The Classroom Bookshelf
Inside The Classroom Bookshelf

Fourth Down and Inches: Concussions and Football’s Make-or-Break Moment

By Carla Killough McClafferty
Published by Carolrhoda Books
ISBN: 978-1-4677-1067-1
Grades 6 and Up
Book Review
This week, much of America’s attention will be devoted to the upcoming Superbowl game. Families are planning Superbowl parties, perfecting their chicken wing recipes and placing bets on who might win the game. With football so much in the spotlight, this may be a very painful week for the families of high school athletes like Nathan Stiles and Eric Pelly, or former NFL players like Tom McHale, Kevin Turner, and Mike Webster, all of whom developed traumatic brain injuries as a result of playing football.  Except for McHale and Turner, the rest are dead. Fourth Down and Inches details the latest cutting edge brain research on the connection between football, concussions, and traumatic brain injuries. Such research tells us that during a game or practice, a seven-year-old Pop Warner football player can experience a hit that is the equivalent to running headfirst into a brick wall at 20 miles per hour, the “same severity as those experienced by high school and college football players.” The research also tells us that high school football players can receive hits that lead to decreased neurological activity without even experiencing a concussion. Between high school and college, “a typical starting player” can sustain upwards of 8,000 hits. The cumulative affect of hits, and the damage done to the brain as it bounces back and forth inside the helmeted head, can lead to decreased brain function, chronic traumatic encephalopathy (CTE), Alzheimer’s, amyotrophic lateral sclerosis (ALS), depression, drug addiction, and death. Research indicates that retired NFL players have ALS and Alzheimer’s at four times the rate of the general population. McClafferty begins and ends her book with a poem written by Eric Pelly, a high school football and rugby player who died from CTE in the fall of his senior year. Throughout the book, she gives voice to former collegiate and NFL athletes, and their families, including Rosalind Gammon, who lost her son Ron to football back in 1897. McClafferty raises difficult questions about the dangers of the game and presents an overview of current research without writing about her own answers and opinions. She recognizes the positive influence of football in the lives of young people and reminds the reader that “[w]e must remember how deep the passion for a game often runs. This is not now and will not ever be a simple issue.” This nonfiction book can serve as a foundation for adolescent football players, parents, coaches, and athletic directors who want to know more about the risks of the game. As a model of meticulous research and engaging writing, this book is ideal for interdisciplinary studies of the brain and how it functions, public policy that focuses on youth and sports, and nonfiction writing.
Teaching Ideas and Classroom Invitations:
  • Common Beliefs About Football. What do your friends and neighbors know about football? Are they aware of the prevalence of brain injuries and diseases, such as CTE and ASL, in retired players? Have your students create surveys in small groups, and have them administer the survey to a range of friends and neighbors of different ages. Your class can brainstorm the commonalities that the surveys must have. You can use plain old paper and pencil to conduct the surveys or a digital tool like Survey Monkey. When the results are in, have the students compare and contrast their findings with one another. What have they discovered? This is a great opportunity to collaborate with the math teacher on your team or within your school.
  • Public Service Campaign. Either drawing from the surveys students completed in the above activity or as a stand-alone activity, have students develop a public service campaign on contact sports and traumatic brain injuries. Students can be divided in small groups based on target audiences, different sports, types of brain injuries, etc. Including them in the decision-making about how you create the categories for the campaign will be an important motivator. This is an ideal activity with which to collaborate with the athletic director of your school district, gym and health teachers, as well as the coaches of after school athletics.
  • Are Football Players Gladiators? While your students are reading Fourth Down and Inches, have them listen to NPR commentator’s story, “The (Very) Long Viewon the State of Football” from January 1, 2014. What are the comparisons and contrasts that Deford makes between ancient Roman gladiators and football players? What connections can they make between the points made in the radio story and the points made about the game in the book?
  • Should Young People Play Football? After reading the book, have your students complete more research on football and traumatic brain injury drawing on the books and digital resources included below. Next, have students write editorial pieces for your local paper arguing for or against playing football at the elementary, middle, and high school levels. Are there enough rules and regulations in place to avoid students getting permanently injured or killed? How so? How not? This is an ideal collaboration with the science or health teacher on your team, if it is possible to time the reading of this book with a study of the brain and how it functions.
  • Contact Sport Research. If all of your students have read this book as a mentor text for research on concussions, traumatic brain injury and disease in football players, divide them into small groups (or have them choose their topic) to research other contact sports and the related injuries, or other sports and performing arts in general, like gymnastics and ballet. What are the risks of participating in a sport or art form that can damage the body? What are the benefits? How does one make choices at a young age? Have the small groups collaborate to conduct research and write digital or print texts modeled on Fourth Down and Inches.
  • Reading Like a Writer: Inform or Persuade?Oftentimes in school, we will tell students that they are either writing to inform or writing to persuade. What is author Carla Killough McClafferty doing in Fourth Down and Inches? Have students consider the title of the book. What does “fourth down and inches” mean in football? Is this football’s “make or break moment?” What about the chapter titles? Opening and concluding paragraphs? Final author’s note? Is she writing merely to inform or is she writing to inform and persuade? Is there even a difference when considering a topic such as this?
  • Reading Like a Writer: Capturing the Past.The first two pages of the book read like an action-packed commentary on a contemporary football game. We are on the field with the players, experiencing the action. It is only towards the end of the second page that we are told the game we have just read about happened in 1897. Collect several short articles on several different topics that stretch back 100 years or more, such as cars, or the telephone. Have students read the articles to learn a little more about the topic 100 years ago, and then have them try to write about it in a “timeless” way. How can they foot their reader into thinking they are reading about something happening right now? What kinds of writing techniques do they draw on? What techniques does the author model for them?
Critical Literacy
  • Football and Concussions. After reading Fourth Down and Inches, have your students examine the ways in which the NFL, NCAA, and Pop Warner discuss the connection between football, concussions, and traumatic brain injuries and diseases. What are some of the differences in approach or language? Does the writing share the same mood or are there differences in tone? Are there inconsistencies in information? If you knew nothing about the connection, what would you learn from reading the websites? What power do they have by shaping the conversation on their website? What responsibility do football organizations have to educate the public about the connections? Do your students think these football organizations do a great, adequate, or poor job of educating the public?
Further Explorations
Carol Killough McClafferty’s Official Website
Sports Legacy Institute
Center for the Study of Traumatic Encephalopathy
National Institute of Health (NIH): Traumatic Brain Injury
Center for Disease Control (CDC) “Head’s Up Concussion in Youth Sports” Tool Kilt
CDC Return to Play Progression
The Center of Excellence for Medical Multimedia: Traumatic Brain Injury
The Brain Injury Association of America
Kevin Turner Foundation
“Think Taylor,” Taylor Twellma Foundation (Retired Soccer Player)
New York Times Topic: Head Injuries
Johns Hopkins: Traumatic Brain Injury in Professional Football: An Evidence-Based Perspective
NFL Official Website
NCAA Official Website
Pop Warner Football Official Website
NFL News: Head Health Challenge
NFL-NIH Brain Research Collaboration, December 2013
National Public Radio (NPR): “Brain Injuries Haunt Football Players Years Later,” 2011
NPR, Frank Deford, “The (Very) Long View on the State of Football,” January 2014
Culverhouse, G. (2012). Throwaway players: The concussion crisis from pee wee to the NFL. North Fayette, PA: Behler Publications.
Hudson, M. A. (2014). Concussions in sports. Mankato, MN: ABDO Publishing.
Kamburg, M.J. (2011). Sports concussions. New York: Rosen.
Markle, S. (2011). Wounded brains: True survival Stories. Minneapolis, MN: Lerner Publications.
Mary Ann Cappiello About Mary Ann Cappiello

Mary Ann is a professor of language and literacy at Lesley University. A former public school language arts and humanities teacher, she is a passionate advocate for and commentator on children’s books. Mary Ann is the co-author of Teaching with Text Sets (2013) and Teaching to Complexity (2015) and Text Sets in Action: Pathways Through Content Area Literacy (Stenhouse, 2021). She has been a guest on public radio and a consultant to public television. From 2015-2018, Mary Ann was a member of the National Council of Teachers of English's Orbis Pictus Award for Outstanding Nonfiction (K-8) Committee, serving two years as chair.