Objective Given findings of increased symptomatology in high school, college, and professional athletes with history of multiple concussions, we sought to identify incidence of symptom reporting at baseline, in middle-school youth athletes on the basis of concussion history.

Design Pre-test only.

Participants A multi-centre sample of 2,600 middle-school athletes, ages 10–14, who completed baseline evaluations, were assigned to groups on the basis of concussion history: None (N=1210), One (N=1191), Two or more (N=199).

Intervention The Post-Concussion Symptom Scale (PCSS) was administered during athletes’ pre-season baseline evaluations. Cross-sectional analyses (ANOVAs) were used to examine symptoms reported at the time of baseline testing by concussion history group

Main results Otherwise healthy middle school athletes with a concussion history were statistically (p<0.001) more likely to report symptoms of headache, light sensitivity, irritability, drowsiness, difficulty falling asleep, and sleeping less than usual, than middle school athletes with no history of concussion. Analysis of symptom clusters revealed increased endorsement of symptoms in physical and sleep clusters on the basis of concussion history (p<0.001), but not in cognitive or emotional clusters.

Conclusions Developmentally, younger athletes may be less insightful in identifying their cognitive or emotional symptoms. Younger athletes who sustain multiple concussions may experience residual symptoms, which may be precursors to future concussion-related difficulties. These results raise poignant implications for: 1) symptom reporting in younger athletes, thus affecting research and clinical assessment, and 2) the possible impact of early concussion residuals on future functioning of college and professional athletes.

Competing interests Dr. Schatz serves on the ImPACT Scientific Advisory Board.