Sport specialization is intensive, year-round training in a single sport to the exclusion of other sports. Early sport specialization generally refers to such year-round activity occurring before puberty. What has led to this concept, and is it truly counterproductive? Early sport specialization is thought to be the outcome of a clash of systems, policies, and structures that produces requirements incompatible with long-term athlete development. Long-term athlete development is a progressive model of sport participation championed by Balyi et al that focuses on a foundation of fun and general athleticism, only gradually leading to sport specialization once developmentally and age-appropriate talent and personal ambition are established. What are some elements of this clash of systems, policies, and structures? They include but are not limited to (1) stakeholder pressure (eg, national governing bodies or academies) for success on the public stage, (2) attempts at prepubertal talent identification and development, (3) early recruiting for collegiate sports, (4) parental pressure, (5) inadequate preparation of sport coaches, and (6) aggressive sport-marketing strategies. The results of this systems clash are not encouraging. It is later—rather than earlier—sport specialization that leads to successful peak performance as an adult. Indeed, most Olympic athletes played multiple sports in their youth, and we have no data to support the possibility that early specialization leads to a greater likelihood of a collegiate scholarship or a career as a professional athlete. But performance aside, are there deleterious health consequences of early sport specialization? We need much better data to answer this question. The sports medicine literature is increasingly addressing the health and medical risks of early sport specialization, but a causal relationship confirmed by large-scale longitudinal tracking has not been established. Little to no systematic tracking of youth sport training has been performed by relevant national governing bodies or other youth sport organizations; most data are derived from smaller studies or consensus meetings. Even without definitive data, the emerging consensus is worrisome. Early sport specialization is linked to overuse injuries, burnout, depression, and sport dropout. Alarming evidence has suggested that leaving organized sport at an early age may lead to a lifetime absence of organized sport and physical activity. On these topics, the emerging consensus is sufficient to compel a radical reshaping of the model of American sport. A culture of unequal, nonuniversal access and poorly conceived early training may cause great harm to both the athlete and society. The long-term athlete-development model has been incorporated into a thoughtful solution for societal change by the United States Olympic Committee's American Development Model (ADM). The ADM is the radical change we need. If followed, the ADM will allow American youth to use sport as a path toward active and healthy lifestyles and create opportunities for athletes to maximize their full potential. The 5 key principles outlined by the ADM are 1. Universal access to create opportunity for all athletes, 2. Developmentally appropriate activities that emphasize motor and foundational skills, 3. Multisport or multiactivity participation, 4. A fun, engaging, and progressively challenging atmosphere, and 5. Quality coaching at all age levels These principles are reflected in progressive, developmentally appropriate stages of sport participation, and all national governing bodies of American sport are signatories to the ADM. However, it will take time for the ADM to influence societal norms, and until those norms change, an undercurrent of pressure for early sport specialization will persist.
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