendous pressure parents are under to place their infants and toddlers in programs that promote giving young children an "edge" in the mad rush to grab a seat on the runaway bus of youth sports.

When the Today Show producer called, she told me she had read the second chapter of my book Home Team Advantage: The Critical Role of Youth Sports Parents titled: "Too Much Too Soon: Making Sure Your Child's Involvement In Sports Is Developmentally Appropriate" and felt it provided ideal background information for the segment. While the book is now four years old, the fact that the tentacles of the youth sports business machine were now reaching into the cribs of babies to provide new customers was not really news.  What is surprising and new is the continued growth and proliferation of such programs even during a recession when money for so many families is so tight.Brooke de Lench with triplet sons

Since my segment aired I have heard from educators and child development experts and MomsTeam visitors (old and new) from around the nation, all applauding my stance and appreciating the research I have done (including the 31 publications listed in the bibliography for Chapter Two) to back up my assertion on the Today Show that "Children who are enrolled in sports programs while still toddlers and infants have no edge - no advantage over other children."

One of my favorite studies on youth sports development is one from 2006 published in the Journal of Physical Education, Recreation, and Dance. The study shows that only one out of four kids viewed as "superstars" at the age of 10, 11, and 12 year olds goes on to star in high school sports.

Brooke de Lench and Lester Holt on The Today Show


One only has to raise non-identical triplet boys, as I have done, to know that each child has their own developmental blueprint and develops at their own rate. To try to force a child to learn a sport long before they are ready is a fool's errand and a waste of money, in my view.  For years, I have suggested to parents that they save their money in a summer camp fund for when the children are older. Perhaps, thirteen or fourteen, when they are developmentally and psychologically ready to start concentrating on a single sport.

In the meantime, a local high school baby sitter with an interest in sports who will play one-on-one with your child, in their own environment at their own pace may be the best investment of your money.

For a transcript of the Today Show segment, Baby Goes Pro, click here

For the video of my interview by Lester, just named as the permanent host of the NBC Nightly News, click here.  


FIFA Scandal A Reminder That Lack Of Oversight And Transparency A Problem In Youth Sports, Too


The story which broke this morning in The New York Times that nine present or former high-ranking members of FIFA, soccer's global governing body, had been arrested in Zurich, Switzerland after being indicted on corruption charges in the U.S., didn't surprise me in the least.

While the FIFA scandal has made national headlines, allegations of embezzlement and theft in sports organizations, large and small, are an almost every-day occurrence in cities and towns across America.

One Hundred Dollar Bills

Here is a quick list of youth sports league theft and embezzlement cases, just from the first three weeks of May alone:

While youth sports organizations pale in size to FIFA, most are run like small - and, in some cases, not-so-small -businesses, with officers, boards of directors, bylaws and annual meetings, and annual budgets running into the hundreds of thousands of dollars. Yet, most operate with virtually no oversight beyond their volunteer (or, in some cases, paid) boards of directors and staff, and their often lax financial controls can make them easy and tempting targets for thieves. Even local youth sports organizations affiliated with national organizations are often not as accountable to the parents and children they supposedly serve as they should be.

Indeed, in reporting that FIFA critics characterize it as "a small group of officials ... operat[ing] with outsize power [and] ... function[ing] with little oversight and even less transparency," The Times could just as easily been talking about the youth sports organizations I just listed.

So, how can youth sports organizations become more accountable to their "customers" (you and your children)? Here are six ways:

1. Identify decisionmakers. In order to hold those who run the show accountable for the "product" they produce, challenge the way they do business, and identify problem organizations, begin by finding out about the structure of the organization. Here are some of the questions you should ask:  

  • Does the group operate as a profit or not-for-profit business? 
  • Does it fall under a national governing body (NGB) like US Lacrosse, USA Hockey, Pop Warner, etc?  
  • Who is accountable or responsible for decisions made or actions taken by the organization? 
  • Is it a corporation or a partnership? (Tip: by going to the website of your state's Secretary of State you can obtain annual reports of profit and not-for-profit corporations, both those incorporated in your state and "foreign" corporations (those registered to do business in your state but incorporated elsewhere) as well as the names of officers and directors. Not-for-profits are also required to register with the state's Attorney General, typically in a division relating to charities, and to file annual reports on their finances and fundraising activities. An organization that hasn't kept current with its annual filings is a red flag that it may be taking short-cuts in other areas, such as player safety, having in place the appropriate insurance in case of negligence etc.) 
  • Are two signatures required on every check? 

2. Parent input. Push for the formation of a Parent Advisory Group (PAC) consisting of parents with children currently playing in the program to provide the Board of Directors with feedback (both negative and positive) from other parents; the input helps to insure that its decisions are reflective of, and responsive to, a broad cross-section of the youth sports community. Run for a seat on the board. Attend meetings.

3. Open meetings. Ask that the mission statement of a youth sports program, its bylaws and the names, phone numbers and e-mail addresses of board members and other officers be publicly available and posted on the program's website, and that the time and place of board meetings be advertised and open to any parent or concerned individual to attend (even if only to observe). All coaches, including the middle school and high school coaches in that sport, should be encouraged to attend at least one meeting a year.

4. Term limits. Like politicians, directors, administrators and coaches who become entrenched in a program for years on end tend to put the "blinders" on and may become too comfortable with the status quo. New blood can keep a program fresh and strong. Longtime board members can be given "emeritus" or "ex officio" status.

5. Financial accountability. Public financial disclosure is one way to avoid embezzlement of funds in youth sports organizations. By partnering with credible, well-established online youth sports registration companies, leagues and teams can track where their money is going.

6. Benchmarking. We need to take a public health approach to injury prevention in youth sports. The first step is surveillance: creating a consistent, comparable, and accurate data system that can track the performance of youth sports organizations, their progress in preventing and treating injuries and keeping kids safe.

6. Make safety a budget priority. Instead of fancy new uniforms, or multi-million dollar stadiums, parents should push for more of a program's funds to be spent on keeping kids safe, such as by purchasing automatic external defibrillators and first-aid kits, to pay for reconditioning or replacing used equipment such as helmets, and to pay stipends to trained health care professionals (e.g., certified athletic trainers, nurses, EMTs, physicians) so they can be on the sidelines in case of medical emergencies.

The bottom line: make sure to follow the money so you know it is being spent wisely. We can and we must put our children and their safety first by making sure a youth sports program's scarce resources aren't going into the pockets of thieves.

Brooke de Lench is Executive Director of MomsTEAM Youth Sports Safety Institute, Founder and Publisher of, Producer/Director of The Smartest Team: Making High School Football Safer, and author of Home Team Advantage: The Critical Role of Mothers in Youth Sports (HarperCollins). You can follow Brooke on Twitter @brookedelench.

Originally published on Huffington Post on Thursday, May 27, 2015.



6 Ways Parents Can Help Make Youth Sports Safer


Although April - which was both National Youth Sports Safety Month and National Child Abuse Prevention Month - is now over, it doesn't mean that the work of parents in helping keep kids safer playing sports is over.

Indeed, as I have learned over the past 25 years, first as a mother, coach, administrator, and youth sports safety activist, then as the Founder and Publisher of MomsTEAM, and now as the Executive Director of the non-profit MomsTEAM Youth Sports Safety Institute, I have learned that, just as it takes a village to raise a child, it takes the continued involvement of every youth sports stakeholder to protect children at play from abuse -- not just physical abuse, but emotional, psychological and sexual -- and from sports injuries, many of which are preventable.

While the Federal Child Abuse Prevention and Treatment Act (CAPTA), provides guidance to states by identifying a minimum set of acts or behaviors that define child abuse and neglect, there are no federal, and very few state laws (outside the realm of concussion safety), which specifically protect children involved in sports; fewer still penalize those that violate its provisions.

But new child protection laws aren't the only way to help improve youth sports safety. There are numerous steps that parents can take, along with other like-minded parents, to make the sports experience safer for all children in their local communities. Here are just six:

1. Push your school and community-based programs to adopt comprehensive risk management programs. If concern is expressed that implementing such a program could end up increasing the exposure to lawsuits because any deficiency or oversight in meeting self-imposed safety requirements could provide the basis for a negligence lawsuit, help the club or school board understand that such fear shouldn't be an impediment to implementation. The alternative is worse: without such safety programs, more kids are likely to get hurt.

Group of girls ostracizing teammate

2. Lobby your community to use the power of the permit. In most places, youth sports organizations (YSOs) don't own their own facilities; they use taxpayer-funded fields, diamonds, tracks, pools, and courts instead. To use them they have to obtain permits.

In my 2006 book, Home Team Advantage: The Critical Role of Mothers in Youth Sports, I argued that, "By utilizing the power of the venue permits, a municipality can reform youth sports by exercising public oversight over the use of taxpayer-funded fields, diamonds, tracks, pools, and courts, denying permits to programs that fail to abide by" municipal ordinances with respect to sports injury prevention and treatment.

It is a power, as University of Missouri Law professor Doug Abrams noted during a presentation at MomsTEAM's September 2014 youth sports safety summit, in a subsequent article on MomsTEAM, in a law review article, and in a recent Huffington Post blog, that has been a "bedrock principle of municipal law" for decades.

And it works.

When her efforts to get the Connecticut state legislature to expand the coverage of its youth sports concussion safety law to cover private sports organizations stalled, a concussion safety activist, armed with information about the power of the permit I had provided to her in an email, was able to successfully lobby the city council in Norwalk, Connecticut to use the power of the permit to force organized youth sports programs utilizing the city's recreational facilities to abide by the state concussion guidelines.

3. Take a public stand against hazing and push for adoption by your child's sports program of a strict anti-hazing policy. The policy emphasized in pre-season meetings and written materials distributed to every student/team member, and, above all, enforced.

4. Push for youth sports organizations to adopt a public health approach to injury prevention. Dr. Jim MacDonald, a clinical professor at Ohio State and pediatric sports medicine specialist at Nationwide Children's Hospital, urges a comprehensive approach to preventing youth sports injuries based on three proven public health strategies: (1) "thinking like Sweden" in setting a target of zero youth sports injuries; (2) encouraging greater use of personal protective equipment shown to reduce injury risk, including properly fitted and maintained helmets, and the wearing of mouth guards and goggles in a wide range of sports; and (3) recognizing that education is not enough to change the cultural and physical environment of youth sports, but requires active implementation of sports safety best practices, including more certified athletic trainers, not just in high school sports but at the middle school and youth level; and by doing a better job of getting high school and youth coaches to "buy" into injury prevention.

5. Ask for safety training of coaches and mandatory evaluations. The United States is the only country in the major sporting world that does not have a national coaching education program. With all the money being poured into youth sports, it is simply astounding that the least investment is in coaches, even though they usually have the most impact on kids and keeping them safe.

6. Call for community-, private- and school-based sports organizations to view youth sports safety from a child's rights perspective. Children playing sports are owed a duty of care. Encourage programs to identify best youth sports health and safety practices and implement child protection programs to combat physical, emotional and sexual abuse in youth sports, as has been done in the United Kingdom. Because such programs implement standards that apply to everyone, not just parents, but coaches, players, officials, and other adults who work with children in sports, they won't just reduce the number of out-of-control parents, but the number of out-of-control, abusive coaches, team-bullies, spectators, and volunteers as well.

Brooke de Lench is Executive Director of MomsTEAM Youth Sports Safety Institute, Founder and Publisher of, Producer/Director of The Smartest Team: Making High School Football Safer, and author of Home Team Advantage: The Critical Role of Mothers in Youth Sports (HarperCollins). You can follow Brooke on Twitter @brookedelench. 


Controversial Headgear Mandate for Girl's Lacrosse Ignored Science


The debate over whether helmets should be mandated in girl's lacrosse, which has been raging for several years, reached a new level of ferocity recently with the publication of a blistering piece in the New York Times reporting on the backlash generated by the controversial decision by the Florida High School Athletic Association (FHSAA) to mandate a soft form of headgear for everyone in a girls' lacrosse game beginning this spring season.

Having written about the debate in the recent past, I don't see much point in rehashing the controversy in detail. Suffice it to say, the new mandate hasn't made anybody happy and has garnered plenty of vocal detractors (and rightly so), from US Lacrosse, the sport's national governing body (which, among other things, called the mandate "irresponsible" and premature), to coaches (who don't see the flimsy headband approved by FHSAA -- what one longtime game official told The Times looked "more like a thick bandana" -- as serving any purpose and no more than a "costly distraction to parents and the players"), to game officials (one told The Times that the only effect the headgear was having on the game was to cause delays because the headbands were prone to falling off) to the athletes themselves, who say all it does is get in the way of their goggles.

But what I and many others continue to find perhaps most disturbing about the mandate is that it was a policy change made by FHSAA in complete disregard of the unanimous recommendation of its own Operations Committee, US Lacrosse staff, nationally renowned sport medicine doctors and the Florida lacrosse community that it hold off until performance standards for helmets were established.

Girl's lacrosse player taking shot on goal

A lot of us in the youth sports safety community are simply scratching our heads, asking ourselves, "Why the rush?" As best as I or any of us can tell, it was because, as FHSAA's Executive Director, Dr. Roger Dearing, told The Times, "The board felt it had to do something." In other words, it was a policy decision which a slim majority of the board decided to take not in recognition of but despite the science. (A familiar occurrence these days in national politics, as well)

As a former college lacrosse and high school field hockey player, and a member of ASTM International's subcommittee on standards for headgear and helmets, which is working with US Lacrosse on developing a new standard for headgear in women's lacrosse, I have reservations about whether requiring female lacrosse players to wear helmets will make the sports safer, or, as a result of the phenomenon called risk compensation (also called the "gladiator effect"), will actually result in more, rather than fewer, head injuries.

There is some evidence to suggest that such fears may be unfounded. A study on the use of protective goggles, albeit in girl's field hockey and involving different protective equipment, for instance, found that their use did not increase concussion rates, despite fears that they would lead to more aggressive play and hence more concussions.

But the only way we will know is to, one, make sure that whatever helmets female lacrosse players wear meet standards that are based on science, and have been developed after a deliberative and collaborative process by an independent organization, like ASTM, which is not funded by helmet manufacturers and which does not just invite, but requires input from equipment manufacturers, product testing laboratories, researchers and governing bodies, in this case US Lacrosse; and, second, to hold off on mandating helmets in the girl's game until there is actual data to show that they help reduce concussions on which to base a policy decision. The only way to do that is by conducting pilot programs comparing injury rates for teams in which girls wear helmets meeting the new, soon-to-be-approved ASTM standard, to rates where they don't.

As The Korey Stringer Institute and University of Connecticut's Doug Casa argued during his presentation at MomsTEAM Institute of Youth Sports Safety's Smart Teams Play Safe summit last year, youth sports safety policies should be developed and implemented by sports medicine professionals.

The appropriate process for developing sports safety policy was summed up nicely in an email I got this week from Ann Carpenetti, vice president of lacrosse operations at US Lacrosse and co-chair of the women's lacrosse headgear task group at ASTM:

US Lacrosse is committed to making evidence based decisions, and we rely heavily on expertise provided by researchers, sports medicine practitioners, educators, athletic trainers, administrators, coaches, officials, parents, [and] players to help us establish a holistic and best practices approach to keeping the sport fun and safe for all.

The girl's lacrosse helmet fiasco in Florida amply demonstrates just how horribly things can and will go off track when that process isn't followed and when politics trumps science.

Brooke de Lench is Executive Director of MomsTEAM Youth Sports Safety Institute, Founder and Publisher of, Producer/Director of The Smartest Team: Making High School Football Safer, and author of Home Team Advantage: The Critical Role of Mothers in Youth Sports (HarperCollins). You can follow Brooke on Twitter @brookedelench.



Impact Sensors: One Step Forward, Two Steps Back

If you follow the subject of sports-related concussions, you've probably seen a flurry of news on the subject of impact sensors in the last couple of weeks. As someone who has been writing about and beta testing impact sensors for the past five years, I have, of course, been monitoring developments, too.

On February 16, 2015, my local paper, The Boston Globe, came out with a powerful editorial in which it urged college, high school, and recreational leagues in contact and collision sports to consider mandating use of impact sensors, or, at the very least, experimenting with the technology, to alert the sideline personnel to hits that might cause concussion, and to track data on repetitive head impacts, which, a growing body of peer-reviewed evidence suggests, may result, over time, in just as much, if not more, damage to an athlete's brain, as a single concussive blow, and may even predispose an athlete to concussion.

The Globe editorial viewed as "shortsighted" the reluctance of players and coaches to adopt the use of impact sensor technology out of fear that sensors, if they triggered an alert, might result in a player's removal from the game (that, after all, is the whole point) or the player being labeled a wimp (what the Institute of Medicine has labeled the "culture of resistance"), and it called on professional leagues, like the NFL, to follow suit, suggesting that star players, by using the devices, could help break down barriers to their more widespread use.

Unfortunately, on February 19, 2015, just three days after than the Globe went on record as urging the NFL to set an example for colleges, high school, and youth leagues to follow by equipping its players with sensors (as the Arena Football League has already done), the league did exactly the opposite.

As first reported by Sports Business Journal and, later that same day, by The New York Times, the NFL decided to suspend a pilot program using sensors in players' helmets for the 2015 season because data collected during the 2013 season was not considered reliable enough (for what, they didn't say), and because the N.F.L. Players Association questioned whether the data would be kept private and not used against a player.

Researchers who have collected data for years, including Stefan Duma, who runs the biomedical engineering department at Virginia Tech and helped develop the STAR helmet rating system, were quick to say that the league was being too careful, and that, while not perfect, even with a 10 to 20 percent error rate, the sensors were valuable and give reasonable data that is useful, not only in football, but in analyzing head hits in sports like soccer and hockey. I agree.  (After all, if a 10-20% error rate hasn't prevented the widespread use of neurocognitive tests such as ImPACT, why should it be any different with sensors?)

Duma speculated that one reason the N.F.L. and the players' union might be ambivalent about the use of sensors was because they could show that players were receiving more blows to the head than was commonly thought. He feared that the decision could dampen research efforts by others and didn't acknowledge "all the good things" that sensors do.

I agree with Duma on that point as well. Indeed, preserving the status quo and making it harder to use impact sensors is a theme explored in a law review article published yesterday in the University of Maryland's Journal of Business and Technology Law, which I co-authored with MomsTEAM Senior Editor Lindsey Straus.  While our article is primarily about the role organizations such as the National Operating Committee on Standards for Athletic Equipment ("NOCSAE")  play in setting performance standards for add-on equipment, such as impact sensors (it is our position that such standards should be set either by governmental agencies, such as the Consumer Product Safety Commission, or by truly independent standard-setting groups, such as ASTM International, and not by groups such as NOCSAE and Sports Legacy Institute funded, primarily or in part, by the equipment manufacturers whose products are subject to the performance standards they set), we also address the same concerns raised by Dr. Duma: that groups like NOCSAE, NFL, and its players have a vested interest in protecting the status quo, which, in the case of impact sensors, means trying to put the brakes on widespread adoption of sensor technology, not because their use is unlikely to make sports like football safer (I think it will), but for fear that it may open Pandora's box by making it clear just how hard and how often players are getting hit, and scare off parents from letting kids play the sport.

What motivates my desire to see widespread adoption of  impact sensor technology? I can trace it back to my childhood. In the early 1960's, before seat belts were standard equipment in every automobile, I remember a time my mother, a now retired emergency room nurse, was driving my three sisters and I in our old station wagon on some errands when we were rear-ended. No one was hurt, thankfully, but the accident prompted her to begin working for enactment of a law requiring car companies to include seat belts as standard equipment in every new car. (By the way, my mom was also an early advocate for installing defibrillators in every ambulance and on banning smoking in public places.) My father, on the other hand, was a gifted athlete who excelled at a variety of sports (baseball, hockey, golf, skiing, tennis), who introduced my sisters and I to every sport imaginable, and never held us back.

No wonder, then, as the product of a mother who, as a result of her work in the ER, was understandably obsessed with safety, and a very athletic father who loved sports and encouraged us to play them with gusto, that when I became a mother raising athletic triplet sons I did everything I could to protect them while playing sports, but at the same time encouraged them to play whatever sport they loved, even ones like football, lacrosse, soccer, and skiing/snowboarding which came with the risk of head injury. In 1999, when my son Spencer sustained a concussion playing high school football (after suffering at least two earlier concussions, one snowboarding and one sledding), I began to focus more on the safety side of the sports equation, especially with respect to concussions.

About five years ago, I started to write about companies who were developing impact sensors, not just for research, but for use at the youth, high school, and college level; sensors that, while not as sophisticated as the ones used for research - which cost upwards of $1,000 per player - could be used to alert sideline personnel to athletes who had sustained hits hard enough to cause concussion, and identify athletes whose poor technique caused them to sustain an unusually large number of high force impacts. 

In 2012, when I was asked by the high school football program in Newcastle, Oklahoma for help in implementing an evidence-based concussion risk management program (one which we now call The Six PillarsTM, it seemed like, pardon the pun, a "no-brainer" to see if a impact sensor manufacturer wanted to beta test its sensors by donating them to the school for installation in some of the Newcastle players' helmets. (We left it up to the players and their parents whether the sensors would be installed in their helmets).


My experience with impact sensors during the filming of "The Smartest Team: Making High School Football Safer" convinced me that they had value as a technological "end run" around the persistent problem of chronic under-reporting by athletes of concussion symptoms, and would, as the cost came down and the reliability went up, eventually become standard equipment in contact and collision sports.

From talking candidly at length with the players in Oklahoma after a duck-hunting trip (next to playing football, their favorite activity), I learned that they actually  wanted to wear the sensors. Why? Because they knew that, if they took a heavy hit, it would register on the iPad the athletic trainer or his assistant was holding on the sideline. In other words, knowing that they would be checked out if the sensor alerted sideline personnel to a blow with the potential to cause a concussion, they felt more comfortable, if they were experiencing concussion symptoms, reporting them to the AT without fear of being labeled a wimp by their teammates or the coach.

Is the technology perfect? No, it's not. But, like Dr. Duma, and others, I believe that, in hitting the pause button on the use of sensors, the NFL is essentially throwing the baby out with the bathwater, and sending out exactly the wrong message about sensors. Our experience at MomsTEAM Institute in field testing seven different impact sensor models over the past three football seasons, at both the high school and youth level, is that they are, at this stage, a bit of a mixed bag. Admittedly, the technology is still in its infancy.

In my view, however, equipping players with sensors does not, as one critic has suggested, turn them into crash-test dummies. With appropriate safeguards in place to ensure that the privacy of the players is protected, and that access to the data the sensors generate is restricted to those who can use that data intelligently (such as an AT or coach), I continue to believe that the best way to refine and improve impact sensor technology, and educate players, coaches, parents, and ATs about their advantages, is, well, to use it. Sadly, the NFL's decision to stop using impact sensors is likely to set back the kind of widespread use MomsTEAM have been advocating for years (not because we have a dog in this fight, but solely because we believe in the technology). How much of a setback remains to be seen. More on this later.

Here are some of our articles on impact sensors:

Impact Sensors: Frequently Asked Questions

Underreporting of Concussions: Is Monitoring Head Impact Exposure A Way Around The Problem? 

Impact Sensors: Many Benefits Of Real-Time Monitoring

AFL Becomes First Professional Sports League to Require Helmet Impact Sensors

Conflict of Interest Statement on Impact Sensors 


Celebrating National Foot Health Awareness Month And A New MomsTEAM Sponsor


People often ask me often what I think the most important piece of safety equipment is for a particular sport. I know I catch them off guard when, instead of saying a helmet, mouth guard, shin guard, or safety goggles (all of which are very important, of course), I say that it is best-made and best-fitting pair of shoes and socks which are the critical to a successful day of activities.

I know first-hand and from reading studies that buying shoes for your child that fit properly is extremely important. Unfortunately, a recent study found that a majority of kids wear shoes that are too small, which put them at risk for developing serious foot deformities, such as bunions.

While allowing kids to wear shoes they have outgrown is certainly understandable, especially when finances are tight and the temptation to pass down shoes is great, I also know that ill-fitting shoes and socks cannot only lead to foot problems down the road, but cause immediate pain and discomfort which can even affect athletic performance. The feet are individualized launching pads; therefore, it is critically important that they are protected in sports. When we walk, the pressure on our feet exceeds our body weight, and when we're running, it can be three or four times our weight. 

While there are lots of studies and good information available on the importance of shoes, not nearly as much is said about the importance of socks. When they were growing up, my three sons never quite understood why I was always so adamant in making sure that they each wore a fresh pair of really well-made socks to school every day, and had a spare pair in their backpack or lockers; not just any old pair, but top-of-the-line socks.  



During summer vacations my sons, like their dad, went away to Pok-O-MacCready Camp in upstate New York which is famous for its hiking of "Forty Sixers" - the 46 peaks in the Adirondack Mountains over 4,000 feet. The camp was rustic without many of the comforts of home.  After coming back from camp, my sons always made a special point of thanking me for packing a dozen or so pairs of padded socks to wear while hiking in the High Peaks. It was my own way of letting them know I cared.

Corny? No, not al all. In fact, it has become a Christmas tradition for my sons to give a great pair of socks as a gift to everyone in our immediate family. It is gesture that I have always appreciated, because it says "no matter how cold or damp or lousy the day has been, if your feet are dry and warm, you know I love and care about you."

Recognizing just how important socks are, when the Statesville, North Carolina maker of Thorlo socks expressed an interest in becoming a sponsor of MomsTEAM Youth Sports Safety Institute, it seemed like a natural fit (pun intended), not just because my sons and I have been wearing Thorlo athletic socks for decades, but because of the company's commitment to making socks meeting the highest standards for quality and performance. No wonder Thorlo's motto is, "We don't make 'socks', we protect your feet."

MomsTEAM is proud to have Thorlo join us as corporate underwriter to help us continue, as we have for the past 15 years, to provide, free of charge, the best youth sports health, safety and product information on the Internet.

Curious about the Thorlo story? Watch and see how a family's simple dream, a set of core values, Southern craftsmanship, and a vision to be the caretaker of the world's feet became the brand now known as Thorlos.

Never tried Thorlo socks? Click here for your free pair.  Have a son or daughter playing soccer, baseball, softball, or lacrosse this spring sports season? Discover Thorlo's fabulous new socks for cleated shoes.

Brooke de Lench is Executive Director of MomsTEAM Youth Sports Safety Institute, a 501(c)(3) tax-exempt non-profit advocacy, educational and watchdog group for children and adolescent athletes whose mission for the past 15 years is to providing sports parents and all stakeholders with comprehensive, well-researched and practical information, best practice resources and solutions to keep student- athletes safe physically, psychologically, and sexually.  She is the Founder of, producer of the PBS documentary, The Smartest Team: Making High School Football Safer, and author of Home Team Advantage: The Critical Role of Mothers in Youth Sports. You can follow Brooke on Twitter @brookedelench. 





Chris Borland Retirement Decision: 3 Lessons for Sports Parents (Link to HuffPo Blog)

The decision by San Francisco 49er Chris Borland to retire from the NFL after just one season out of concern for the long-term effect of head trauma has predictably generated a media firestorm. But lost amid the hoopla is what it means for sports parents.

Here are two lessons I think parents with kids playing -- or considering playing -- football or other contact and collision sports can take away from the Borland retirement, and one lesson they shouldn't take away:

1. Retirement from contact/collision sports should always be an option

Borland is to be applauded for making his decision to walk away from a pro career only after carefully weighing the risks and rewards with family, friends, doctors, and concussion experts, and after doing his own research. Parents need to let themselves and their children know that there is no shame in doing the same.

To read the full blog on Huffington Post, click here