The Youth Sports Machine: Destructive Juggernaut or Vehicle for Success?

Recently, the Aspen Institute’s Project Play released its State of Play 2016 (²³) which provided a mixed review on the topic of youth sports and physical activity. The good news: regular team sports participation for kids increased in 2015 to 40%. The bad news? Kids who are active in sports to a “healthy level” — defined as engaging in high-calorie burning activities a minimum of 151 times during the year — continued to decline, to 26.6%. Other credible sources (^12,20,28) have identified a boom in travel team participation, in which a “pay-to-play” environment has left many kids out of the lineup. The economic divide in youth sports has become increasingly apparent: in 2015, only 38% of kids from homes with income ≤ US $25,000 played team sports, compared with 67% of the kids from homes with household income > US $100,000 (²³). Early single-sport specialization remains a key contributor to declining activity, as overuse injuries, burnout, and lack of athletic development have troubled youth participants who choose to focus on one sport prematurely (^3,23). The average child athlete now plays fewer than two team sports, according to data released by the Aspen Institute (²³) — a rather notorious milestone since recording data on this topic began nearly a decade ago.

Many in the lay press and sports medicine communities have posed the following question: Is the professionalization of youth sports (complete with single-sport specialization, year-round training, weekend travel, and sacrifice of family and non-sports events) promisingly productive or tantalizingly destructive?

Since 2001, the American Academy of Pediatrics (AAP) Committee on Sports Medicine and Fitness has issued iterative policy statements acknowledging the benefits, as well as the risks and limitations of organized sports programs (²⁷). In early versions, the focus was on how organized sports could 1) reduce injury through rules, protective equipment, and adult supervision; 2) reduce obesity-related health complications; 3) negatively affect physical maturity and the youth psyche; and 4) tarnish kids’ sports experience through parental and adult influence. Fast forwarding to 2017, few would disagree that the level of sophistication and complexity of organized youth sports — steadily evolving from a cottage industry to big business — has increased exponentially since the original AAP publication nearly two decades ago. Reaffirming such a policy statement today would be a daunting and unenviable task.

As two practicing pediatric sports medicine physicians and fathers of young athletes, the authors of this commentary have “tackled” this topic on several occasions, presenting at various academic meetings and writing on related topics (^13,14). Each time we delve into this issue, we find new examples revealing the dark underbelly of youth sports participation, inspiring us to share our findings with our colleagues who struggle with these same issues. Unfortunately, 2017 has thus far proven to be no different than recent years, providing ample content (^1,6,17,21) for youth sport advocates to analyze and develop research, policy, and commentary initiatives. Collectively, these avenues have potential to protect our youth from the perils of adult influence on sport.

Do youth sports do any good from physical activity, academic, and psychosocial perspectives? Recent peer-reviewed literature and real-world events provide stakeholders an opportunity to update the AAP policy statement on youth sports participation. In short, there is the good, the bad, and the ugly.

Regarding the good: Teneforde et al. (²⁴) performed a systematic review of the literature and found that participation in sports during early puberty may enhance bone mass, but only continued sports participation in physical activity provides the full benefit of increased peak bone mass in adolescents. Dohle et al. (⁴) surveyed a random sample of World War II veterans and found that playing a varsity high school sport was the single strongest predictor of later-life physical activity. Fox et al. (⁹) performed a survey of metropolitan middle and high school students from diverse racial, ethnic, and socioeconomic backgrounds and concluded that among high school females, moderate-vigorous physical activity and team sport participation were both independently associated with higher grade point average (GPA). Conversely, among high school males, only team sport participation was independently associated with higher GPA. Eime et al. (⁵) published a systematic review of 30 manuscripts, citing improved self-esteem, social skills, self-confidence, competence, and reduced depressive symptoms as the most common psychosocial benefits of youth sport participation. Additionally, youth athletes participating in team sports had improved health outcomes compared to individual sport participants, including less risk-taking behavior, less psychological and general health problems compared to nonparticipants, and less depression, hopelessness, and suicidality, even when controlling for physical activity levels.

And what about the physical, mental, and psychological health risks — the “bad” of youth sport participation? David Fleming provided insightful commentary (⁸) on Pee Wee football players participating in the Oklahoma drill, a controversial hitting drill even at the college and professional level. Stamm et al. (²²) investigated the relationship between age of first exposure to organized American football and adult brain function in former professional players, identifying an association between tackle football participation before age 12 years and later-life cognitive impairment, raising an important question: is the cumulative exposure or the age of first exposure to collision sports more detrimental to an athlete later in life?

Numerous lay sources (^7,18,19) have revealed growing exploitation in youth sports, with verbal commitments to Division I schools becoming more common in 8th grade. Early recruiting practices have become more common particularly among “lower revenue” sports such as lacrosse and in women’s sports, as there are fewer women competing for collegiate roster spots than men (^10,25). The psychological and physical toll of this exploitation on early adolescents is substantial: early commitment creates a culture of increased exposures (e.g., multiple leagues, showcases, etc.) at a younger age which often translates into increased injury, increased anxiety, and increased burnout as the selection process favors those who mature early over “late bloomers.”

And then there is the “ugly.” Mountjoy et al. shed some light on the VERY dark side of youth sports in a consensus statement published by the International Olympic Committee, acknowledging the pervasive nature of bullying, harassment, hazing, and physical/psychological/sexual abuse in competitive sports (¹⁵). Arguably, the worst-case scenario of youth sports is the potential for physical and sexual abuse. Unfortunately, 2016 abounded with stories of this behavior across the globe. USA Gymnastics faced a crisis when its team physician was found to have sexually abused multiple young women during his tenure. In an evolving situation, the effects of this scandal are shaking the very foundations of the organization (⁶). These incidents of abuse are not confined to the United States. Youth soccer in the UK faced its own crisis, with the NY Times reporting that “at least 20 police forces across Britain have opened investigations into 83 suspects in cases involving about 350 possible victims and 98 soccer clubs from the amateur level to the Premier League”(²).

Let us be clear. The authors of this commentary are involved at different levels in several youth sports programs. As much as we note (and bemoan) the negative impact on the institutions where such abuse takes place, our real concern is with the hundreds of victims. These unfortunate youth will be facing long-term and extremely damaging costs to their physical and mental well-being. A young but growing literature demonstrates that the various abuses seen in youth sport are associated with issues including disordered eating, substance abuse, anxiety disorders, post-traumatic stress disorder, depression, self-harm, and suicide (¹⁵).

What appears to be a crisis in youth sports has stimulated many to address the problems and strengthen the positives. The subject of “safeguarding” in youth sports has gained traction (^16,26). Some stakeholders are arguing for youth sports clubs to consciously adopt World Health Organization (WHO) principles on health promotion embodied in the “Ottawa Charter” (¹¹). In this model of health promotion as it applies to youth sports, the emphasis is placed on young people’s social, physical, and mental well-being, while traditional concepts of competition and skills development are deemphasized. UNICEF has declared that any organization providing for sports activities for children should have an eight-point safeguarding policy in place (²⁶). Among the principles contained in this policy, there is a proactive stance taken to address issues such as the potential for physical and sexual abuse.

We believe strongly that youth sports can be a profound good for all involved, from the children themselves to the adults entrusted to care for them. But the various stakeholders in youth sports cannot ignore the “bad” and the “ugly” that we have touched on in this commentary. We call out to our fellow professionals in health care involved in pediatric sports medicine to become involved in advocacy. There are many serious public health issues in youth sports. We must go outside the boundaries of our typical clinical world and become involved on a broader level in this enterprise if we are to ensure that youth sports in the coming decades is a productive, and not a destructive, venture.