OBJECTIVE: To identify enduring prolonged neuropsychological effects of cerebral concussion in high school youth athletes. METHODS: High school athletes (n = 223) underwent baseline neuropsychological evaluation between 1999 and 2000, assigned to independent groups on the basis of concussion history: athletes with no concussion history or present medical and/or neuropsychological complaints (n = 82), symptom-free athletes who experienced one (n = 56) or two or more (n = 45) concussions (not in the prior 6 mo), and those who experienced a concussion 1 week before testing (n = 40). Main outcome measures included a structured clinical interview, demographic form, symptom checklist, the Repeatable Battery for the Assessment of Neuropsychological Status, and the Trail Making Tests A and B. Analyses of variance were used to determine between-group differences. RESULTS: Athletes with recent concussions performed significantly worse on measures of attention and concentration than youth athletes with no concussion history. Symptom-free athletes with a history of two or more concussions performed similar on testing to youth athletes who had just experienced a recent concussion. Similarly, cumulative academic grade point averages were significantly lower not only for youth athletes with two or more previous concussion groups, but for youth athletes who experienced recent concussions, suggesting that athletes with lower grade point averages may be more prone to concussion. CONCLUSION: There seem to be subtle yet significant prolonged neuropsychological effects in youth athletes with a history of two or more previous concussions.