CHAPTER 2: Manuscript 2.1 Abstract Context: Evidence suggests that concussion knowledge, attitudes, and behaviours have a substantial impact on concussion reporting and concussion care. Despite the recent growth in awareness, concerning gaps in concussion knowledge have been found in groups of physicians, coaches, parents, high school, and collegiate athletes. However, limited studies have examined concussion knowledge in the pediatric population, particularly those below the high school age range. The lack of evidence limits the specificity of educational interventions designed for this age group, thus limiting its effectiveness and consequently putting the neurological health of our youth at risk. To address this gap, the present study explored concussion knowledge, attitudes, and reporting behaviours in a sample of children between grades 5-9 who were currently involved in organized sport. Methods: The study used a cross-sectional observational design. Twenty youth sport participants between grades 5-9 formed a convenience sample. A total of 11 females and 9 males enrolled in the study. The primary sport of participants surveyed was hockey (n=17), followed by swimming (n=2), and basketball (n=1). The average number of concussions experienced by each participant was 0.84 ± 0.70. A 51-item, online, anonymous questionnaire, consisting of factual and scenario-based questions was used to explore beliefs, knowledge of, and attitudes towards concussions. The questionnaire was designed using previously validated concussion knowledge surveys, then merged and adapted to the fit the target population. The adapted questionnaire was reviewed and validated by three certified athletic therapists familiar with questionnaire development. Results: The most commonly identified symptoms were having headaches (100%), feeling dizzy (95%), trouble concentrating (85%), and feeling like the room is spinning (80%). Commonly misidentified symptoms were having trouble falling asleep (30%), feeling like you are going to faint (35%), having problems finishing tasks (35%), and having a hard time learning new things (35%). Participants displayed inadequate knowledge towards key concussion concepts, such as up to date concussion management, return to learn, and return to play protocols. The majority of participants (80%) held the outdated belief that they must remain in a dark room until all concussion symptoms were resolved. Few participants (25%) perceived it to be very important to avoid participating in sports while experiencing symptoms of a concussion. Furthermore, 40% believed that if you hit your head, it was okay to return to play in the same game. Lastly, only 10% of participants thought it was very important to report concussion signs and symptoms to a coach. Conclusions: The present study highlights specific concussion concepts that should be addressed when developing effective educational and training material designed for the pediatric population. Additionally, our results indicate that factors such as concussion history, age, and gender, may influence concussion knowledge and reporting behaviors. These factors should be further explored to advance prevention efforts targeting concussions in youth athletes. Future initiatives should aim to increase awareness towards the less common symptoms of concussions, up to date concussion management protocols, and specifically highlight the importance of immediate removal from play with suspected concussions, and returning to play in a stepwise, progressive manner.