In an office adorned with brightly-colored athletic jerseys on every wall, Kevin Crutchfield—director of LifeBridge Health’s Comprehensive Sports Concussion Program—practices neurology as if it’s a stand-up act. During this morning’s concussion clinic, Crutchfield reaches into his doctor’s bag (“my toy bag,” he calls it) to produce a small oregano-filled canister to test a patient’s sense of smell, then guides another patient to walk heel-to-toe toward what he calls his “time-out” corner, and holds yet another young man hostage to ensure that—despite headaches caused by a series of football- and ice-hockey-related collisions—the patient hasn’t lost his ability to laugh at Crutchfield’s never-ending arsenal of corny jokes.

“This is what I call my numbskull treatment,” says the neurologist as he numbs the teenager’s skull before injecting him with an occipital nerve block to alleviate severe headaches. (The patient alternately winces in pain and smiles.)

Laughing matters aside, Crutchfield, who learned the tricks of his trade during a residency at Walter Reed National Military Medical Center, approaches his role with missionary zeal as he spreads the gospel of concussions to patients (including Ravens and Orioles players), parents, athletic directors, and anyone else within earshot. His message is loud and clear: Concussions are a medical issue to be reckoned with, and, if not treated correctly (ideally, within 48 hours in Crutchfield’s book), can cause devastating problems, both long- and short-term, to the brain.

Within the past four years or so, concussions, commonly found in high-contact sports, have become a topic of increasing concern and controversy as stories of the injury’s aftermath—early dementia, depression, visual processing, and even death—come to light. Although researchers have studied the issue for decades, about four years ago, “the NFL admitted they had a problem,” says Crutchfield, a former soccer player himself at St. Mary’s College. “They stopped sweeping it under the rug.” Landmark congressional hearings in 2009 led to more stringent rules in the NFL, preventing players from returning to practice or a game if significant signs of a concussion were shown.

These days, the spotlight shines on the playing fields of youth sports—from the lacrosse rec leagues at Brooklandville’s Meadowood Regional Park to the football field at Dulaney High School—amplifying the need to tend to these injuries seriously and urgently at every level. What happened in the NFL, says Andrew Tucker, Ravens’ head team physician and medical director of sports medicine at MedStar Union Memorial Hospital, has “focused our attention even more so on concussions and on the importance of taking very conservative care not only in the football league, but in youth sports where people start their careers.”

Fourteen-year-old Coral Dittmar, who attends George Fox Middle School in Pasadena, was playing club field hockey when an out-of-control ball socked her straight in the temple.

“It completely knocked her off her feet,” recalls Coral’s mom, Ginny. “She had a huge bump that looked like a horn sticking out of the top of her head.”

After being evaluated at a local emergency room, Coral was sent on her way. “We were told it was just a bad contusion,” says Ginny. “They said because she hadn’t lost consciousness or vomited, it wasn’t a concussion.” But a year and a half after the initial accident in October 2010, Coral still suffered from balance and memory issues. After a referral to Crutchfield’s clinic, Ginny learned that her daughter had, in fact, suffered a concussion. “I thought that if it was a concussion, it would have been something they’d pick up that day,” says Ginny. “I never expected she’d still be suffering.”

In part, because there is no standardization of concussion care, Coral is one of many kids who didn’t even know that they had a concussion until much later.

“We are still fighting the mentality of, ‘Oh you dinged yourself,’” says Bill Ashton, sports medicine manager at LifeBridge Health. “We like to say, ‘It’s not just a sprain, it’s your brain.’ Kids need to understand you need your brain for everything. It’s not like treating a pulled muscle or a broken arm.”

Part of the issue, experts say, is that concussions can be tricky to diagnose. “Brain injury is what we call the silent epidemic,” says Bryan Pugh, executive director of the Brain Injury Association of Maryland. “You look typical, but the eggs are scrambled.”

Though there’s still a long way to go, the hope is that Maryland’s new youth concussion law (House Bill 858) signed on May 19, 2011, to protect student athletes from the dangers of concussions, will finally raise long-overdue awareness. (Maryland is the 18th state in the country to introduce such a law.) Now, when a concussion is suspected, the law mandates that a student be removed “from practice or play and returned only after clearance by an appropriately licensed health-care professional.”

And although the law is new, it has already had a dramatic impact on the way in which concussions are handled.

“In the olden days, it was no exercise for a week and then it was okay to go back into the game,” says Paul Bernstorf director of athletics at St. Paul’s School for Boys. “The severity of the injury didn’t matter. Now, it’s a gradual re-entry to play.” (Interestingly, private schools are exempt from the law as it is written, but most schools have their own protocol to protect students.)

While some studies suggest that concussions among student athletes are on the rise, it is hard to say whether sports have become more competitive or whether, with growing awareness, the reporting rates are simply higher. Crutchfield has his own theory. “Athletes are bigger, and they are faster these days, so the force of impact is greater. . . . It’s like running into a train.”

When Crutchfield joined Sinai in 2008, he recognized a need to grow a comprehensive clinic that specifically addressed the multifaceted issues surrounding sports concussions. By fall 2009, he helped expand the mild brain-injury program of Sinai’s Berman Brain & Spine Institute and initiated the development of the Comprehensive Sports Concussion Program, the first integrated interdisciplinary mild brain-injury program on the East Coast.

Eighteen-year-old Kyler Barrett, a recent graduate of Marriotts Ridge High School in Howard County, is among the clinic’s many patient athletes. Barrett was first injured in the fall of 2009, during a high-school football game. “He never came out of the game,” recalls his mother, Robin. “We don’t know when it happened. He said he felt a little ‘off,’ but he thought he was hungry.” Two days later, Kyler was diagnosed with a “mild concussion” at a local hospital. And though the symptoms have ebbed and flowed, nearly three years (and 10 doctors) later, Barrett is still suffering. Under Crutchfield’s care, he will possibly undergo surgery to alleviate his crippling headaches.

“I know people who have had concussions and they talk about headaches,” says Barrett. “But I wish that all I had was the headaches. I’ve had violent mood swings, depressions, sleep issues. Over time you learn to cope with it.”

With cases this severe, some parents are re-evaluating their decision to let their children play contact sports at all.

Betsy Berner’s daughter Naomi, a multisport athlete at Park School, has sustained two concussions (although one was the result of a fluky accident off the field.). Now, Betsy struggles with whether or not to let Naomi play.

“I guess you have to weigh the risk of injury against the very real benefits like leadership, teamwork, increased strength, and agility that are derived from playing team sports,” Betsy says. “I don’t know what the answer is.”

But Michael Dvorkin, an orthopedic surgeon whose son, Garrett, plays football at Gilman, puts his faith in the coaches and educators at that school.

“Gilman School considers its athletes’ health and well-being their first priority,” he says. “As a parent, this eases my mind and I have complete trust in the program.”

Crutchfield says that when a child gets concussed, parents often have one of two extreme reactions: Either they remove the child from the field of play entirely or they rush him back too soon.

“I would hope that every parent is more concerned with their child’s brain as opposed to a sport,” he says, noting that as awareness has increased, parents have become more cautious.

But he feels that if the concussion is treated properly—that is, as an emergency and within the first 48 hours—the risks of permanent brain damage are greatly decreased.

Too much delay in treatment (or the wrong kind of treatment) as was the case with Kyler Barrett, can result in no resolution of symptoms or lead to surgery, says Crutchfield. “If I can [immediately] guide the brain down the proper path of recovery, it’s so much easier than six months or a year later,” he notes.

Thirteen-year-old Grace, the daughter of WBAL-TV anchor Lisa Robinson, was one of the lucky ones. She was referred to Crutchfield’s clinic within 48 hours of a collision during basketball practice at The Bryn Mawr School where she was captain of her middle-school team.

“The other player’s head hit me right on the side of my face,” recalls Grace, who had also suffered a concussion the previous year. “I was hurt so badly, I couldn’t see straight, and my coach had to help me walk to the trainer’s office.”

Although Grace was back at school the next day, Robinson recalls getting a phone call at the station. “They said, ‘You have to come get Grace. She just doesn’t seem herself.’”

In Crutchfield’s office the next day, it became clear that Grace had, in fact, suffered a concussion. “He did the balance test with me, and my balance was awful,” says Grace. “He referred me to do the Wii Fit every day as therapy.”

Within several months, Grace was able to return to sports and feel more like her old self. Though happy to be symptom-free, she was less happy about saying a final farewell to the clinic. “On our last appointment she turned to me and said, ‘You mean I don’t get to go anymore?’” says Robinson, laughing at the memory.

Kid-friendly is exactly what Crutchfield is aiming for as he establishes his clinic as the go-to place for young athletes. “The message to kids when they walk through the doors is that this is their clinic,” he says.

And if it’s up to Grace, who has become something of an expert on the matter, the concussed will keep coming to Crutchfield.

“Every time she sees someone who appears to have a concussion,” says Robinson, “she gives out Dr. Crutchfield’s number.” Adds Grace, “I’ve given the balance test right there on the court.”

For 18-year-old McDonogh senior Tyler Meagher, the hardest part
about last year’s prom wasn’t deciding who he was going to take—that
would be his girlfriend, Payton Sanchez—but how he was going to ask her.

“My girlfriend hates being the center of attention,” explains Meagher, “so I decided to make her the center of attention.”

His idea: to post a series of cardboard signs, beginning at the end
of her Towson driveway and ending many miles away at the McDonogh School
in Owings Mills.

“The first one said, ‘How Many People Do You Think Will See This?’”
recounts Meagher. Another sign was posted at the Reisterstown Road
Beltway exit.

“Finally, at the entrance to McDonogh, I had a 30-foot sign that read
‘Payton, Prom?’ with me standing under it,” Meagher says triumphantly.

Sanchez was sufficiently mortified. “All the school buses drove past
the signs, so everyone saw them,” she says. “It was definitely
embarrassing.”

Still, Meagher’s efforts were rewarded.

“Her first reaction was, ‘I’m going to kill you,’” he laughs. “But she did say yes.”

Gone are the days when going to the prom meant streamers strung up in
the gym and brownie bites baked by the PTA, where dates were arranged
spontaneously while standing in line in the school cafeteria. This teen
rite of passage has experienced seismic shifts in the past few decades,
from wedding-worthy proposals to limos, and ripped-from-the-runway
dresses.

“Prom is their red-carpet moment,” explains Marissa Grumer, senior
market editor at Seventeen. “They understand that this is their moment
to feel in the spotlight in a way we didn’t growing up.”

These days, the prom is a multi-billion dollar industry that has
spawned a slew of magazines, prom-related websites, and blogs with
important tricks, tips, and trends. (At promblogger.net, there’s even
advice on how to earn the coveted prom queen crown: “Be fun and happy.”)

But the biggest trend of the past few years is the all-important “ask.”

“The newest thing is how they ask each other to prom,” explains
makeup artist Lauren Rutkovitz, owner of A-Style Studio, a Pikesville
boutique that also specializes in event makeup. “And kids will go to any
lengths.”

Adds Grumer, “There’s this showmanship that goes on that mimics
weddings, and the guys get really into it. People come up with songs and
tap into the social media by putting them on YouTube.”

The ask is a throwback to old-fashioned romance and courting rituals,
says Josh Coonin, a Pikesville High School graduate, now a sophomore at
New York University. “At Pikesville High School it is imperative to ask
in a clever way. The pressure is on to make the girl feel really
special.”

There are two ways you can ask, Coonin says. “There is the public
way, such as spelling out the question in tennis balls on a fence as
someone I know did,” he notes. “And there’s the more private way. You
have to think about which way the girl might like.”

Coonin himself choose the public approach, sending hand-delivered
notes during every school period via a messenger to his would-be date.
“Each note rhymed, and the last one said, ‘Will you go to prom with
me?’” he says. “And then, when she came out of her last class, I was
waiting outside the door to get the ‘Yes.’”

Whether public or private, the sky’s the limit—quite literally—when
it comes to inventiveness. When Owings Mills High School student Matthew
Rosenfeld and his girlfriend, Carly Feldman, went skiing in Vermont
with Feldman’s family, Rosenfeld decided to stage his ask while on board
a Southwest Airlines flight.

“Since everyone did creative things, I knew I had to think of
something,” says Rosenfeld. He distracted Carly while her mother huddled
with the flight attendant. And right after giving the seat-belt
instructions, the flight attendant proceeded to announce: “Carly,
Matthew wants to take you to prom.”

“I think I was more embarrassed than she was,” Rosenfeld says.
(Ironically, Rosenfeld tore his ACL just before prom. “I couldn’t even
dance because I was on crutches,” he says laughing. “The build-up to
prom was definitely the best part.”)

Another common practice? Enlisting teachers as collaborators.

“One year, I had a student who knew I was doing a PowerPoint
presentation in honors pre-calculus say, ‘I really need help in asking
my girlfriend to prom,’” recounts McDonogh Upper School math teacher Jan
Kunkel. “And I said, ‘How about we sneak in a slide amongst exponential
powers?

A slide came up that said: “‘Taylor, prom? Love, Matt.’”

“Taylor was truly confused,” chuckles Kunkel. (But she said yes.)

This wasn’t the only time Kunkel was recruited to help with an ask
(once her Australian shepherd pup, Tiamo, even got in on the act), and
she’s all for it. “It’s never an inconvenience,” she says. “It’s always
so important to them. It’s a no-brainer. I don’t have any reservations
about helping—I think it’s fun.”

Yet another McDonogh student, Joshua Johns, staged his ask around a
mandatory Upper School assembly, combining then-girlfriend Madelyn
Rubenstein’s love of rubber duckies, photography, and electronic dance
music (dubstep).

“She sat in the front row at the assembly,” recalls Johns, now a
freshman at College of Charleston, “and I had made a YouTube video set
to dubstep music. The video played, and a spotlight shined on her. She
came up on stage and sat next to a 12-foot papier-mâché rubber ducky I
had made with the help of a theater teacher.”

As if that weren’t enough, Johns sealed the deal with a move that was
wedding worthy. “I got down on one knee when I asked her,” he recalls.
“And that was it.”

Baltimore businesses are catering to prom’s growing popularity, as
the end-all event—“a Cinderella moment,” Karen Mazer owner of
Synchronicity Boutique calls it—in a high-schooler’s life.
Synchronicity, where dresses are registered to ensure no two girls wear
the same frock, recently transformed itself from a trendy tweens and
teens boutique to a year-round special-occasion shop where celebrity
prom designers such as Tony Bowls stop by to press some sequined flesh
and show off their latest lines of dresses. The store was forced to
expand from three to 11 dressing rooms to accommodate all of the prom
traffic.

“How crazy is this?” asks Mazer, who sold more than 1,000 dresses
(ranging in price from $150-800) last prom season. “This is the worst
recession in anyone’s lifetime, and I’m expanding and improving.”

Indeed, some experts say that treating the prom like it’s the Oscars is just another example of excess in today’s youth culture.

“This generation of young people thrives on immediate gratification
and less boundaries,” says Park Upper-School counselor Krista Druhv.
“There is little happening in moderation.”

Even so, Druhv believes that proms serve a purpose in getting kids
ready for the next chapter of their lives—as long as it’s all kept in
perspective.

“There is something really healthy about mulling over whom to go to
prom with, dressing up, having a nice dinner, and dancing all night,”
she says, “But I know it’s possible to do that without going broke or
worrying about the superficial short-term gain of a $3,000 gown and
teeth whitening.”

And then there’s the fear that the actual event won’t live up to all
the hype. But, with the exception of poor injured Rosenfeld, most of the
students we interviewed said that simply wasn’t the case.

“The build-up was so great,” says Coonin, “that I didn’t know how it
would go. But I was on the dance floor with my friends all night, and
there was very little of what is referred to as ‘prom-a’.” (Think:
rhymes with drama.)

In the words of Pikesville High School Class of 2010 graduate, Hannah
Marcin, who served on the Senior Prom Committee, “It gives you
something to look forward to at the end of senior year. I loved high
school, and it was the grand finale. Even two years later, I still feel
like prom was the greatest thing ever.

Sixteen-year-old Anna Hiser has been planning her costume for this month’s Otakon since last October. It’s only her second time attending the annual Japanese anime (or animation) conference, but the rising senior at Notre Dame Preparatory School has already become fully immersed in the Otaku culture.

Anna fell in love with manga (Japanese comics) five years ago, when her neighbor loaned her one of his books. Last year, she attended her first conference and was immediately hooked. She felt, for the first time, like she was surrounded by thousands of people who simply got her.

“The very idea of Otakon is that there is no judgment at all,” Anna explains. “You can show up in the most crazy, bizarre outfit and you would get a round of applause. It’s just great energy, and I have never met one unpleasant or unfriendly person there. The craziness just comes out of the walls!”

Costumes, or “cosplay,” are a major part of the conference. The main goal is to be able to enter into the character’s world and actually become that character for a weekend. Fellow conference goers take pictures, ask for autographs, and even call the attendee by the character’s proper name. This year, Anna has decided to dress as “Hungary” from the manga Hetalia Axis Powers. Her costume will consist of a white apron, a bow tie, an olive green dress, and a white kerchief fashioned into a hat.

Since much of her costume is homemade, Anna relies on her mother, architect Helen Hiser, for trips to fabric and craft stores. This resulted in an inevitable crash course in anime/manga for Helen. And while some parents might be freaked out by the outrageous and elaborate nature of the costumes, Helen is impressed by her daughter and her Otakon friends.

“Although there are a few [costumes] that aren’t especially appropriate, the vast majority are amazing,” she says. “They’re very creative; obviously, the wearers put a great deal of thought and work into them.”

Anna’s father, Fred, also an architect, echoes his wife’s sentiments: “The first time I saw Anna in her Otakon costume, I was very excited for her because I know that it is something that brings her great joy, and that she is having a lot of fun.”

Lisa and Michael Martin have also kept their hearts and minds open when it comes to their son Luke’s passion for all things anime. In fact, they took him to his first Otakon convention seven years ago, when he was just 10. When they were kids, they say, they were more into competitive sports and less into comic books and Star-Trek-convention-type stuff (which they see as the Otakon of their time). However, they have embraced the Otaku culture, for Luke’s sake.

“The first year was a little scary because I have never seen anything else like it—ever,” Lisa recalls. “My husband at first was like, ‘I don’t know.’ It was definitely a whole new world for us. But this will be his seventh year going, and it is nothing like you would expect. It is so much more about people expressing their creativity and artistic side.”

What’s more, the Martins are convinced that this is no mere phase for Luke, who will be a senior next year at Loyola Blakefield. He’s working hard on turning his passion into a career. This summer, he is taking a three-credit course at MICA in animation and hopes to build a future in the art and design world.

“It is one of the top things I look forward to out of the year,” Luke enthuses of Otakon. “It is three days of absolute paradise. I know of 20 or 30 other [kids] that would say the exact same thing.”

Anyone who has been around the Inner Harbor on the last weekend in July has already experienced the Otakon conference in some way. Numerous teens roam the streets, dressed up as unrecognizable (and sometimes scary) animated characters—as throngs of people photograph them. It is not uncommon to see swords, tails, 10-inch platform shoes, striped tights, and even stilts.

Baltimore hosts one of the largest Japanese anime/manga conventions in the country. And while the Otakon community is still small enough to remain shrouded in mystery, it’s large enough to attract 26,000 people every year and generate $15.3 million for Baltimore City businesses. (And according to Otakon officials, it’s not just kids who attend; the conference attracts enthusiasts ranging in age from 10 to 65 years old.)

Last year alone, 4,575 hotel rooms were booked for the Otakon weekend. All three days are jam-packed with concerts, karaoke, art galleries, video game rooms, panels with guest speakers on Japanese culture, and live action role playing (LARP) activities.

Luke’s friend Nick Anstett, also an incoming senior at Loyola Blakefield, attended his first Otakon convention last year. He dressed, somewhat conventionally, as Peter Parker from the Spiderman comic. But this year, he’s really getting into the spirit of things, dressing up as Nyan Cat, a Japanese Internet sensation with a pink coat and a rainbow tail.

“You are more a part of the community when you dress up,” he explains. “It is so neat to be a part of the experience.”

Nick’s father, Frank Anstett, takes a little credit for his son’s involvement in the anime community.

“I am maybe guilty of getting Nick started in it with my interest in ’50s and ’60s sci-fi movies,” he admits. “The Trekkie stuff was always centered around one common theme—but this brings out a lot of different expressions and story lines, which definitely fuels creative expression. I live vicariously through Nick and look forward to pictures of what he saw, what he did, and the panel discussions he attended.”

Counselors who focus on adolescent development emphasize that Otakon—and other conferences of its ilk—are a completely normal part of growing up.

“High school is hard,” says Dr. Arachchige Muthukuda, who specializes in children and adolescence at Sheppard Pratt. “The transition is difficult. College is in their head, the pressure from peers. There can be a lot of rejection and [teens] become highly sensitive to finding their own identity. It comes down to a matter of being accepted.”

And Dr. Linda Baker, the psychology chair at University of Maryland, Baltimore County, says that finding a simpatico peer group is almost always a healthy step. “Peers play a vital role in socialization at all periods of development,” she says. “[High school] is the time when children are actively seeking an identity, and their sense of self includes a social self. Adolescents define themselves, in large part, in terms of who their friends are. Children who are not accepted by their peers typically do not fare as well in school and in life as those who are accepted.”

As for Otakon’s over-the-top costumes, Baker says that parents shouldn’t be in the slightest bit alarmed.

“Teens learn important skills as they devote time and effort into creating the costumes,” she notes. “It is important that teens have a chance to find their passion, and to express it, even if that passion is not one that parents can readily appreciate.”

And more and more, the parents of Otakon kids do seem to appreciate the conference, and all its trappings—as long as their children take a few precautions.

For one, “the cell phone is a wonderful thing,” says Helen Hiser. In the past, a kid at such a convention would have no way of communicating with home. Now, if they need help, a ride, some money, even a safety pin to hold up a torn costume, mom and dad are just a speed-dial button away.

Also, there is safety in numbers. Most of these kids go with groups of friends (or make new friends the first time they attend) and, often, the parents become friends with each other. These relationships help ease the trepidation of dropping a child into an unfamiliar world.

“It’s a little unnerving to have your 15-year-old girl going to the convention where there are 26,000 people,” says Helen. “It was definitely a little bit of a leap of faith. But the kids were going to go in a group, and I knew the friends and their parents so there was a level of comfort in that.”

It helped that Anna’s Otakon friends are her “regular friends,” Helen says, the ones she brings home after school. “They are, without exception, smart, funny, highly imaginative, and a joy to have around. Very cool people.”

Ultimately, ghoulish or edgy as it may seem, the Otakon conference really has become something of a family affair. Whereas once popular role-playing games like Dungeons & Dragons or Magic: The Gathering were played in locked basements or other “no-parents-allowed” zones, Otakon is out in the open. Families like the Martins, who live in Baltimore County, have gone so far as to reserve a downtown hotel room for the entire span of the event. (This year, Nick will be staying with them.) For out-of-town visitors, the July weekend in Baltimore is like a freaky trip to Walt Disney World.

Whether the parents actually participate in some of the conference events or just use it as an excuse to go sightseeing or shopping in Baltimore, it all speaks to the growing acceptance of the entire genre and lifestyle.

“If you’re a parent that’s worried,” Helen says, “probably the best way to sort of see what Otakon is all about is just to go.”

And Fred Hiser couldn’t be happier that his daughter is part of this eccentric and lively community. “[Anna and her friends] are able to be creative and imaginative through Otakon,” he says. “They read a lot and are really into theater and the arts, and this is just another outlet. Doing something where they aren’t taking drugs or drinking and are accepted by their friends? What more could I ask for?”