Psychological Injury in Pediatric and Adolescent Sports

Fig. 13.1

Modified Hellstedt’s athletic triangle

The existing research on psychological harm within the relationships an athlete has with the parent, coach, and teammates will be addressed in turn.

Psychological Harm Within the Athlete–Parent Relationship

“Mary, kill the bitch!” These are the words of Jim Pierce, father of the former French and Australian Open champion Mary Pierce, when his daughter was 12 and playing a junior match. He also punched two fans at the French Open in 1992 … Mary later acquired a restraining order against her father and hired a bodyguard to protect her; the Women’s Tennis Association banned her father from all tournament sites. [15]

“My dad could be pretty intense, too. He’d needle me anytime I decided to come home after school instead of going to the recreation center to work on my basketball game and play pickup with older kids. At high school basketball games, students who wanted a little bit of a sideshow with the main event would sit near my father, who could be counted on to yell things like, “Don’t sub in Jeff! He’s fucking terrible!” … It got a little intense, and there were times when my father’s exhortations made me cry, and when I said things to him that I regret ever saying.” [16]

Clearly, one of, if not the most, critical relationships a young athlete has is with her or his parent(s). A plethora of literature highlights the important role parents can play by introducing young people to sport, and providing financial, instrumental, and psychological support for athletes to train and compete [17, 18]. On the other hand, researchers have also identified parental behaviors that have detrimental effects on young athletes’ psychological health.

Child and adolescent athletes’ perceptions of parental overinvolvement for example, have been positively associated with anxiety and burnout [19]. Similarly, perceived parental pressure and excessively high expectations for performance have been linked with increased anxiety amongst youth athletes [20, 21]. Sometimes the excessive pressure to perform well is manifested in harsh criticisms from parents; in fact, Shields, Bredemeier, LaVoi, et al. [22] reported that amongst 189 U.S. youth sport parents, 13 % admitted to angrily criticizing their child’s performance. Similarly, in Kidman and colleagues’ observations of youth sport competitions, 34 % of the verbal comments from parents were negative in nature, and included scolding the child and criticizing their child’s performance [23].

In addition to having direct influences on a child’s psychological health, parents play important roles in helping the child navigate important relationships with others in sport including the coach and teammates. One may intuitively assume that parents play a protective role for their children; in fact, Brackenridge [24] suggests that parents play a key role in preventing the sexual abuse of their children by coaches. Interestingly however, research on athletes’ experiences of emotionally abusive coaching behaviors suggests that parents are socialized into the sport culture in such a way as to become bystanders in their children’s experiences of abuse. More specifically, Kerr and Stirling [25] reported that parents are socialized to accept the coach’s authority and expertise and to relinquish control of the nature of their children’s sport experiences to the coach. Further, parents learn that what they may initially deem to be inappropriate coaching methods are normalized by other parents as just “part of the game” and thus come to accept them as well.

Further research is needed to examine ways in which parents can enhance their child’s psychological health in the sport environment, including the protection of their child from potentially harmful interactions with other stakeholders. Consistent with this view, Fredricks and Eccles ([26], p.145) write, “considering the potential of parents to have either a positive or negative role in children’s sport experiences, it is unfortunate that research on this topic is limited.”

Precipitating Influences

Although research has not directly examined the precipitating influences of harm within the parent–athlete relationship, several possibilities have been proposed. Excessively high expectations and inappropriate criticisms may be attributed to a lack of education about sport and talent identification and/or child and adolescent development. As Tofler and DiGeronimo [27] have suggested, parents may live their own unmet aspirations through their children, and in the process, lose perspective of their child’s abilities and interests. Numerous researchers have discussed the powerful influence of the “win-at-all-costs” attitude or narrowly focused pursuit of excellence that so often characterizes the culture of sport, including children’s and adolescent sport [6, 28]. Without appropriate attention to developmentally appropriate experiences for young people, the potential for physical and psychological harm as well as drop-out from sport increases. An overemphasis on wining also encourages parents to relinquish control of decision-making to the coach [25]. Future research is needed to better understand the influences on harm within the parent–athlete relationship.

Psychological Harm Within the Athlete–Coach Relationship

A 13-year-old male hockey player described his coach’s behavior as follows:

My coach would scream and freak out over things in practices, breaking sticks and singling me out in the dressing room saying, ‘You don’t care about this game, you have no commitment to the team and shouldn’t be playing,’ He’d say, ‘I told you to take that kid’s head off and you didn’t.’ It made me not want to go to my games and practices because I was going to get yelled at. It demoralizes you. [29]

A parent told the Daily Press that Mercedes Winchester, the high school volleyball coach, forced the team to do bear crawls and push-ups on the blacktop at practice, causing the girls’ hands to blister and bleed. The reported temperature on that day reached a high of 101 degrees. “The coach had them doing drills and I guess they weren’t doing them fast enough or correctly, so she took them outside as punishment,” Irene Castro, the mother of a 14-year-old volleyball player, told the Daily Press. “She told them their hands couldn’t leave the ground and then she took them back inside and they had regular practice, so they were sliding across the gym floor and the blisters ripped open.” [30]

The research on the occurrence of psychological harm within the athlete–coach relationship is characterized predominantly through the study of emotional abuse which is defined as “patterns of nonphysical harmful interactions” between a child and a caregiver [31]. Although the study of emotional abuse of young people has long-existed in the fields of child development, psychology, sociology and social work, empirical research on emotional abuse in sport has emerged only recently.

Of this work in sport, studies have focused on emotionally abusive coaching practices experienced by athletes, and usually student-athletes, aged 18 years and older. In some cases, these young adults were asked to recall and report on their experiences when they were child athletes [32, 33]. For example, a recent online survey of more than 6,000 students reported childhood experiences of harm in sport including emotional, sexual, physical, and self-harm, and body image issues [32]. Emotional harm was the most commonly reported type of harm experienced, with 34 % of the athletes indicating that their coach or trainer was involved in treating them in an emotionally harmful manner. More specifically, both male (29 %, n = 328) and female (36 %, n = 1,056) athletes reportedly experienced emotional harm from their coach. A greater percentage of athletes from individual sports (e.g. dance, swimming, athletics) compared to athletes from team sports (e.g. netball, football, hockey, rugby) reported emotionally harmful coaching experiences.

In all of the existing studies of young adult athletes across a number of countries and sports [32–34] emotional abuse is the most commonly reported form of maltreatment within the athlete–coach relationship. The behaviors that characterize emotionally abusive coaching practices include verbal comments (e.g. yelling, belittlement, degrading comments), physical behaviors (e.g. throwing objects with the purpose of intimidating the athlete), and the denial of attention [34].

To date, the research on emotionally abusive coaching practices is limited by its focus on young adult athletes and intercollegiate student-athletes. There is a paucity of work on child and adolescent athletes’ experiences of emotional abuse, and one may speculate that this dearth of research is due, in part, to ethical challenges associated with probing vulnerable populations about such sensitive topics.

Preliminary evidence of the psychological harm experienced by athletes as a result of emotionally abusive coaching behaviors has been provided by Stirling and Kerr [35] who interviewed retired elite athletes from a variety of sports. When asked to reflect on their responses to emotionally abusive coaching practices, these retired athletes reported low mood, anger, low self-efficacy and esteem, anxiety, and reduced enjoyment.

In summary, emotionally abusive coaching behaviors are frequently reported as being experienced by athletes. Preliminary research suggests that psychological harm results from such experiences although further study is needed to better understand the psychological sequelae of emotionally abusive coach–athlete relationships. In addition, future research is needed on current rather than retrospective examinations of child and adolescent experiences of emotionally abusive coaching practices.

Precipitating Influences

A significant body of literature exists on the sources of power held by the coach; this power may be used appropriately or misused in such ways as to harm young athletes. Simply by virtue of their age, size, expertise, access to resources, and ascribed authority as a coach, young athletes are in an unbalanced power relationship with the coach [36]. The abuse of positions of power is at the core of all forms of maltreatment—sexual, physical, and emotional abuse as well as neglect.

Further, some authors have proposed that coaches are ill-prepared for the role and responsibilities of the position and the power that comes with it [37, 38]. While coaches may understand the technical and tactical aspects of a particular sport, there is no guarantee they have a foundational knowledge of child and adolescent development. The latter cannot be assured because no formal educational requirements exist for coaches. In addition, it is not unusual for youth sport settings to rely on volunteer coaches, many of whom are parents from the team. Again, there are no assurances that these volunteer coaches have the requisite competencies for working with young people.

Psychological Harm Within the Athlete–Teammate Relationship

Hayleigh Abbott, a 12-year-old Quebec Junior Champion had a promising future as a figure skater until her coach allegedly kicked her out of the program after she reported repeated bullying by an older male student. “He would pass her on the ice and he would just swear at her and just call her names,” said Cynthia Ruffino, Hayleigh’s mother. According to Hayleigh, the verbal insults quickly escalated to physical intimidation. “He would cut me off right before I would jump and he would speed at me really quickly and almost hit me. When I would fall he would just charge at me.” said Hayleigh. Her parents began to fear for her safety but despite several complaints to the coach, Hayleigh’s family insists nothing was done. [39]

Some Juneau students came back from a high school wrestling meet in Petersburg a few weeks ago with injuries not common to their sport. The frostbitten hands and welts on backsides were the result of hazing from older teammates, according to accounts from parents. The frostbite came after being ordered to hold onto ice until the skin burned. The welts came from being held down and paddled by a group of students. [40]

Peer relationships have been well-recognized in the sport psychology literature as having a significant influence on the psychological development of young athletes. According to some researchers, peers enhance perceived physical competence, motivation for engagement in physical activity, feelings of companionship, and self-esteem [41, 42]. Conversely, recent research on hazing and bullying indicates that peers can also affect a young athlete’s psychological health in profoundly negative ways; each of these will be addressed in turn.

Hazing

In 2008, a community in New Mexico was rocked with a scandal that involved a group of male junior high school football players being sodomized by senior teammates as part of a hazing incident [43]. In Saskatchewan, Canada, eleven senior high school athletes were charged in a hazing event that involved hitting younger Grade 9 and 10 team members with hickey sticks [44]. Hazing is defined as: Any potentially humiliating, degrading, abusive, or dangerous activity expected of a junior ranking athlete by a more senior teammate, which does not contribute to either athlete’s positive development, but is required to be accepted as part of the team ([45], p.449).

Studies examining the prevalence rates of hazing in sport have demonstrated that 17 % of adolescent athletes and approximately 80 % of intercollegiate athletes experience hazing from fellow members of their sport team [46, 47]. Examples of hazing behaviors within sport teams include, being shouted or cursed at, forced sleep deprivation, being contained in a small area, degrading comments based on race, ethnicity, or sex, serving as a personal attendant to someone, or being pressured to consume excessive alcohol or engage in sexual acts [48, 49]. Potential psychological injuries identified as a result of hazing experiences outside of sport environments include loneliness, depression, posttraumatic stress disorder, suicide ideation, and loss of self-esteem [50] although to the best of our knowledge, psychological harm caused by hazing practices in sport has not been explored.

Bullying

Milena Clarke, a 14-year-old basketball player, describes the following experiences of bullying amongst teammates:

How it [the bullying] started was during one practice, some girls restrained my arms during a drill, then it started going into verbal [taunts]. I tried to go to the coaches and [in front of the team] they told me to ‘Toughen up, act as a leader.’” Clarke said the girls teased her with ethnic slurs, which she said she had to look up because she did not even know what the words meant. She lost weight, had trouble sleeping, her grades suffered and she contemplated quitting basketball. “I was just thinking since I wasn’t given any chance [to play without being bullied] and they weren’t going to do anything to help me, I’ll just quit and it will all be over.” [51]

According to Mishna ([52], p. 9), bullying is identified as a detrimental relationship problem, which is pervasive throughout society, and tends to result in harmful consequences for those who experience it. Bullying is broadly conceptualized as a repeated behavior characterized by aggression, in a relationship where a power differential exists [52, 53]. An individual can attain power within a peer relationship as a result of personal characteristics (e.g., size, strength, age) or position within a social network (e.g., high social status) [54]. These behaviors are often employed with the intention to cause social, psychological, or physical harm on a target who is perceived as vulnerable or unable to defend oneself with repeated exposure to these behaviors over time [53, 54]. Due to the subjective nature of bullying, experiences may not require repetition over time to be considered harmful; instead, Collot-D’Escury and Dudink [55] propose that a single incident of bullying has the potential to have a strong or chronic impact.

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