NYT on head injuries in youth sports; adults not enforcing Pop Warner rules

[brittone2]

http://www.nytimes.com/2012/10/23/sports/football/pee-wee-football-game-with-concussions-brings-penalties-for-adults.html?_r=1&hp

I know this can sometimes be a heated topic, but I think it is an important one. (eta: and since I feel the need to give this disclaimer every time the discussion comes up, I don't think football is the only concern by any stretch, and I'm not anti youth sports. DH and I were both athletes and I think it is a tremendous, tremendous experience for many kids.)

[sste]

Thank you for posting. That is absolutely insane that those coaches kept on playing! Our friend is a sports med doc who volunteers at high school games and he has told us some horrifying stories too. :(

It seems to me that it is very important for parents to personally meet and vet their kids' coaches as well as assess the program standards.

[AngB]

I absolutely believe this is going to be a problem.

My brother is a 15 year old sophomore in high school and was playing JV football. Their school has a decent concussion policy, they are supposed to take any risk of concussions very seriously and do an assessment before the season starts so they can compare results if there is ever a question of a concussion. I'm pretty sure the coaches have all had training on this (can't say for sure, but I'm VERY familiar with the district and can't imagine they don't have training on it.)

Three weeks ago during a game, my brother took a hard hit against a kid twice his size (against an 18 year old senior they were letting start for varsity AND start for JV--I have a problem with that too but that's another discussion). He told his coach after the play, "I think I'm hurt. My head and neck hurt. I have a headache."

Instead of asking what happened, or calling over the trainer/telling him to go talk to the trainer, or doing any of the possible options that would have been appropriate, this coach asks a 15 year old who generally plays 90% of their games on both offense and defense, "Can you go back out there?" And my dummy but typical 15 year old brother shrugs and says "I guess so." And went back on the field for another play or maybe two. Finally then he came off the field saying his head was hurting too much to continue--then and only then did the coach send him over to the trainer and even after that a little while later the coach tried to send him back in (the trainer stopped it.) They weren't sure if he had a concussion or not, and gave my mom paperwork saying that he should be okay to go to school the next day, nothing about seeking professional medical advice, etc. The next day he went to school with a bad headache all day and after school the trainer did the comparison assessment and determined that he had indeed had a concussion. When he finally went to his doctor the next day, he was NOT happy that they had told my mom to send him to school with a headache less than 12 hours after a concussion. (And I don't even think she told him the part about how his coach put him back in to play after it.) My mom is a teacher in the district and her instincts seriously questioned sending him to school but since the trainer specifically told her-and gave her paperwork that specifically said it was okay for them to go to school the next day- she trusted that.

My uncle is a head coach for another school and has been for 10+ years and was flat out furious that he had been put back in. And I know it isn't *all* coaches that would handle it badly, but there are enough out there who put football over the health and well-being of these kids, I think, that could be putting these kids at serious risk.

[crl]

Thank you for posting.

Catherine

[brittone2]

And I know it isn't *all* coaches that would handle it badly, but there are enough out there who put football over the health and well-being of these kids, I think, that could be putting these kids at serious risk.
I agree. Sometimes I really just think even with training, there are a lot of coaches who just don't get the seriousness of a head injury, or the culture of the sport is such that they don't think it is a big deal (for ex "you got your bell rung, kid" type of attitude).

I also think that most leagues and districts have policies that look great on paper, but I'm not sure in reality those policies are always being applied correctly.

I don't know if all states require an on-site ATC now, but even then, I don't think all states require an ATC on site and available at all practices (I could be wrong on that). So think of what might be missed during a practice vs. a game if that's the case. Even with training, a coach is not medical personnel, and of course, they aren't unbiased. Counting on them to do the right thing can be a bit iffy, IMO. I do believe most coaches have the kids' interests at heart, but I do think there is still naivete about the seriousness of head injuries, and since many of these older guys coaching grew up in a time when it was not a recognized issue, they are prone to brushing it off IMO.

Add in that ATCs are often in a very difficult position and especially in certain districts, there is likely pressure on them to clear players for play, etc. We've had posts about that topic in the past. In high school I volunteered with an ATC, attended a camp for HSers interested in pursuing a career as an ATC, etc. but ultimately decided I wouldn't be able to put up with the possible pressure to clear players, not diagnose, etc. that can come from coaches, parents, etc. I still think most ATCs do their very best to protect young athletes, but it can be tough to push back firmly against the type of pressure in some of the high powered sports schools, I think.

I think vetting a coach and policies is tough, because I don't think the average parent without a medical type of background is really going to know if those policies are being followed, whether things are being properly diagnosed, etc. unless there is some really egregious stuff going on.

(eta: I say this as someone who dealt with a terrible high school track coach. I was a serious long distance runner, had a history of running and competing through many nagging injuries. My high school xc coach was excellent and drove us hard, but she was also sensitive to injuries. She coached track my freshman year but eventually stopped and stuck to just xc. The coach who took over minimized all injuries. I had some serious stuff going on and he kept brushing it off as "shin splints," which was ridiculous, as I knew that was not the case, having dealt with more than my share of shin splints through the years. Not only would he not allow me to back off my training, I had to race 4 races every meet, including in meets when we mathematically could not lose at that point. I ran 3-5 miles every track meet between my races, and then warmup and cooldowns. I eventually went to a private doc who took xrays. I suspected a stress fracture, as my pain was very, very localized. Xrays revealed that I had been running on a stress fracture to the point that I had actually fully fractured my fibula.

Despite my own awareness of sports injuries at the time (again, I had taken ATC camps, volunteered at PT facilities and with ATCs, had been running and dealing with run of the mill injuries for years), and a demonstrated willingness to train and compete with various nagging injuries through the years (ie not a complainer, not a wimp), this guy would not listen to me, nor allow me to back off my training. The same was true for several other teammates, and we did eventually get him fired, as our principal asked to meet with us and discuss this and other issues with him. So again, I don't think this is just an issue with football. I think a mildly clueless coach can really cause some serious damage to a young athlete. I didn't want to complain to my parents, as I had previously been able to manage my injuries using the school ATC, talking to my coach, modifying my own training, etc. Thankfully, my situation wasn't a *head* injury.

[AngB]

I think vetting a coach and policies is tough, because I don't think the average parent without a medical type of background is really going to know if those policies are being followed, whether things are being properly diagnosed, etc. unless there is some really egregious stuff going on.

Right. And at the high school level it isn't really possible, you don't get to pick. Presumably those coaches are *teachers first* and should care about kids' brains more than anyone, but that isn't always the case. Unfortunately, I think it may take some kids getting seriously hurt and subsequent lawsuits against school districts for *some* coaches to "get it". Though in my brother's case, if he had been seriously,seriously hurt from going back out with a concussion, we probably wouldn't have ever known that he had already told his coach about his injuries. We were only sitting 20ish feet from the sidelines but those games are so chaotic we only saw he was hurt when he went to the trainer.

On the flip side, in some cases, there are some parents who seem not to get it just as much as the coaches, or are worse than the coaches. My uncle (the head coach) was taken to the school board for refusing to let a senior play because he couldn't get a doctor to sign off on it (back injuries). The kid was being scouted for scholarships and the parents were livid that they wouldn't let him play with their consent even if it was without medical clearance. (The school board supported him.)

And my brother has a kid on his team who had 3 concussions in a year when they were in 8th grade before a doctor finally pulled him out of any contact sports for a year. He's since had at least one more concussion. I don't know his parents enough to say if they are concerned about it or not, but 4 concussions in 3 years for a 15 year old and they are still letting him play football? That's not a choice I would be making with my kid's brain at risk.

[brittone2]

On the flip side, in some cases, there are some parents who seem not to get it just as much as the coaches, or are worse than the coaches.


I totally agree. THat's one reason I mentioned that coaches and ATCs also get pressure from parents. Scouting, the "big game" of the year, fear that their child is going to lose their starting position, etc. all play into this.

[sste]

Well, as I mentioned, I am totally sold on the importance of this. These discussions always devolve into a focus on the downside (injury risk) but in our family's case the upside is probably the determining factor. There is NO WAY that my children are going to be built, physically or mentally for that matter, for the more aggressive contact sports. I can already see that their talents are in other directions, they are both small-average in size, and as a family we don't have an attachment to or interest in football or hockey, etc. So, in our case, the decision could not be easier!

But, if you are a family that is interested in pursuing football or similar or your child is highly motivated to pursue those sports, what should those families do? Besides vetting the coach and asking around about his reputation, checking the policies, asking about enforcement, seeing if there is a medically trained person at the games, etc., I am not sure what else the parents can do other than forbidding their child from participating??

[brittone2]

But, if you are a family that is interested in pursuing football or similar or your child is highly motivated to pursue those sports, what should those families do? Besides vetting the coach and asking around about his reputation, checking the policies, asking about enforcement, seeing if there is a medically trained person at the games, etc., I am not sure what else the parents can do other than forbidding their child from participating??
Maybe some of the resident ATCs here have an idea. I honestly don't know. I guess you hope there are some medically minded parents who are kind of keeping an eye on what is happening in the culture of the team, the history of how injuries are managed, etc. THrough other parents anecdotes, I'd listen for signs of coaches retaliating for kids coming to them with injuries, whether coaches refer families for outside evaluation, whether parents "brag" on the sidelines about Jimmy playing through (insert fairly serious injury here).

I also think parents should make sure their kids are well-educated from early on about the seriousness of head injuries, and the parents should hopefully emphasize strongly how we are talking about your brain being injured, how second impact syndrome can be deadly, and how you should absolutely not hesitate to tell someone if you think you are "off." (tougher with a very young child). I guess parents should also be aware and open to taking their kids for *independent* evaluations...but again, the kid needs to be communicating with the parent, and hopefully the child can be open and honest with the parent, coach, ATC, etc without being perceived as a wimp or not dedicated to the team.

Again, I'm totally supportive of sports, but this is also why I would be careful if my child was participating in sports at independent facilities...for ex., gymnastics, where it is unlikely there will be an ATC on site, probably not much oversight of coaches by anyone other than parents, etc.. Not that we should helicopter all aspects of training and so forth, but I wonder about how well many coaches can identify and manage injuries. I mean, I've personally witnessed coaches saying to parents, "oh, that's just X" going on. But really, where is that coming from? They aren't medical personnel. They aren't doing a thorough evaluation, and that's outside of their scope. They may *suspect* it is a specific common injury, but IME, they can be wrong. And I'd say really it is isn't uncommon for them to be wrong. Telling someone to do "ice and advil" for an injury the coach is attempting to "diagnose" (putting that in quotes since it is outside of their scope), etc. can sometimes lead to the athlete missing proper diagnosis and treatment. Yes, coaches usually learn quite a bit about common injuries in their sport, but many do not know how to properly evaluate and diagnose injuries. I would want to know that parents are directed to outside medical care for suspected injuries and so forth. Relying on a coach's judgment for identifying, treating, managing return to play/participation, etc. is IMO iffy at times. I'd want to know the coaches of my children were not afraid to say they should seek outside care.

[dogmom]

Maybe some of the resident ATCs here have an idea. I honestly don't know. I guess you hope there are some medically minded parents who are kind of keeping an eye on what is happening in the culture of the team, the history of how injuries are managed, etc. THrough other parents anecdotes, I'd listen for signs of coaches retaliating for kids coming to them with injuries, whether coaches refer families for outside evaluation, whether parents "brag" on the sidelines about Jimmy playing through (insert fairly serious injury here).

.

Yes, well as a medically minded parent part of the problem is I wouldn't have my kid playing in the highest risk sports, so I wouldn't be there to open up my big mouth. Even in soccer I'm already mulling over how long I will let my son play once they start heading the ball. So I really think the most observant and diligent among us won't be there. And if I saw a culture in a sport my kid did play, like soccer, and I felt that they weren't the kind of group that would enforce concussion rules I wouldn't have me kid playing. I mean, why couldn't the parents just walk out on a field of 10-12 year olds and yank there kids if it was as bad as the article made it sound? I realize it's hard to to, but someone has to stand up for your kid.

[JBaxter]

Here they take it serious. Any HINT of concussion they get evaluated the next day and if you dont pass you get reevaluated the next week no practice no game. < this is high school level> Logan is a junior in college but even when he played pop warner he and got his bell rung his 8th grad year his coach made us have him checked out by his ped. Some do care.

[AngB]

Yes, well as a medically minded parent part of the problem is I wouldn't have my kid playing in the highest risk sports, so I wouldn't be there to open up my big mouth. Even in soccer I'm already mulling over how long I will let my son play once they start heading the ball. So I really think the most observant and diligent among us won't be there. And if I saw a culture in a sport my kid did play, like soccer, and I felt that they weren't the kind of group that would enforce concussion rules I wouldn't have me kid playing. I mean, why couldn't the parents just walk out on a field of 10-12 year olds and yank there kids if it was as bad as the article made it sound? I realize it's hard to to, but someone has to stand up for your kid.

I volunteered in the radiology department of our hospital for several months and most of the CT techs there were adamantly against letting their kids play football, they had done so many head scans on football players especially.

[Cam&Clay]

Concussions are a problem in soccer as well. DS1 is a keeper and has been very lucky even though he's taken a few cleats to the head. His coach cares. Now, she's been known to say, "How high?" when told a player had a fever but when it comes to injuries, she takes it very seriously.

The kids feel pressure to keep playing as well. DS1 knows that he is the only keeper on his team. If he is out, they stand a much better chance of losing. I have to remind him that if he is hurt seriously, he could ruin his chances of playing again ever if he doesn't rest and do exactly what the doctor says.

[sste]

This is interesting - - we are also a medical family as dh is a md and many of our friends are as well. And I have to admit that informs our response. DH has just seen so many awful things happen medically that if there are some that we can prevent, and that prevention is not high-cost to our family, we are there. In the case of football, well, you would have to meet my DS to understand how entirely ill-suited and unhappy he would be playing that sport! A no-brainer.

I will say I have had some major hesitations about gymnastics for DD. DD would love gymnastics and seems very inclined to it already--my safety concern is if she continues which seems fairly likely. We are going to enroll her despite my mixed feelings because the upside for her is so high and I think we can manage the risk.

I just lost multiple members of my family to obesity/diabetes so I am cognizant that inactvity is probably my kids' biggest risk factor. It is not an easy calculus . . .

[brittone2]

Yes, well as a medically minded parent part of the problem is I wouldn't have my kid playing in the highest risk sports, so I wouldn't be there to open up my big mouth. Even in soccer I'm already mulling over how long I will let my son play once they start heading the ball. So I really think the most observant and diligent among us won't be there. And if I saw a culture in a sport my kid did play, like soccer, and I felt that they weren't the kind of group that would enforce concussion rules I wouldn't have me kid playing. I mean, why couldn't the parents just walk out on a field of 10-12 year olds and yank there kids if it was as bad as the article made it sound? I realize it's hard to to, but someone has to stand up for your kid.

Yeah, it is tough. My kids are not suited to football and have never really been interested in soccer. I personally am opposed to football for my own family (disclaimer: went to a high school and college without football so none of it really means much to me, whereas perhaps I'd feel slightly different if it was part of my family culture) and soccer as well once they are heading the ball, as you said. I'm not sure if I'd fully ban it if it was my child's passion, but I would have to think really long and hard about it.

My DS1 plays baseball (fall ball and spring) and that has risks as well. DH was hit in the eye in high school to the point that he still has ongoing issues with vision in that eye and a scarred macula. He had to be seen at an eye hospital, specifically, and it wiped out his chances of playing in college. THat's a lasting and not insignificant injury, although there wasn't much that could have been done to prevent it.

I totally get that sports are wonderful, and they were very important in my life as well as DH's life. But, I definitely have concerns about how injuries are identified, treated, return to play managed, etc. While I don't really want to helicopter, 2nd guess, or micromanage, I dislike the power that many coaches are given. I do think there are many who do take injuries seriously, etc. but I think there's still a lot of coaches out there, especially in the older generations, that do not and will not get it, even with training about the severity of concussions. And I think that concern extends beyond football.

I agree that it is shocking the parents wouldn't just pull their kids, but I guess there are still parents out there where dad played football and just considers a kid "getting their bell rung" part and parcel of the game, and nothing out of the ordinary. Even with the coverage of concussions, etc. I think there are a lot of people who just do not get it. I can't really comprehend any other reason someone wouldn't step in when we're talking 10yos in particular. It boggles my mind.

eta: sste, DD has asked about gymnastics but we are doing ballet for now. I can only handle so many activities per kid. In any case, I have the same concern. I am not willing to outright ban it, and there's a very good chance we'll end up there eventually. I know we'll be paying close attention to the culture of the gym, coach's receptivity to referring out when injuries are present, how injured athletes are directed to train/rest/rehab, etc. I think there are many, many, many wonderful, concerned, fantastic coaches out there doing the right thing. I just think all parents need to really tune into what is going on behind the scenes. I don't think written policies and coaches being trained is enough to be sure things are handled appropriately.

[g-mama]

This is especially relevant for me right now. A few weeks ago, the keeper on my 11yo's soccer team got was lunging for the ball and the player from the other team kneed him in the eye. He was taken off the field and threw up three times. They took him to the ER and it turns out not only did he suffer a concussion, his orbital bone (around eye socket) was broken, and his optic muscle was twisted. He had to have a surgery to untwist it. He will likely have to have a second surgery as his eye is somewhat crossed now.

During the game, the coach for the other team was telling his own player, "you did nothing wrong, he'll be fine, don't even worry about it." He was telling our keeper, "shake it off, you're fine, be tough." So, it was the second half and our coach tried to put the same keeper in the goal as he'd had in the first half since the team only has two. The other coach threatened that if that happened, it would be breaking the rules of the game and he'd make sure it was an instant loss. We won the game and that coach reported it as a loss. Don't you think he might back the hell off GIVEN THE CIRCUMSTANCES?

So, I've since heard that the two boys who were involved go to the same school and when the keeper returned to school, after missing two weeks, the boy who hurt him was shocked to see him wearing an eye patch. IMO, they should've told the boy and his parents what happened! I'm not saying it's definitely his fault, but he was given a yellow card so the referee thought there was excessive force. IMO, the league should send out a message, telling it as a cautionary tale, but acc to my dh, who is a lawyer, he said they're more worried about possibly opening themselves up to lawsuits.

The whole situation scares me to death. DS wants to play football and I've always thought it was too dangerous. Now I feel like it's all too dangerous and I'm destined to be a worrywart.

[MommyAllison]

Thanks for posting. DS is a very athletic kid, and his current love is playing football catch with DH. He seems to be good for his age, but DH and I have already talked and decided that we aren't comfortable with him playing football when he is old enough. BIL played football in high school (lineman) and said concussions were unavoidable in his experience, and he's not sure if he'll let his son play either. However, I hadn't realized the issues extend into soccer now too. DS got hit in the head with a baseball this past spring, and his coach was very watchful of him (he was fine...thankfully 4 year olds don't throw very hard ;) ).

[LizLemon]

Sorry to be dense but what does ATC stand for?

[brittone2]

Sorry to be dense but what does ATC stand for?
Certified Athletic Trainer

[zoestargrove]

This is an area that really scares me as the mother of a very athletically driven 8yo. He plays hockey now, but I think after this year we will take a break. Aside from the risk of injury, the demanding schedule is IMO too much for this age group.

He would LOVE to play football, but we've decided he can only play flag football.

I caught the tale end of an interview on NPR with a doctor who just wrote a book about concussions and kids. http://www.npr.org/2012/10/15/162909960/head-injuries-rattle-even-devout-football-parents

I felt validated in our decision to keep it at flag football. That was his recommendation and even mentioned that Tom Brady's parents didn't allow their son to play football until high school.

Here is a link to his book. http://www.amazon.com/Concussions-Our-Kids-Americas-ebook/dp/B006R8PDNS/ref=wl_it_dp_o_pC_nS_nC?ie=UTF8&colid=OJWE0UOA7Z0T&coliid=I2VCYJQWRQVO9X

[AngB]

I felt validated in our decision to keep it at flag football. That was his recommendation and even mentioned that Tom Brady's parents didn't allow their son to play football until high school.


There are actually at least a couple NFL players that have said they hope their children don't play football (or might not allow them to play) because of the serious injuries (Kurt Warner, Troy Aikman).http://articles.businessinsider.com/2011-02-03/sports/30046454_1_troy-aikman-bryant-gumbel-helmets

[LizLemon]

I felt validated in our decision to keep it at flag football. That was his recommendation and even mentioned that Tom Brady's parents didn't allow their son to play football until high school.
For Tom Brady's parents that may have been a Pyrrhic victory, since he probably accrued much more damage to his brain playing high school, college, and pro-football.

[stefani]

This is especially relevant for me right now. A few weeks ago, the keeper on my 11yo's soccer team got was lunging for the ball and the player from the other team kneed him in the eye. He was taken off the field and threw up three times. They took him to the ER and it turns out not only did he suffer a concussion, his orbital bone (around eye socket) was broken, and his optic muscle was twisted. He had to have a surgery to untwist it. He will likely have to have a second surgery as his eye is somewhat crossed now.

During the game, the coach for the other team was telling his own player, "you did nothing wrong, he'll be fine, don't even worry about it." He was telling our keeper, "shake it off, you're fine, be tough." So, it was the second half and our coach tried to put the same keeper in the goal as he'd had in the first half since the team only has two. The other coach threatened that if that happened, it would be breaking the rules of the game and he'd make sure it was an instant loss. We won the game and that coach reported it as a loss. Don't you think he might back the hell off GIVEN THE CIRCUMSTANCES?

So, I've since heard that the two boys who were involved go to the same school and when the keeper returned to school, after missing two weeks, the boy who hurt him was shocked to see him wearing an eye patch. IMO, they should've told the boy and his parents what happened! I'm not saying it's definitely his fault, but he was given a yellow card so the referee thought there was excessive force. IMO, the league should send out a message, telling it as a cautionary tale, but acc to my dh, who is a lawyer, he said they're more worried about possibly opening themselves up to lawsuits.

The whole situation scares me to death. DS wants to play football and I've always thought it was too dangerous. Now I feel like it's all too dangerous and I'm destined to be a worrywart.


I don't understand... a goal keeper cannot play as a keeper for both halves of the game?

DS plays soccer and sometimes I wonder about the safety aspect of it. Especially against a team that have parents and coaches who are determined to win and their players learn to play dirty.

[Cam&Clay]

I don't understand... a goal keeper cannot play as a keeper for both halves of the game?

DS plays soccer and sometimes I wonder about the safety aspect of it. Especially against a team that have parents and coaches who are determined to win and their players learn to play dirty.

My son is a U14 keeper and is the only one for his team. He always plays both halves.

[tmahanes]

Disclaimer I haven't read the article yet (I should be getting ready for work :) but am on BBB instead)

I am an ATC and I have thought about this a lot. I have control issues so it will be hard for me to have someone else have control since I won't be on the field. :)

My plan is to start very early in whatever sport B chooses to play (which may be a lot of them if he continues like he is now at 2 and a half) in discussing the importance of reporting injuries. He is loving tennis so hopefully that will stay the top sport. Regardless we will start early with discussions about differences between hurts (soreness etc that is normal with exercise) and injuries. From the start I an going to reinforce that absolutely all head hurts or injuries MUST be reported and I am going to explain the risks. Especially with second impact syndrome etc.

When I worked with high schoolers one of the biggest things I tried to do was to reinforce that I wanted to know about all injuries. "But I won't get to play" is a very prevailing mentality. My response was always I an not going to hold you out for the fun of it. If I hold you out it will be because you playing will cause further injury.



Sent from my DROID RAZR

[o_mom]

I don't understand... a goal keeper cannot play as a keeper for both halves of the game?

DS plays soccer and sometimes I wonder about the safety aspect of it. Especially against a team that have parents and coaches who are determined to win and their players learn to play dirty.

In soccer a player who has been taken out by substitution cannot return to the game. You don't usually see it at lower levels, though.

[g-mama]

In soccer a player who has been taken out by substitution cannot return to the game. You don't usually see it at lower levels, though.

I don't exactly know if it's this, or that they don't allow one keeper to play more than half the game. I think it's that they don't allow one goalkeeper to play the entire game in our league, and it's been that way since they began having goalkeepers at age u9. I've never understood it, but we always happened to have just one good goalkeeper so it's unfortunate.

[stefani]

In soccer a player who has been taken out by substitution cannot return to the game. You don't usually see it at lower levels, though.

Ah, got it! Thanks for the explanation. At DS's current level (he plays one age bracket up) players are substituted in and out. Usually every "quarter" (half of 2 halves) but as needed if a player looks tired, hurt, etc.

[o_mom]

Ah, got it! Thanks for the explanation. At DS's current level (he plays one age bracket up) players are substituted in and out. Usually every "quarter" (half of 2 halves) but as needed if a player looks tired, hurt, etc.

It may be another rule in that particular league (as g-mama said). However, I know when I played HS (eons ago), we could sub at will, but then in college, there were more stringent rules - FIFA rules are even more strict.