PORTSMOUTH — Dylan Mello’s been a soccer player for as long as he can remember. The sport is in the Portsmouth High School senior’s blood, passed down by his father, Humberto, who played in high school, along with his brothers, and later coached his son. Dylan has several cousins playing at the college level now.

But Dylan no longer suits up with his high school teammates. The 17-year-old with thick, shaggy black hair sits on a bench, watching them run up and down the field. It may be a puzzling sight for those who know what a fine athlete he is and how much he loves to play. After all, Dylan has not been disciplined by his coaches and he appears physically fit.

He’s not. Dylan’s hurt. You just can’t see it.

Dylan experienced three separate concussions last year — one while playing hockey, two on the soccer field. Not long after his last one, which occurred last December after he was still feeling the effects of a previous hit, a concussion specialist recommended that he be benched for the rest of the academic year to allow his brain time to fully heal.

“I haven’t played sports in seven months,” said Dylan, who has “no idea” what the future holds for him. “I kind of had a plan of playing soccer in college and now that’s gotten disrupted because of all this.”

Dylan’s journey from the playing field to the sideline is a cautionary tale of missed signs, communication breakdowns and parental guilt. Dylan’s mom, Donna Mello, said no one realized the extent of her son’s brain injury while he was playing. If they had, she said, there’s no way he would have been allowed to continue until his brain was properly rested. Now she wants other parents and teenagers to know the dangers of allowing young athletes to continue playing after receiving a serious hit to the head.

“A concussion is worse than a broken limb, because you can’t see the damage. Everyone blames themselves in hindsight for not getting treatment earlier, but the injury is difficult to detect,” said Ms. Mello, noting that even a CAT Scan can’t detect a concussion, which someone can suffer even if they haven’t been unconscious. “Knowing what I know now, I would have consulted with a concussion specialist after Dylan’s first concussion.”

The good news is that Dylan is resting and getting better, while his experience — and that of fellow athlete and friend Matt Chappell — has led to mandatory concussion screenings called ImPACT tests at Portsmouth High School. More about that later.

Same injuries, different outcomes

Dylan and Matt — the latter began his freshman year at Plymouth State University in New Hampshire this week — have been playing hockey together since they were 6 or 7. They both suffered their first concussions on the ice in separate incidents when they were seventh-graders.

“My head slammed into a kid’s chest and on impact, everything was a mess,” said Dylan. “I was only out of school for two days and then I played a week later. It wasn’t a big deal.”

Matt got hit in the boards and his “eyes were going back into his head,” according to his mother, Jamie Chappell.

“My dad was the coach, so he was on the scene. I didn’t play the rest of the game, but nothing was really done about it,” said Matt.

Matt suffered one or two more concussions while playing football as a sophomore and then experienced a more serious hockey hit that same academic year. Ms. Chappell said that for a parent, it was a terrible sight. “His whole body went limp and he just slid like a rag doll into the boards. He was out cold,” she said.

Matt said he was unconscious for three minutes, went to the hospital and didn’t play for a while. He was cleared to compete in sports in his junior and senior years and hopes to play hockey in college.

Dylan, who in 2008 suffered three separate concussions, hasn’t been as fortunate.

As a sophomore, he was hurt during an altercation with another hockey player against the boards. “I continued to play the game, but afterwards I realized that I was in a fog and out of it. I sat down a week or two,” he said.

During a regional soccer matchup that June, Dylan was hit on the side of his head by a cast worn by a much taller and heavier player. (Players are allowed to wear casts if they’re properly wrapped, but the family doesn’t believe that was the case here.)

“I knew right away something was wrong because for 15 minutes I was just out of it,” said Dylan, adding that the team’s trainer told him to come by the next day for a fresh assessment. “I woke up in the morning and I actually felt fine. I felt like I slept it off so I continued to play, which was really dumb on my part. But we figured that it was just a knock.”

Dylan said he played the next game and felt OK. “But the next day, a huge change occurred where everything felt very out of place — dizzy, foggy. It was a weird feeling but it went away and I slept it off,” he said.

Things got worse nine days after the hit, when he started getting bad migraines which kept him up nights. “For six to eight months — that whole summer and halfway through school — I woke up every day with a headache. Everything was spinning,” said Dylan, adding that there were also periods when his heart was racing.

His grades dropped, although he was still doing “OK.” “Everything was harder,” said Dylan, whose mother credits school officials and coaches for being very accommodating to him during his struggles.

Kept playing

Still, Dylan kept playing soccer even though he never felt entirely right. “I don’t have a good way to describe it other than it was like I was drunk,” he said. “I’d go onto the field and feel like I was out of it with a huge headache. But I played because at the time it was the only thing that kept me going. On the field was the only time I didn’t think about it. So it helped me get through that whole period, but it also made it worse.”

He acknowledges not disclosing everything to his parents and coaches so he could keep playing. “They knew I wasn’t 100 percent, but they didn’t know how bad it was,” he said.

And that’s the trap that befalls many young athletes who want to play all the time, said Ms. Chappell.

“I don’t think at the time he knew all of them were (concussions),” she said. “That’s the real danger here. Kids get hit in the head and they just go, ‘Oh, I’ll be OK. I got my bell rung and I’ll be OK in a little bit.’ ”

In December, Dylan competed in a highly regarded soccer tournament in Florida — a showcase for college coaches — with his Providence-based team. He played two games before being matched up against the Georgia state champions.

Dylan never even got a chance to play that third game. After warm-ups, he was leaning down to grab a towel when a kicked ball hit him squarely in his head — the exact spot where he was slammed by that cast six months earlier. For the rest of the day, Dylan had little green dots in his peripheral vision and felt “ridiculously out of it.”

Shortly afterwards, Dylan saw a doctor who specializes in concussions. By this time, Dylan was getting headaches on top of his head, which he had never experienced before. Simply reading or watching TV could trigger them. He quit his hockey team in January of this year and hasn’t played sports since.

The family now believes Dylan may have suffered what is called second impact syndrome — when the brain swells rapidly before the symptoms from an earlier concussion have subsided. It’s a potentially life-threatening condition; last year a North Carolina medical examiner ruled that the death of a high school football player in that state was due to second impact syndrome.

“If you’re not completely healed and you’re hurt again, that’s second impact syndrome,” said Ms. Mello.

Parents need to be vigilant, said Ms. Chappell. Before she learned more about the dangers of athletes taking the field too quickly after a concussion, she said she was “extremely guilty” of allowing Matt to continue playing.

“You have to rest. No TV, no nothing,” she said. “If we were smart in the beginning and knew then what we know now, we would have taken them out of play and introduced aerobic activity back into their schedule and made sure they were headache-free before they went back out and got that second impact.”

Mr. Mello also feels guilty for not taking his son out of sports earlier. “I wish I could go back, but I can’t. You just have to stick to your guns and say, ‘No, that’s it,’” he said.

Ms. Mello said to be safe, all concussions should be treated the same way. “If it appears bad, you’ll perceive it as bad. If it doesn’t appear as bad, like in Dylan’s situation, you won’t perceive it that way. But Dylan is in a worse state right now than Matt,” she said.

ImPACT test

Hoping to spread the word about post-concussion treatment, Matt picked that very topic for his high school senior project. He didn’t stop there. Last year he and Dylan made a presentation to the Portsmouth Athletic Boosters, who were impressed enough to fund the implementation of ImPACT tests at the high school.

The test, which can be taken at home on a PC, tests things like reflexes, word memory and symbol and color matching. Students first take a baseline (pre-injury) test, which is kept on record and compared to a second test taken if that teenager later experiences a head injury. The data collected from the two tests are compared to norms for the age group and are helpful in managing recovery. (Dylan and Matt never had a baseline, which made evaluating their post-concussion test results more complicated.)

“The test measures the brain’s ability to shift, adjust and process information at a normal rate of speed,” according to Dr. Michael S. Sefton, a neuropyschologist who’s implementing the test and analyzing the collected data. “The ImPACT test does a much more careful assessment of neurocognitive functions than anything else out there.”

The test provides doctors with accurate information of how a brain is functioning, which comes in handy when their patients aren’t forthcoming about their symptoms. “It’s quite common; even the professional athletes I work with will lie,” he said.

Although the ImPACT test is not expensive — Ms. Chappell said it costs under $1,000 annually for the entire school — Portsmouth is only the second high school in Rhode Island to offer it.

“Most of the colleges now are using ImPACT. We’d like most of the high schools to have it. It’s good for three years, so the freshmen should take it,” said Dr. Sefton, adding that it’s intended for non-athletes, too. “At one school I work with, there was a child who fell out of bed and suffered a concussion.”

On the bench

Meanwhile, Dylan will continue to watch from the sidelines. He’s putting on a brave face, but his parents aren’t fooled.

At a Barrington round-robin soccer game last week, Mr. Mello watched his son sitting on the bench. “He had his head down. That kind of broke my heart. It’s his senior year and he wants to play so bad. He lives for it,” he said.

Ms. Mello nodded her head. “We never realized how important it was to him until he couldn’t do it anymore — like how much he needed it,” she said. “But I told him, ‘You’ve gotten a second chance. Look at it that way, Dylan.’ ”

But she knows those aren’t the most comforting words for an adolescent, who lives in the moment.

Dylan’s setback complicates his dreams of playing Division 1 soccer, but sitting his senior year doesn’t totally diminish his chances of playing college soccer, said Ms. Mello. “He’s got enough support around him that he might be fine with that because they do have walk-ons in the college world,” she said, adding that Dylan’s exposure to colleges at various “showcase” tournaments will also improve his chances.

At the moment, however, the family’s not even thinking about that.

“Our main goal now is just to get him better,” said Mr. Mello.

Spotting the signs

You can’t see a concussion, so it’s not always easy to tell when a young athlete has suffered from one. Signs and symptoms can show up right after the injury or take days or even weeks to appear.

If your child reports any symptoms of concussion, or if you notice the symptoms yourself, seek medical attention right away. An athlete should return to play only after a sufficient rest period and approval from an appropriate health care professional.

For learn more, visit www.concussionassessment.com.

Signs observed by parents or guardians:

• Appears dazed or stunned

• Is confused about assignment

• Forgets plays

• Is unsure of game, score or opponent

• Moves clumsily

• Answers questions slowly

• Loses consciousness

• Shows behavior or personality changes

• Can’t recall events prior to hit

• Can’t recall events after hit

Symptoms reported by athlete:

• Headache

• Nausea

• Balance problems or dizziness

• Double or fuzzy vision

• Sensitivity to light or noise

• Feeling sluggish

• Feeling foggy or groggy

• Concentration or memory problems

• Confusion

SOURCE: Department of Health and Human Services and Centers for Disease Control and Prevention.