Lifelong Repercussions

How do childhood experiences shape the rest of our lives? How does adversity in early life affect us later on? These questions have occupied researchers’ interest for decades.

While many unknowns remain, one overarching consensus has emerged—individuals who experience abuse and neglect while growing up tend to carry the aftereffects of that trauma into their adult lives. The repercussions can range from the emotional to the physical, manifesting in risk-taking behaviors, such as drug use, or mental and physical health problems, like depression and heart disease.

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Now, a study involving former National Football League players is adding a new dimension to research in the field.

Former professional football players experienced childhood adversity at rates similar to the general population. Those with a childhood history of abuse and neglect were more likely to screen positive for dementia, and were placed at significantly greater risk for pain and depression in their later years.

Moreover, the authors of the new study said, instances of childhood adversity were strongly associated with concussion symptoms and should be investigated among professional football players and other populations as a possible indicator of high concussion risk.

The research, published March 22 in JAMA Open, was based on surveys of 1,755 former NFL players ages 28 to 92, comparing outcomes between players who reported a history of family dysfunction and childhood adversity and those who did not.

The study was conducted by investigators at the Harvard T.H. Chan School of Public Health and Harvard Medical School as part of the ongoing Football Players Health Study at Harvard University.

The key findings include:

• The frequency of NFL players’ experience of childhood adversity is similar to that of the general population in the United States.
• Former NFL players who reported having four or more adverse experiences in childhood were 48 percent more likely to screen positive for dementia and had a greater risk for cognitive problems in later life.
• Players who reported childhood adversity were more likely to also report depression and problems with pain in their daily life.
• Players with four or more adverse childhood experiences were 60 percent more likely to suffer concussion symptoms during their football career.

Harvard Medicine News discussed the findings and implications of the research with study senior author Andrea Roberts, a senior research scientist at the Harvard T.H. Chan School of Public Health.

Harvard Medicine News: What prompted you to look into the link between childhood adversity and possible neuropsychiatric consequences among former NFL players?

Roberts: As the long-term effects of concussions have become better understood, former professional football players have become more concerned about their thinking and memory. So, this issue is of great interest to them. Childhood adversity, especially abuse and neglect, has been associated with worse memory and problem-solving in children, so it’s possible that these associations might persist into later adulthood, and, if so, this might point to possible treatments for former players and others.

HMNews: Were any of your findings unexpected, surprising, or particularly concerning?

Roberts: Yes. We did not expect that players who experienced neglect or abuse would be at higher risk of having a lot of concussions during their playing years. This was surprising, although it makes sense.

HMNews: You report a link between childhood adversity and concussion symptoms. What is a possible explanation for that surprising connection?

Roberts: Children who experience abuse, neglect, or other adversities, like having a parent with alcoholism, are more likely to experience aggression and engage in risk-taking behaviors. They might be more risk-taking or aggressive as adults. Although we don’t know for sure, it may be that players who had difficult childhoods have a more risk-taking, aggressive playing style that could lead them to have more concussions.

HMNews: The link between childhood adversity and adult health problems is well known in the general population. Is there anything different about this dynamic in football players that emerges from your findings?

Roberts: Childhood adversity can affect anyone. It is neither unique nor more common among athletes. What is important to note is that former NFL players have gone on to become exceptional athletes, despite the adversity. They have overcome substantial obstacles in life through discipline and perseverance. But it is also important to note that no one is immune to the lingering effects of childhood hardship. Science-wise, there has been almost no research on possible associations between childhood adversities and memory and thinking problems, including dementia, in later life. Our study suggests that childhood adversity might be a risk factor for cognitive health problems in addition to the psychological and physical health problems we already know about.

HMNews: In your paper, you and your colleagues outline recommendations for former NFL players and their health care providers. What are some of those central takeaways?

Roberts: We suggest that former players who experienced childhood adversities consider treatment of psychological trauma in addition to physical injury to improve symptoms of depression, pain, or cognitive problems. Emotion-regulation strategies, narration of trauma memory, anxiety and stress management, interpersonal skills training, mindfulness, and meditation are current best practices for treatment of trauma. In former players with a history of family dysfunction, treatment suited to this history might improve their health and well-being.

HMNews: Are there any cautions, limitations, and caveats to your findings?

Roberts: The players in our study were, on average, in their 50s, so many years have passed since their childhood and since their playing years. It’s possible that their memories of their childhood experiences or concussion symptoms during their playing years are not accurate. Also, their current health might affect how they remember their past, which could have biased our results. It would be helpful to study younger current or former players to see how their childhood experiences are associated with concussion, memory, and thinking.

Other investigators on the research included Ross Zafonte; Lori Chibnik, Aaron Baggish, Herman Taylor, Jillian Baker, Alicia Whittington, and Marc Weisskopf.

Relevant disclosures:

The Football Players Health Study is funded by the National Football League Players Association. The National Football League Players Association did not contribute to the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Roberts had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis.