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A single, widely accepted definition of sport specialization does not exist. A consensus definition is necessary to guide youth sport stakeholders on issues associated with sport specialization. The aim of this study was to develop a consensus definition of youth sport specialization and to identify elements that support the construct of specialization. Delphi Study Setting: Directed Surveys Patients or Other Participants: A consensus panel of 17 experts was created to provide a broad multidisciplinary perspective on sport specialization in youth athletes. The final definition was developed per an iterative process that involved four rounds of review. A comprehensive review of literature and expert input supported our initial proposed umbrella definition that included six additional elements. The study team reviewed the results after each round and changes were made to the definition based on panel feedback. Panel members were provided with the definition and six elements and then asked to rate each specific to importance, relevance, and clarity using a 4-point Likert scale. In four Delphi consensus rounds, 17 experts reviewed the umbrella definition and six elements before consensus was reached. The umbrella definition and three of the initial six elements achieved >80% agreement for importance, relevance, and clarity after the fourth round of review. The remaining 3 components did not reach >80% agreement even after iterative edits and were removed. The process resulted in a final consensus definition: Sport specialization is intentional and focused participation in a single sport for a majority of the year that restricts opportunities for engagement in other sports and activities. A consensus-based conceptual definition for sport specialization has been developed using a Delphi method. This definition has important implications for clinicians and sports medicine professionals who support youth athletes.

Background: Early sport specialization is not a requirement for success at the highest levels of competition and is believed to be unhealthy physically and mentally for young athletes. It also discourages unstructured free play, which has many benefits. Purpose: To review the available evidence on early sports specialization and identify areas where scientific data are lacking. Study Design: Think tank, roundtable discussion. Results: The primary outcome of this think tank was that there is no evidence that young children will benefit from early sport specialization in the majority of sports. They are subject to overuse injury and burnout from concentrated activity. Early multisport participation will not deter young athletes from long-term competitive athletic success. Conclusion: Youth advocates, parents, clinicians, and coaches need to work together with the sport governing bodies to ensure healthy environments for play and competition that do not create long-term health issues yet support athletic competition at the highest level desired.

Sport specialization, commonly defined as intensive year-round training in a single sport to the exclusion of other sports, has been associated with an increased risk for overuse injury. Two pathways to becoming highly specialized are recognized: (1) having only ever played 1 sport (exclusive highly specialized) and (2) quitting other sports to focus on a single sport (evolved highly specialized). Understanding the differences in injury patterns between these groups of highly specialized athletes will inform the development of injury-prevention strategies. To compare the distribution of injury types (acute, overuse, serious overuse) among evolved highly specialized athletes, exclusive highly specialized athletes, and low-moderately specialized athletes. Cross-sectional study. Tertiary care pediatric sports medicine clinic between January 2015 and April 2019. A total of 1171 patients (age = 12.01-17.83 years, 59.8% female) who played ≥1 organized sports, presented with a sport-related injury, and completed a sports participation survey. Distribution of injury types (acute, overuse, serious overuse). The percentage of injuries due to overuse was similar between the exclusive and evolved highly specialized athletes (59.2% versus 53.9%; P = .28). Compared with low-moderately specialized athletes, exclusive and evolved highly specialized athletes had a higher percentage of overuse injuries (45.3% versus 59.2% and 53.9%, respectively; P = .001). Multivariate analysis of the highly specialized groups revealed sport type to be a significant predictor of a higher percentage of injuries due to overuse, with individual-sport athletes having increased odds of sustaining an overuse injury compared with team-sport athletes (odds ratio = 1.95; 95% CI = 1.17, 3.24). The distribution of injury types was similar between evolved and exclusive highly specialized youth athletes, with both groups having a higher percentage of injuries due to overuse compared with low-moderately specialized athletes. Among highly specialized athletes, playing an individual sport was associated with a higher proportion of overuse injuries compared with playing a team sport.

Background: The prevalence of adolescent athletes who specialize in sports has increased in recent years. Substantial literature on youth sports has linked early sport specialization to negative consequences, such as burnout and injury. However, empirical evidence directly comparing burnout rates in sport specialization versus sport sampling is very limited. Purpose: To conduct a systematic review and meta-analysis to evaluate psychological burnout in adolescent athletes who sport specialize compared with adolescent athletes who sport sample. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed through use of the PubMed, SportDiscus, PsychInfo, and CINAHL databases (between inception and May 2019) according to PRISMA-IPD (Preferred Reporting Items for Systematic Reviews and Meta-Analyses of individual participant data) guidelines. Results from the 3 measures of the Athlete Burnout Questionnaire and athlete specialization status were recorded and analyzed. An athlete was determined to be a “sport specializer” if he or she met the following 3 criteria: (1) athletic participation limited to 1 sport, (2) which is competed in > 8 months in 1 year, and (3) to the exclusion of all other sports. Results: Of 3578 studies, 8 met criteria for final meta-analysis, which included 1429 athletes (mean age, 15.59 years; range, 12.5-17.2 years). Of these, 1371 (95.9%) were sport specializers, whereas 58 (4.1%) were sport samplers. A total of 1422 (99.5%) athletes completed the Athlete Burnout Questionnaire. Athletes who specialized reported higher levels of burnout than athletes who did not specialize. Specializers had a greater sense of reduced accomplishment (difference of means [△], 0.87; 95% CI, 0.67-1.08; P < .01). Specializers also reported greater exhaustion (△, 0.46; 95% CI, 0.24-0.68; P < .01) and sport devaluation (△, 0.41; 95% CI, 0.22-0.60; P < .01) than athletes who were samplers. Conclusion: Adolescent sport specialization was associated with greater levels of burnout in all 3 aspects (reduced sense of accomplishment, sport devaluation, and exhaustion) compared with sport sampling.

Background: The rate of early sport specialization in professional baseball players is unknown. Purpose: To report the incidence and age of sport specialization in current professional baseball players and the impact of early specialization on the frequency of serious injuries sustained during the players’ careers. We also queried participants about when serious injuries occurred, the players’ current position on the field, and their opinions regarding the need for young athletes to specialize early to play at the professional level. Study Design: Descriptive epidemiological study. Methods: A total of 102 current professional baseball players anonymously completed a 7-question written survey. Early sport specialization was defined as “single-sport participation prior to high school.” Injury was defined as “a serious injury or surgery that required the player to refrain from sports (baseball) for an entire year.” Chi-square tests were used to investigate the risk of injury in those who specialized early in baseball versus those who did not. Independent-sample t tests were used to compare injury rates based on current player position. Results: Fifty (48%) baseball players specialized early. The mean age at initiation of sport specialization was 8.91 years (SD, 3.7 years). Those who specialized early reported more serious injuries (mean, 0.54; SD, 0.838) during their professional baseball career than those who did not (mean, 0.23; SD, 0.425) (P = .044). Finally, 63.4% of the queried players believed that early sport specialization was not required to play professional baseball. Conclusion: Our study demonstrated a statistically significant higher rate of serious injury during a baseball player’s professional career in those players who specialized early. Most current professional baseball players surveyed believed that sport specialization was not required prior to high school to master the skills needed to play at the professional level. Our findings demonstrate an increased incidence of serious injuries in professional baseball players who specialized in baseball prior to high school. Youth baseball athletes should be encouraged not to participate in a single sport given the potential for an increased incidence of serious injuries later in their careers. No data are available to suggest that early specialization is needed to reach the professional level.

Early sport specialization is a growing concern among youth sport athletes, particularly in baseball. Motivation to participate in sports is an important factor in determining which sports youth athletes participate in and why. To qualitatively investigate the youth sport participation behaviors and motivations of collegiate baseball players. Qualitative study. Online teleconference. We conducted 25 semistructured interviews with collegiate baseball athletes who were classified as high-level (n = 8), moderate-level (n = 9), or low-level (n = 8) specialists before college. Participants completed individual semistructured interviews to allow us to develop an understanding of their youth and high school sports experiences and associated motivations to engage in those experiences. A framework analysis approach was used to analyze the transcript data and identify themes among the 3 specialization groups. From our interview analysis, 6 overall themes emerged: (1) motivation, (2) stress, (3) quitting, (4) barriers, (5) facilitators of success, and (6) future directions. Moderate- and high-level specialists described greater levels of passion, participating in deliberate practice, greater levels of performance-related stress, and more desire to quit sports than low-level specialists. None of the groups cited parents as an overbearing external motivator to participate in sport at an early age. Participants who were classified as low-, moderate-, or high-level specialists noted different experiences related to their motivation, stress level, desire to quit, barriers to participating in baseball, facilitators of success, and their overall future career goals after completing baseball. This information may be useful for parents, coaches, and health care professionals to better communicate the benefits and risks associated with sport specialization to youth athletes. Future research is needed to determine if differences in motivation levels exist in younger populations.

Background: There are a variety of proposed motivations for sport specialization, such as improving sport skills to an elite level, making all-star or travel teams, or receiving a scholarship or professional contract. However, there has not been a quantitative examination of the attitudes and beliefs that may be contributing to the trend of sport specialization and year-round sport participation. Purpose: The primary aim was to describe the attitudes and beliefs of youth club sport athletes regarding sport specialization and sport participation. A secondary objective was to investigate whether an association exists between the level of sport specialization and the belief in receiving a college scholarship. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 974 youth athletes (578 female; mean age, 14.2 ± 1.6 years) completed an anonymous questionnaire that focused on attitudes and beliefs toward sport specialization and sport participation. Questions were developed utilizing the feedback of a panel of content area experts and the University of Wisconsin Survey Center. Data were summarized using frequencies, proportions (%), and means ± SDs. Results: Fewer than half of all athletes (45.8%) believed that specialization increased their chances of getting injured either “quite a bit” or “a great deal.” However, 91% of athletes believed that specialization increased their chances of getting better at their sport either “quite a bit” or “a great deal.” Similarly, the majority of athletes believed that specialization increased their chances of making their high school team (80.9%) or a college team (66.9%) either “quite a bit” or “a great deal.” Overall, 15.7% of athletes believed that they were either “very” or “extremely” likely to receive a college scholarship based on athletic performance. Highly specialized athletes were nearly twice as likely to have a high belief in receiving a college scholarship compared with low-specialization athletes (20.2% vs 10.2%, respectively; χ2 = 18.8; P = .001). Conclusion: Most youth athletes in this study believe that specialization increases their sport performance and ability to make not only a college team but also their high school team. Highly specialized athletes were more likely to believe that they will receive a college scholarship.

Background: There are 60 million US youth who participate in organized athletics, with large increases in both sport participation and specialization during the past 2 decades. There is some evidence that increased sport specialization and training volumes may be associated with increased injuries in adolescent populations. This study examines these variables in a population of elite college athletes. Hypothesis: Early sport specialization (ESS) and a high training volume are risk factors for injury and/or surgery in National Collegiate Athletic Association (NCAA) Division I athletes. Study Design: Cross-sectional study; Level of evidence, 3. Methods: All Division I athletes at a single institution were surveyed regarding demographics, scholarship status, reason for specialization, age at specialization, training volume, and injury history. Chi-square and Mann-Whitney U tests were performed to identify significant differences. Results: Athletes who specialized in their eventual varsity sport before age 14 years were more likely to report a history of injuries (86.9% vs 71.4%), multiple injuries (64.6% vs 48.8%), multiple college injuries (17.2% vs 6.0%), a greater number of total injuries (2.0 vs 1.0), and require more time out for an injury (15.2 vs 6.5 weeks) than those who did not. They were also more likely to be recruited (92.9% vs 82.1%) and receive a scholarship (82.8% vs 67.9%). Athletes who trained for greater than 28 hours per week in their eventual varsity sport before high school were more likely to report multiple injuries (90.0% vs 56.3%), multiple college injuries (40.0% vs 12.5%), a surgical injury (60.0% vs 22.9%), multiple surgical injuries (30.0% vs 4.7%), a greater number of total injuries (2.5 vs 2.0), and more time out for an injury (36.5 vs 11.0 weeks) than those who did not (all P < .05). However, these athletes were not more likely to be recruited (90.0% vs 89.8%) or receive a scholarship (80.0% vs 74.5%). Conclusion: NCAA Division I athletes with ESS and/or a high training volume sustained more injuries and missed more time because of an injury, but those with ESS were more likely to be recruited and receive a college scholarship. This knowledge can help inform discussions and decision making among athletes, parents, coaches, trainers, and physicians.

To describe the socioeconomic status, measured by household income and educational attainment, of parents with children participating on youth club sport teams. Cross-sectional survey. Local sport events. 949 parents (571 female) of youth athletes between 10 and 18 years old were recruited at club team events and practices to complete an anonymous questionnaire. SES variables included total household income (THI) and educational attainment. Sport specialization was classified as low, moderate, or high using a previously utilized 3-point specialization scale. Chi-square tests were used to compare frequencies SES categories with child specialization. Parents reported spending a median of 1500 [500-3000] USD per year on their children's club sports activities. Most parents reported a THI greater than 100,000 USD per year and a bachelor's degree or higher level of education. Parents in the higher THI categories were more likely to have a child that is highly specialized in one sport. The current youth sports system in the United States, which emphasizes year-round participation on club teams, may be limiting the participation of families without the resources to participate in this system. •Parents spent an average of $1500 per year on their child's club sports activities.•Most club sport parents had a household income greater than $100,000 per year.•Higher income parents were more likely to have a child that is highly specialized.•Children of higher income/education parents reported increased sport volume.