Key Words: Youth athlete, injury, sports
This blog is based on recent research published on BJSM (1).
Why is this study important?
Sport participation is a common way for children and adolescents around the world to stay physically active. However, the professionalization of youth sports has led many young athletes to select a main sport at a young age and then intensely focus on their main sport. Sport specialization is defined as participation in a single sport for most of the year that restricts opportunities and engagement in other sports or activities (2). Research on sport specialization has grown exponentially in the last decade, with most studies showing negative physical and psychological effects to be related to sport specialization. Notably, youth sport specialization has been linked to increased risk of overuse injury (3) and the development of adverse psychological symptoms such as burnout (4). Despite the growing amount of sport specialization research, studies measure sport specialization in different ways which makes it very challenging to compare results and provide clear recommendations to athletes, coaches, families, or other stakeholders.
Previous methods to quantify sport specialization typically included yes or no questions pertaining to the sport participation habits of the athlete. The most frequently used questionnaire asked whether the athlete
1) had a main sport,
2) had quit other sports to participate in their main sport, and
3) had participated in their main sport more than eight months of the year (5).
However, we believe that the behavior of youth sport specialization includes social and motivational influences, in addition to physical demands, that lead athletes to participate in their main sport for most of the year. Additionally, asking athletes to answer several dichotomous questions may not be sensitive enough to accurately reflect small fluctuations in an individual athlete’s level of specialization over time. Therefore, our study aimed to develop a new questionnaire to accurately measure a youth athlete’s level of sport specialization, named the Wisconsin Sport Specialization Questionnaire (abbreviated WISSQ).
How did the study go about this?
To create the WISSQ, the research team first created a modern definition of sport specialization. The updated definition was used to develop a set of questions that were relevant, comprehensive, and understandable to youth athletes. To accomplish this, we interviewed multiple youth athletes aged 8-18 years and revised the questions until they were clear to athletes and comprehensively assessed their youth sport experience. We created the WISSQ using items for 14-18 year old athletes because high school-aged athletes have slightly different opportunities and experiences than younger athletes.
The WISSQ consists of 25 questions across three groups (physical, motivation, social domains). A 3-point response option (yes, sometimes, no) was used for questions in the physical domain, while questions in the motivation and social domain utilized a 5-point Likert scale (not at all like me – a lot like me).
Figure 1. Example items from WISSQ Motivation Domain
To assure accuracy of the WISSQ, we recruited a large sample of athletes across the United States to complete the survey. All participants were between the ages of 14 to 18 years and participated in at least one organized sport in the past year.
What did the study find?
This study produced a questionnaire that accurately and reliably measures sport specialization in adolescent athletes aged 14 to 18 years. Ultimately, 12 of the 25 items are used to create a sport specialization score (4 social items, 5 motivation items, 3 physical items). The scored items produce the best measurement with the fewest number of questions.
When completed, the WISSQ produces four separate scores related to sport specialization, an overall score and one for each domain (physical, motivation, social). These scores are on a scale from 0-100, with higher scores representing higher specialization. This continuous scale allows for a more accurate and precise measure of an athlete’s level of specialization. Additionally, the three-domain structure allows clinicians to have a more nuanced interpretation and enhanced understanding of the individual pressures sport specialization may have on each youth athlete.
What are the key take-home points?
- The Wisconsin Sport Specialization Questionnaire (WISSQ) is the first valid and reliable tool to measure sport specialization in youth athletes aged 14-18 years.
- The WISSQ measures overall sport specialization and three domains of specialization (social, motivation, and physical) on a scale from 0-100, with higher scores representing increased specialization.
- Given that sport specialization may be associated with increased risk of overuse injuries and burnout of sport, clinicians working with youth athletes can accurately monitor their patient’s level of specialization using the WISSQ.
References
- Kliethermes SA, Nelson EO, Biese KM, et al Development and validation of the Wisconsin Sport Specialization Questionnaire (WISSQ) for older adolescent athletes British Journal of Sports Medicine 2025;59:1135-1142.
- Bell DR, Snedden TR, Biese KM, Nelson E, Watson AM, Brooks A, McGuine TA, Brown RL, Kliethermes SA. Consensus Definition of Sport Specialization in Youth Athletes Using a Delphi Approach. J Athl Train. 2021 Nov 1;56(11):1239-1251. doi: 10.4085/1062-6050-0725.20. PMID: 33787895; PMCID: PMC8582622.
- Bell DR, Post EG, Biese K, Bay C, Valovich McLeod T. Sport specialization and risk of overuse injuries: a systematic review with meta-analysis. Pediatrics. 2018 Sep 1;142(3):e20180657.
- Giusti NE, Carder SL, Vopat L, Baker J, Tarakemeh A, Vopat B, Mulcahey MK. Comparing burnout in sport-specializing versus sport-sampling adolescent athletes: A systematic review and meta-analysis. Orthopaedic journal of sports medicine. 2020 Mar 2;8(3):2325967120907579.
- Jayanthi NA, LaBella CR, Fischer D, Pasulka J, Dugas LR. Sports-specialized intensive training and the risk of injury in young athletes: a clinical case-control study. The American journal of sports medicine. 2015 Apr;43(4):794-801.
Authors: Madison N Renner, Evan O Nelson, Stephanie A Kliethermes