REVIEW

CURRENT
OPINION Adolescent athletes: psychosocial challenges and
clinical concerns
Katherine A. Tamminen a, Nicholas L. Holt b, and Peter R.E. Crocker a

Purpose of review
To review the recent literature (over the past 18 months) regarding psychosocial challenges and clinical
concerns among adolescent athletes, and to address the advances made in understanding adolescent
athletes’ coping processes.
Recent findings
Coping research has moved from identifying discrete stressors and coping strategies to examining the
processes of coping over time. Parents and coaches play an important role in young athletes’ sport
experiences and athletes’ use and development of coping strategies. In terms of clinical concerns, findings
regarding the prevalence of disordered eating have been equivocal. However, disordered eating may be
of greater concern among athletes participating in ‘leanness’ sports. Sport participation may contribute to
increased alcohol consumption among adolescent athletes but decreased use of drugs and smoking
cigarettes, while steroid use appears to be relatively rare compared with athletes’ use of alcohol and
cigarettes.
Summary
The reviewed studies have implications for future research by identifying opportunities for intervention and
education regarding clinical and nonclinical psychosocial challenges. Researchers have emphasized the
importance of athletes’ social context and relationships in coping with psychosocial challenges in sport.
One concern is that adolescent athletes’ disordered eating and substance use may reflect maladaptive
coping. Experimental and intervention research is limited; however, incorporating members of athletes’
social network into future research and interventions may be a practical avenue to achieving positive
outcomes among adolescent athletes.
Keywords
coach, coping, disordered eating, parent, sport, stressors, substance abuse

INTRODUCTION Lazarus’s [8] transactional approach has been most

Sport participation can improve motor skills,
physical and mental health, and psychosocial devel-
&
opment [1–3,4 ]. However, youth report both
positive and negative experiences associated with
competitive sport participation [5]. In this review,
we examine psychosocial challenges and coping in
sport, with particular attention paid to the role of
parents and coaches, followed by a review of clinical
concerns among adolescent athletes (disordered
eating and substance abuse).
PSYCHOSOCIAL CHALLENGES AND
COPING AMONG ADOLESCENT ATHLETES
Early research in this area focussed on the identifi-
cation of psychosocial challenges or stressors associ-
ated with sport participation and the ways in which
athletes attempt to cope with these demands [6,7].
widely used to study stressors and coping among
adolescent athletes [9,10]. From this perspective,
stressors are subjective appraisals influenced by
the strength of an individual’s goal commitment
and values concerning his or her sport participation
and competition. Adolescent athletes report a num-
ber of stressors, including making physical or men-
tal errors, parent, teammate, and coach criticism,
a
School of Kinesiology, The University of British Columbia, Vancouver,
British Columbia and bFaculty of Physical Education and Recreation,
University of Alberta, Edmonton, Alberta, Canada
Correspondence to Katherine A. Tamminen, PhD, Exercise and Sport
Psychology Lab, School of Kinesiology, The University of British Colum-
bia, 210 - 6081 University Boulevard, Vancouver, BC, V6T 1Z1, Canada.
Tel: +1 604 822 9192; e-mail: katherine.tamminen@ubc.ca
Curr Opin Psychiatry 2012, 25:293–300
DOI:10.1097/YCO.0b013e3283541248

0951-7367 ß 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins www.co-psychiatry.com

Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
 Child and adolescent psychiatry
KEY POINTS

Young athletes report a number of stressors associated
with sport participation (e.g., making errors, criticism,
pressure to perform, and fear of injury), and coping is
important for performance, well being, and minimizing
sport withdrawal.

Researchers are investigating the development of
adaptive coping among adolescent athletes as well as
social influences on young athletes’ coping.

Parents and coaches influence athletes’ sport
experiences through positive and negative behaviours;
however, experimental research is required to
determine whether targeting adults’ behaviours
improves athletes’ psychosocial experiences in sport.

Participation in leanness sports such as gymnastics,
ballet, and figure skating may contribute to disordered
eating among elite athletes, although more research is
required examining the trajectory and development of
disordered eating among young athletes.

Sport participation may protect against drug use and
smoking cigarettes, but it may also contribute to
increased alcohol consumption because of peer norms
and social influences, particularly among male athletes.
pressure to perform, fear of injury, viewing
opponents cheating or performing well, official
and referee decisions, and organizational stressors,
including time management, travel, and balancing
sport with school demands [11–14]. Coping is
defined as on-going conscious and deliberate
attempts to manage specific external and internal
demands that are appraised as taxing or exceeding
the resources of the person [8,15]. Coping is import-
ant for achieving subjectively and objectively suc-
cessful sport performances [16], and in preventing
sport withdrawal or dropout [17,18].
Some studies have examined variability in stres-
sors and coping over short periods of time (e.g., over
the course of one competition) [19,20], whereas
others have examined coping over longer periods,
such as an entire season [14]. These studies showed
that stressors fluctuate over time and stressor
appraisals also appear to change with development.
In a longitudinal study among early and middle
adolescent competitive soccer players [13], athletes
(mean age ¼ 14.48 years) reported differences in
both the nature and frequency of stressor appraisals
depending on age; early adolescents reported a
higher mean stressor frequency than middle adoles-
cents over the entire season. Furthermore, early
adolescents reported more stressors in the early part
of the season, whereas middle adolescents reported
more stressors in the mid-season to late season. Both
294 www.co-psychiatry.com
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
early and middle adolescents frequently reported
stressors which included making a physical or men-
tal error and receiving a wrong decision from an
official. However, some stressors early adolescents
reported more frequently than middle adolescents
included observing an opponent cheat and observ-
ing another player perform well, whereas the types
of stressors middle adolescents reported more fre-
quently included injury and criticism from coaches,
parents, and other players. The differences in early
and middle adolescent athletes’ stressor appraisals
may reflect different developmental stages as well as
contextual changes associated with middle adoles-
cents playing at higher competitive levels. Thus, the
use of longitudinal designs in sport coping research
has drawn attention to the fluctuating nature and
frequency of stressor appraisals within athletes’
social environment, as well as the changing
demands athletes face over the course of a season.
Studies examining the effect of gender on cop-
ing have produced equivocal results [6,21,22]. How-
ever, a limitation of these studies is that they have
generally examined stressors as generic events at a
‘macro level’, without fully examining the subjec-
tive appraisal processes associated with specific
stressors. An examination of stressors and coping
which takes into account stressors appraisals and
stressor sources may explain some differences in
male and female athletes’ coping [23]. One recent
study helped produce a more refined understanding
of gender differences in stressors and coping. Hoar
et al. [24] had 524 male and female adolescent team
sport athletes (n ¼ 274 male, n ¼ 250 female, mean
age ¼ 13.1 years) complete measures of coping
with interpersonal stressors in sport. There were
no significant differences in the amount of coping
strategies male and female athletes used overall.
However, there were gender differences across differ-
ent sources of interpersonal stress. Female athletes
used more instances of seeking social support in the
context of stressors related to coach and personal
social behaviour than male athletes. Female athletes
also reported using more cognitive reappraisal than
male athletes, but only in the context of referee
stressors. These findings draw attention to the differ-
ences between male and female athletes’ relation-
ships and social connectedness goals; however, this
study only focussed on gender differences in coping
with interpersonal stressors. It remains unclear how
gender differences would emerge in relation to other
competitive stressors in sport.
Few experimental or intervention studies have
examined ways to improve coping among adoles-
cent athletes. One exception was a theoretically
driven small-scale intervention among five male
soccer players (mean age ¼ 13.6 years) [25 ]. Using
&
Volume 25
Number 4
July 2012

a coping effectiveness training program, the authors
found that athletes’ coping self-efficacy improved,
whereas coping effectiveness and performance
showed some improvements in effect sizes compared
with baseline, but not all athletes reported improve-
ments. Interestingly, athletes’ perceptions of coping
effectiveness peaked following the intervention ses-
sion on problem-focussed coping, which has been
reported as most effective in dealing with stressors in
sport contexts [26]. This intervention was conducted
among a small sample, and researchers have called for
more studies which evaluate the effectiveness of
interventions to improve athletes’ coping, achieve-
& &
ment, and well being in a sport context [27 ].
Role of parents and coaches
Parents help their children understand and interpret
their experiences in sport by acting as role models of
behaviours, beliefs, and attitudes [28]. However,
some young athletes report parental pressure as a
stressor associated with sport participation [29].
Recent research has focussed on identifying those
parental behaviours which affect young athletes’
experiences in sport and athletes’ perceptions about
parental behaviours. Interviews with elite tennis
players and their coaches and parents revealed
positive parental behaviours included providing
social support, positive communication, providing
motivation, developing psychological and social
skills, and keeping sport in perspective [30]. Nega-
tive parental behaviours included being pushy or
placing too much pressure on the athlete, yelling
or criticizing the athlete, over-involvement and
controlling behaviours, ineffective or negative
communication, and an overemphasis on winning.
Mindful of the potential negative effects parents may
have on adolescent athletes, researchers continue to
focus on understanding the athlete–parent relation-
ships to optimize parental involvement in sport.
Researchers have sought adolescent athletes’
perspectives to determine their preferences for
parental behaviours. Athletes’ specific preferences
for parental involvement in sport include making
comments on effort and attitude (not performance),
providing practical advice, and wanting parents to
match supportive comments with nonverbal behav-
iours [31]. Athletes also preferred specific behaviours
before, during, and after competition [32]. Prior to
competitions, athletes wanted parents to help them
prepare physically and mentally (e.g., ensuring
proper hydration and helping the athlete to relax).
During competitions, athletes wanted parents to
encourage the entire team, focus on athletes’ effort
rather than on the outcome of the competition,
interact positively with athletes, and athletes
0951-7367 ß 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Adolescent athletes Tamminen et al.
wanted parents to maintain control of their
emotions. Athletes did not want parents to coach
from the sidelines, argue with officials, or engage in
behaviours which might draw attention to them-
selves or the athlete. After competitions, athletes
wanted parents to provide positive and realistic post-
game feedback. These findings offer some promising
guidelines for parental behaviour, but to our knowl-
edge there is no recent research which has adopted an
intervention approach to target parental behaviour
and to examine whether optimizing parental behav-
iours results in more positive sport experiences or
performance outcomes among athletes.
Nicolas et al. [27 ] examined the perceptions of
supportive coaching behaviours, coping, and sport
achievement among 80 individual sport athletes
(mean age ¼ 18.46 years) to investigate the influence
of coaches on athletes’ coping. Task-oriented coping
(i.e., thought control, mental imagery, relaxation,
logical analysis, seeking social support, and effort
expenditure) was associated with improved sport
achievement, whereas distraction-oriented coping
(e.g., disengagement and resignation, venting of
unpleasant emotions) was associated with decreased
sport achievement. Perceptions of unsupportive
coach behaviours prior to competition were associ-
ated with disengagement-oriented coping during
competition, whereas supportive coach behaviours
were significantly associated with task-oriented
coping during competition and sport achievement.
Further analyses indicated perceptions of supportive
coaching had a prospective influence on athletes’
sport achievement during competition via the
initiation of task-oriented coping strategies. These
findings suggest that perceptions of coaches as
either supportive or unsupportive may represent a
factor in the use of adaptive or maladaptive coping
strategies among adolescent athletes.
Researchers have recently begun to examine the
ways in which parents and coaches influence ado-
lescent athletes’ development of coping strategies.
Extending this line of research, Tamminen and Holt
&
[33 ] developed a grounded theory of the ways in
which young athletes learn to cope with stressors in
sport and the role of parents and coaches in this
process. This study sampled 17 athletes (mean
age ¼ 15.6 years), 10 parents (six mothers and four
fathers), and seven male coaches to qualitatively
investigate the development of adolescent athletes’
coping. Findings suggested that athletes’ learning
about coping was an experiential process facilitated
by exposure to multiple sport experiences and by
reflecting on one’s coping. Parents and coaches
played an important role in helping athletes to
learn about coping by creating a supportive context
for learning and by using a number of specific
www.co-psychiatry.com 295
 Child and adolescent psychiatry
strategies to help athletes learn about coping,
including questioning and reminding athletes
about effective coping strategies, providing
perspective, sharing their own experiences, dosing
or structuring potentially stressful experiences for
athletes, initiating informal conversations about
coping, creating learning opportunities, and direct
instruction about coping. This study suggested
ways in which adolescent athletes’ coping may be
supported and guided by members of their social
networks, providing targets for intervention. How-
ever, this qualitative study was limited to team sport
athletes, and the interviews were retrospective in
nature. Future longitudinal research could examine
the correspondence between athletes’ day-to-day
(short-term) coping and its influence on long-term
psychosocial outcomes.
CLINICAL CONCERNS
Clinical sport psychology has recently emerged as
a distinct discipline separate from applied sport
psychology or performance enhancement. As such,
little research to date has specifically investigated
clinical issues among adolescent athletes, particu-
larly within the past 18 months. More broadly,
researchers have found that the prevalence of
psychological problems among high-performance
athletes (e.g., generalized anxiety disorder, depres-
sion, panic disorders) is not higher than in the
general population, although specific social or
environmental stressors associated with competi-
tive contexts may contribute to the development
of certain disorders [34]. Consequently, two clinical
issues have emerged as significant areas of interest
in the past 18 months among researchers and
practitioners: disordered eating and alcohol and
drug abuse.
Disordered eating
Researchers’ use of varying definitions and measures
of disordered eating has created some conceptual
confusion in the literature. Some researchers have
made distinctions between anorexia nervosa, buli-
mia nervosa, eating disorders not otherwise speci-
fied (EDNOS, e.g., when some but not all criteria are
met for diagnosis of anorexia nervosa or bulimia
nervosa), and subclinical conditions such as prob-
lematic eating behaviours and attitudes which do
not meet the diagnostic criteria for disordered eating
but are still associated with severe physical, psycho-
logical, and behavioural disturbances [35]. Other
researchers have made distinctions between diagno-
ses of ‘eating disordered’ (including anorexia nerv-
osa, bulimia nervosa, EDNOS, and binge eating
296 www.co-psychiatry.com
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
disorder), ‘symptomatic’ (individuals report disor-
dered eating but not at a threshold for diagnosis),
or ‘nonsymptomatic’ (individuals do not report any
criteria for diagnosis) [36]. Additional diagnoses
pertinent to athletic populations include anorexia
athletica (characterized by reduced body mass
or weight cycling for performance, dieting and
excessive exercise), exercise dependence, body dys-
morphic disorder (a preoccupation with perceived
defects in appearance) [35], and the female athlete
triad (the co-occurrence of disordered eating, ame-
norrhea, and osteoporosis) [37]. The age of onset for
athletes’ disordered eating has been suggested to
occur during adolescence; however, the prevalence
of adolescent athletes’ disordered eating is not well
established [38,39].
To date, most research examining disordered
eating in sport has focussed on elite adult athletes;
however, there is cause for concern regarding young
athletes’ disordered eating. Adolescent athletes
experience physical changes associated with matu-
ration, including gains in height, weight, and body
fat; these changes may affect athletes’ perceptions
of their physical appearance and physical ability,
potentially contributing to restrictive eating practi-
ces [38,40,41]. Disordered eating is more prevalent
among adolescent athletes participating in ‘lean-
ness’ sports (e.g., dance, gymnastics, swimming,
etc.) versus ‘non-leanness’ sports (e.g., alpine skiing,
soccer, basketball, etc.) [42]. Krentz and Warschbur-
&
ger [43 ] conducted a prospective study among
65 male and female adolescent athletes (mean
age ¼ 14.0 years) participating in aesthetic or ‘lean-
ness’ sports. Boys reported significantly lower levels
of disordered eating at 1-year follow-up, whereas
girls’ disordered eating remained stable. Overall,
athletes’ desire to be leaner in order to improve
sport performance was predictive of disordered eat-
ing, and not vice versa, which supports the notion
that athletes’ beliefs about leanness as being import-
ant for sport performance contribute to a higher
prevalence of eating disorders [44]. However,
this study did not describe specific diagnoses of
anorexia nervosa, bulimia nervosa, etc., but rather
it examined athletes’ levels of disordered eating
which included subclinical conditions. In another
recent study of adolescent aesthetic athletes
(52 female and 16 male athletes aged 11–21), Van
Durme et al. [45] used three separate measures to
assess disordered eating pathologies and psychologi-
cal characteristics related to eating disorders
(drive for thinness, bulimia, body dissatisfaction,
perfectionism, and interpersonal distrust). Female
aesthetic sport athletes reported significantly higher
drives for thinness and more features of bulimia,
engaged in more dieting behaviours, and had
Volume 25
Number 4
July 2012

greater concerns about their weight and body
shape compared with a female adolescent control
group. Competitive state anxiety (e.g., feelings of
nervousness or worry prior to competition) [46],
age, and eating concerns accounted for a significant
amount of variance in dieting behaviour among
aesthetic sport athletes. Thus, cognitive concerns
regarding one’s body and competition are import-
ant as core features of adolescent athletes’ disor-
dered eating.
There are some contradictory findings despite
&
the studies reported above. Martinsen et al. [47 ]
examined dieting and disordered eating among
15–16-year-old elite athletes (n ¼ 606) and nonath-
lete controls (n ¼ 355). Disordered eating was
examined through the assessment of athletes’ drive
for thinness and body dissatisfaction, attempts to
lose weight, pathogenic weight control, or self-
reported menstrual dysfunction. Martinsen et al.
&
[47 ] classified athletes on the basis of having one
or more symptoms of disordered eating, under the
assumption that it is important to measure subclin-
ical eating disorders in addition to clinical eating
disorders. The non-athlete controls reported a higher
incidence of dieting and disordered eating than elite
athletes. Furthermore, there was no difference in the
prevalence of self-reported dieting or disordered eat-
ing between athletes participating in leanness and
non-leanness sports. One possible explanation for
this finding is that young athletes under-report dis-
ordered eating symptoms, and disordered eating may
appear and be diagnosed more frequently among
older athletes in leanness sports because of a longer
period of involvement in sport and extended
exposure to leanness requirements.
Generally, disordered eating has been investi-
gated to a greater extent among older adolescents
and adult athletes [48–50]. Clinical and subclinical
disordered eating is more prevalent among elite ath-
letes compared with the general population, is higher
among female athletes compared with male athletes,
and is higher among athletes participating in lean-
ness sports than those participating in nonleanness
sports [51]. On the balance of evidence, young ath-
letes participating in ‘leanness’ sport may be at risk for
developing disordered eating. But, given that some
findings have been contradictory, further research is
required to understand the development and trajec-
tory of disordered eating among athletes throughout
adolescence and into adulthood.
Alcohol and drug abuse
Another clinical issue of concern is adolescent ath-
letes’ alcohol and drug abuse. A recent review
reported that sport participation was related to
0951-7367 ß 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Adolescent athletes Tamminen et al.
higher alcohol use among athletes but lower levels
of cigarette smoking and use of illicit drugs [52]. In
a longitudinal survey using data from a national
cohort of 11 741 American adolescents, Terry-McEl-
&
rath and O’Malley [53 ] examined graduating high
school students’ sport and exercise participation
and its relationship to substance use, conducting
four follow-up measurements at 1-year intervals.
Findings indicated that adolescents who initially
(at age 18) participated in team sports reported
higher alcohol use, and higher initial frequency of
alcohol use was related to significantly higher
frequency of use throughout young adulthood.
However, initial sport participation was also associ-
ated with decreased cigarette and drug use, and
decreased drug use at age 18 was associated with
decreased drug use through adulthood. Terry-McEl-
rath and O’Malley’s longitudinal study corroborates
findings which suggest that sport participation may
contribute to alcohol consumption; however,
participation in sport may also protect against
smoking and drug use [52].
Current research is focussed on identifying the
factors which contribute to alcohol and drug use
among athletes. Male and female adolescent ath-
letes may have different intentions to consume
alcohol. Davies and Foxall [54] found that young
men involved in sport were more likely to consume
alcohol to the extent of getting drunk compared
with their nonathletic male peers; however, find-
ings were not significant for women. Parental and
peer subjective norms regarding drinking were also
significant predictors of male and female athletes’
intentions to consume alcohol. Although peer and
parental norms have been found to predict athletes’
intention to consume alcohol [54], greater drives for
muscularity and thinness have been found to pre-
dict stronger intentions to use doping substances,
regardless of level of sport involvement [55]. Under-
standing the psychological and social contributors
to alcohol and drug use as well as disordered eating
continues to be an important area of research.
Researchers have raised concerns about young
athletes’ use of performance-enhancing substances
&
and anabolic–androgenic steroids [56 ]. A number
& &
of studies have examined the prevalence [57 ,58 ,
&
59] and predictors [55,56 ] of adolescents’ use of
performance-enhancing substances. Findings from
studies within the past 18 months suggest that the
prevalence of high school students’ steroid use is
& &
low, ranging from 0.9 [58 ] to 4% [57 ] of surveyed
adolescents, and the relationship between adolescent
athletes’ sport participation and steroid use is not
clear. In one study, sport participation was not
significantly related to Icelandic high school stu-
dents’ steroid use (n ¼ 10 918, 48.2% men, mean
www.co-psychiatry.com 297
 Child and adolescent psychiatry
age ¼ 17.7 years), although steroid use was associated
with participation in informal physical fitness activi-
ties (e.g., exercise outside formally organized sports;
weightlifting, etc.). Conversely, according to analysis
of national data from the Youth Risk Behavior Sur-
veillance System, participation in multiple sports was
associated with a higher probability of male athletes’
&
steroid use [57 ]. Generally speaking, it appears the
prevalence of steroid use ‘is not rampant among
high school students’ and ‘compared to smoking
&
and drinking, steroid use is relatively rare’ ([57 ],
p. 211). Adolescent athletes’ steroid use may be rela-
tively low compared with alcohol and cigarette use
&
[57 ]; however, steroid use could be part of a broader
&
experimentation with substances [58 ,59] or part
of adolescents’ motivation to secure a position on
& &
an elite team or to gain athletic scholarships [56 ,57 ].
More research is needed to investigate young ath-
letes’ motivation and perceived incentives for steroid
use, although adolescent athletes’ alcohol use
appears to be a more pressing issue.
Researchers have focussed on establishing the
prevalence of disordered eating and alcohol and
drug use, as well as psychological and social factors
which contribute to these issues. However, to date
there is little published research adopting interven-
tion approaches which target adolescents’ disor-
dered eating or alcohol and drug use in sport
contexts, which would be a valuable addition to
the current research addressing clinical concerns
among adolescent athletes.
DISCUSSION
Sport is viewed as a context for adolescents’ positive
development; however, there is a large body of
literature revealing psychosocial challenges and
clinical concerns associated with youth sport
participation. Recent research has examined how
young athletes cope with challenges in sport con-
texts and the process by which athletes learn to
cope, with parents and coaches being implicated
as important social agents in athletes’ coping. This
line of research may provide valuable information
about adolescents’ coping in other contexts,
particularly in achievement contexts such as school
and academic settings. For example, task-oriented
coping (e.g., logical analysis, seeking social support,
effort expenditure) is associated with improvements
&
in sport achievement [27 ], and athletes’ percep-
tions of coping effectiveness increased following
educational sessions dealing with problem-focussed
&
coping [25 ]. Educating athletes about task-oriented
and problem-focussed coping may be useful in help-
ing athletes to deal with competitive demands, as
well as demands in other achievement contexts (i.e.,
298 www.co-psychiatry.com
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
school). There is abundant research in recent years
examining the development of life skills and the
potential for the transfer of life skills learned in sport
to other contexts [60,61]. Despite these advances,
there is little research examining the transfer of the
coping skills athletes gain in sport contexts to other
areas of their lives.
Why do some adolescent athletes develop eating
disorders? Researchers have identified the import-
ance of cognitive concerns as core features of ado-
lescent aesthetic sport athletes’ disordered eating. It
would appear that cognitive concerns regarding
body weight and competitive anxiety about per-
formance contribute to the development of disor-
dered eating [45]. Thus, perceptions that striving for
a thin body ideal will be beneficial for performance
may put athletes at risk for developing disordered
&
eating [45,47 ]. Although disordered eating is
suggested to develop as a result of young athletes’
desire to be leaner to improve performance
& &
[43 ,47 ], research among adolescent athletes is lim-
ited in scope and has provided equivocal results. It
may be the case that disordered eating is diagnosed
more often in contexts which emphasize aesthetics
and weight management. It should also be noted
that most research examining athletes’ disordered
eating has been conducted with older, elite popu-
lations. Nonetheless, eating disorders diagnosed
among adult elite athletes may begin during ado-
lescence, particularly if pressures to perform con-
tribute to young athletes’ cognitive concerns
regarding their body shape and weight. Further
longitudinal research which examines the trajectory
of development of disordered eating is warranted.
The definitions and diagnoses of clinical versus
subclinical eating disorders is an important issue to
be addressed. Subclinical eating disorders are those
which are not considered diagnosable as a clinical
eating disorder; yet, the athlete still presents symp-
toms of disordered eating and may experience
severe physical, psychological, and behavioural
disturbances as a result [35]. It is not entirely clear
how subclinical eating disorders are different from
‘eating disorders not otherwise specified’ (e.g. when
some but not all criteria are met for diagnosis of
anorexia nervosa or bulimia nervosa), and it is also
not clear how practitioners and researchers under-
stand and apply these different definitions and
diagnoses. Petrie and Greenleaf [35] have previously
drawn attention to this issue, and we agree that
greater clarity and consistency surrounding these
definitions and diagnoses are needed.
Why do young athletes drink alcohol? Several
reasons have been offered to account for adolescent
athletes’ alcohol use. Young athletes’ increased
social standing and pressure to maintain academic
Volume 25
Number 4
July 2012

and sport performances may create increased
demands, and socialization processes may encourage
the association between sports and alcohol consump-
tion [52,54]. Therefore, perceptions of increased
demands or greater difficulty in managing chal-
lenges, along with a ‘normalization’ of drinking,
may contribute to an increase in adolescent athletes’
alcohol consumption. Peer group influence and
parental norms are important in predicting adoles-
cent athletes’ alcohol use, which suggest key oppor-
tunities for intervention and education [54]. Parent
communication and modelling of appropriate
behaviours may be a viable avenue for decreasing
adolescent athletes’ alcohol consumption. Research-
ers may wish to examine the efficacy of team and
parental interventions to examine the short-term
and long-term effects on adolescent athletes’
alcohol use.
Over the past 18 months, researchers have estab-
lished evidence for psychosocial challenges and
clinical concerns among adolescent athletes; how-
ever, one limitation is a lack of studies adopting
intervention or experimental studies designed to
target these issues among young athletes. There is
a need for studies which evaluate the effectiveness of
educational or preventive programmes regarding
disordered eating or substance abuse, to improve
parental involvement in sport, and to enhance cop-
ing among adolescent athletes. Moving forward, it
would be worthwhile for researchers to consider
intervention research aimed at adolescent athletes
as well as members of their social network to
promote psychosocial well being and lifelong
sport participation.
CONCLUSION
Sport may serve as a context for youth development;
however, there are demands and pressures inherent
in competitive contexts which may be stressful and
potentially overwhelming for adolescent athletes.
Athletes’ coping in sport contexts may be valuable
for learning to deal with stressors, but in some
extreme cases athletes may engage in maladaptive
behaviours such as disordered eating, substance ab-
use, and steroid use to deal with the demands of
sport. Progress is being made in understanding how
athletes perceive psychosocial challenges in sport
and how interventions can equip young athletes
with the necessary coping skills to manage their
demands in an adaptive manner.
Acknowledgements
During the preparation of this manuscript K.A.T. was
supported by a postdoctoral fellowship from the Social
Sciences and Humanities Research Council of Canada.
0951-7367 ß 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Adolescent athletes Tamminen et al.
P.R.E.C. was supported by a standard research grant
from the Social Sciences and Humanities Research
Council of Canada.
Conflicts of interest
There are no conflicts of interest.
REFERENCES AND RECOMMENDED
READING
Papers of particular interest, published within the annual period of review, have
been highlighted as:
& of special interest
&& of outstanding interest
Additional references related to this topic can also be found in the Current
World Literature section in this issue (p. 332).
1. Côté J, Strachan L, Fraser-Thomas J. Participation, personal development,
and performance through youth sport. In: Holt NL, editor. Positive youth
development through sport. New York: Routledge; 2008. pp. 34–45.
2. Weiss M, Wiese-Bjornstal D. Promoting positive youth development through
physical activity. President’s Council on Physical Fitness and Sports Re-
search Digest 2009; 10:1–8.
3. Schumacher Dimech A, Seiler R. The association between extra-curricular
sport participation and social anxiety symptoms in children. J Clin Sport
Psychol 2010; 4:191–203.
4. Schumacher Dimech A, Seiler R. Extra-curricular sport participation: a po-
& tential buffer against social anxiety symptoms in primary school children.
Psychol Sport Exerc 2011; 12:347–354; doi: 10.1016/j.psychsport.
2011.03.007.
A repeated-measures cohort study among 208 children (mean age ¼ 7.86 years)
investigating the potential benefits of youth sport participation. Findings suggest
that children participating in team sports had fewer symptoms of social anxiety than
those participating in individual sports or no sport participation.
5. Fraser-Thomas J, Côté J. Understanding adolescents’ positive and negative
developmental experiences in sport. Sport Psychol 2009; 23:3–23.
6. Anshel MH, Delaney J. Sources of acute stress, cognitive appraisals, and
coping strategies of male and female child athletes. J Sport Behav 2001;
24:329–353.
7. Gould D, Wilson CG, Tuffey S, Lochbaum M. Stress and the young athlete:
the child’s perspective. Pediatr Exerc Sci 1993; 5:286–297.
8. Lazarus RS. Stress and emotion: a new synthesis. New York: Springer; 1999.
9. Tamminen KA, Holt NL. A meta-study of qualitative research examining
stressor appraisals and coping among adolescents in sport. J Sports Sci
2010; 28:1563–1580; doi: 10.1080/02640414.2010.512642.
10. Nicholls A, Polman RCJ. Coping in sport: a systematic review. J Sports Sci
2007; 25:11–31; doi: 10.1080/02640410600630654.
11. Kristiansen E, Roberts GC. Young elite athletes and social support: coping
with competitive and organizational stress in ‘Olympic’ competition. Scand J
Med Sci Sports 2009; 20:686–695; doi: 10.1111/j.1600-0838.2009.
00950.x.
12. Nicholls A, Holt NL, Polman RCJ, James DWG. Stress and coping among
international adolescent golfers. J Appl Sport Psychol 2005; 17:333–340;
doi: 10.1080/10413200500313644.
13. Reeves CW, Nicholls AR, McKenna J. Longitudinal analyses of stressors,
perceived control, and coping effectiveness among early and middle ado-
lescent soccer players. Int J Sport Psychol 2011; 42:186–203.
14. Tamminen KT, Holt NL. Female adolescent athletes’ coping: a season-
long investigation. J Sports Sci 2010; 28:101–114; doi: 10.1080/
02640410903406182.
15. Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer;
1984.
16. Gaudreau P, Nicholls AR, Levy AR. The ups and downs of sports perfor-
mance: a diary analysis of stress, coping, and performance. J Sport Exerc
Psychol 2010; 32:298–311.
17. Smith RE. Toward a cognitive-affective model of athletic burnout. J Sport
Psychol 1986; 8:36–50.
18. Kolt GS, Kirkby RJ, Lindner H. Coping processes in competitive gymnasts:
gender differences. Percept Mot Skills 1995; 81:1139–1145.
19. Gaudreau P, Blondin JP. Differential associations of dispositional optimism
and pessimism with coping, goal attainment, and emotional adjustment during
sport competition. Int J Stress Manage 2004; 11:245–269; doi: 10.1037/
1072-5245.11.3.245.
20. Gaudreau P, Blondin JP, Lapierre AM. Athletes’ coping during a competition:
relationship of coping strategies with positive affect, negative affect, and
performance-goal discrepancy. Psychol Sport Exerc 2002; 3:125–150.
21. Crocker PRE, Graham TR. Coping by competitive athletes with performance
stress: gender differences and relationships with affect. Sport Psychol 1995;
9:325–338.
www.co-psychiatry.com 299
 Child and adolescent psychiatry
22. Kowalski KC, Crocker PRE, Hoar SD, Niefer CB. Adolescents’ control beliefs
and coping with stress in sport. Int J Sport Psychol 2005; 36:257–272.
23. Tamres LK, Janicki D, Helgeson VS. Sex differences in coping behavior: a
meta-analytic review and examination of relative coping. Pers Soc Psychol
2002; 6:2–30.
24. Hoar SD, Crocker PRE, Holt NL, Tamminen KA. Gender differences in
adolescent athletes’ coping with interpersonal stressors in sport: more
similarities than differences? J Appl Sport Psychol 2010; 22:134–149;
doi: 10.1080/10413201003664640.
25. Reeves CW, Nicholls AR, McKenna J. The effects of a coping intervention on
& coping self-efficacy, coping effectiveness, and subjective performance
among adolescent soccer players. Int J Sport Exerc Psychol 2011;
9:126–142; doi: 10.1080/1612197X.2011.567104.
One of only a few coping intervention studies conducted among adolescent
athletes. This study provides preliminary evidence for a theoretically driven inter-
vention; however, because of its limited sample size and short follow-up period,
further research is required to extend these findings.
26. Nicholls AR, Holt NL, Polman RCJ. A phenomenological analysis of coping
effectiveness in golf. Sport Psychol 2005; 19:111–130.
27. Nicolas M, Gaudreau P, Franche V. Perception of coaching behaviors, coping,
& and achievement in a sport competition. J Sport Exerc Psychol 2011;
33:460–468.
This study demonstrates the importance of supportive coaching behaviours on
athletes’ use of task-oriented coping and goal attainment. Task-oriented coping
partially mediated the relationship between athletes’ perceptions of supportive
coaching behaviours and goal attainment.
28. Fredricks JA, Eccles JS. Parental influences on youth involvement in sports.
In: Weiss MR, editor. Developmental sport and exercise psychology: a life-
span perspective. Morgantown, WV: Fitness Information Technology; 2004.
pp. 145–164.
29. Goyen MJ, Anshel MH. Sources of acute competitive stress and use of coping
strategies as a function of age and gender. J Appl Dev Psychol 1998;
19:469–486. doi: http://dx.doi.org/10.1016/S0193-3973(99)80051-3.
30. Lauer L, Gould D, Roman N, Pierce M. Parental behaviors that affect junior
tennis player development. Psychol Sport Exerc 2010; 11:487–496; doi:
10.1016/j.psychsport.2010.06.008.
31. Knight CJ, Boden CM, Holt NL. Junior tennis players’ preferences for parental
behaviors. J Appl Sport Psychol 2010; 22:377–391; doi: 10.1080/
10413200.2010.495324.
32. Knight CJ, Neely KC, Holt NL. Parental behaviors in team sports: how do
female athletes want parents to behave? J Appl Sport Psychol 2011; 23:76–
92; doi: 10.1080/10413200.2010.525589.
33. Tamminen KA, Holt NL. Adolescent athletes’ learning about coping and the
& roles of parents and coaches. Psychol Sport Exerc 2012; 13:69–79; doi:
10.1016/j.psychsport.2011.07.006.
This study proposes a theoretical model regarding adolescent athletes’ process of
learning about coping, suggesting possible strategies for improving athletes’
coping via the influence of parents and coaches.
34. Schaal K, Tafflet M, Nassif H, et al. Psychological balance in high level
athletes: gender-based differences and sport-specific patterns. PLoS ONE
2011; 6:1–9; doi: 10.1371/journal.pone.0019007.
35. Petrie TA, Greenleaf CA. Eating disorders in sport: from theory to research to
intervention. In: Tenenbaum G, Eklund RC, editors. Handbook of sport
psychology, 3rd ed. Hoboken, NJ: Wiley; 2007. pp. 352–378.
36. Hausenblas HA, McNally KD. Eating disorder prevalence and symptoms for
track and field athletes and nonathletes. J Appl Sport Psychol 2004; 16:274–
286; doi: 10.1080/10413200490485630.
37. Thein-Nissembaum JM, Carr KE. Female athlete triad syndrome in the high
school athlete. Phys Ther Sport 2011; 12:108–116; doi: 10.1016/
j.ptsp.2011.04.002.
38. Byrne SM. Sport, occupation, and eating disorders. In: Fairburn CG, Brownell
KD, editors. Eating disorders and obesity, 2nd ed. New York: Guilford Press;
2002. pp. 256–259.
39. Bryant-Waugh R, Lask B. Childhood-onset eating disorders. In: Fairburn CG,
Brownell KD, editors. Eating disorders and obesity, 2nd ed. New York:
Guilford Press; 2002. pp. 210–214.
40. Cumming SP, Standage M, Loney T, et al. The mediating role of physical self-
concept on relations between biological maturity status and physical activity in
adolescent females. J Adolesc 2011; 34:465–473; doi: 10.1016/j.adoles
cence.2010.06.006.
41. Malina RM, Bouchard C, Bar-Or O. Growth, maturation and physical activity.
Champaign, IL: Human Kinetics; 2004.
42. Rosendahl J, Bormann B, Aschenbrenner K, et al. Dieting and disordered
eating in German high school athletes and nonathletes. Scand J Med Sci
Sports 2009; 19:731–739.
43. Krentz EM, Warschburger P. A longitudinal investigation of sports-related risk
& factors for disordered eating in aesthetic sports. Scand J Med Sci Sports
2011. doi: 10.1111/j.1600-0838.2011.01380.x. [Epub ahead of print]
Although most research has been cross-sectional, this was a longitudinal
study examining sport-related variables which may contribute to disordered
eating among young athletes. Social pressure to be thin increased at 1-year
follow up among women but not among men; findings suggest that athletes may
be at risk for developing disordered eating if they believe it will help improve
performance.
300 www.co-psychiatry.com
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
44. Thompson RA, Sherman RT. Eating disorders in sport. New York: Routledge;
2010.
45. Van Durme K, Goossens L, Braet C. Adolescent aesthetic athletes: a group at
risk for eating pathology? Eat Behav 2011; 13:119–122; doi: 10.1016/
j.eatbeh.2011.11.002.
46. Martens R, Burton D, Rivkin F, Simon J. Reliability and validity of the
Competitive State Anxiety Inventory (CSAI). In: Nadeau CH, Halliwell
WC, Newell KM, Roberts GC, editors. Psychology of motor behavior and
sport. Champaign, IL: Human Kinetics; 1980. pp. 91–99.
47. Martinsen M, Bratland-Sanda S, Eriksson AK, Sundgot-Borgen J. Dieting to
& win or to be thin? A study of dieting and disordered eating among adolescent
elite athletes and nonathlete controls. Br J Sports Med 2010; 44:70–76; doi:
10.1136/bjsm.2009.068668.
Findings suggest that dieting and weight control are more prevalent among
controls than athletes; however, athletes’ motivations to diet and engage in
disordered eating include losing weight and improving performance, whereas
controls’ motivations concerned improving appearance. Interventions to reduce
disordered eating should target specific motivations in athletic and nonathletic
populations.
48. Reel J, SooHoo S, Petrie T, et al. Slimming down for sport: developing a
weight pressures in sport measure for female athletes. J Clin Sport Psychol
2010; 4:99–111.
49. Haase AM. Physique anxiety and disordered eating correlates in female
athletes: differences in team and individual sports. J Clin Sport Psychol
2009; 3:218–231.
50. Greenleaf C, Petrie T, Reel J, Carter J. Psychosocial risk factors of bulimic
symptomatology among female athletes. J Clin Sport Psychol 2010; 4:177–
190.
51. Sundgot-Borgen J, Torstveit MK. Prevalence of eating disorders in elite
athletes is higher than in the general population. Clin J Sport Med 2004;
14:25–32.
52. Lisha NE, Sussman S. Relationship of high school and college sports
participation with alcohol, tobacco, and illicit drug use: a review. Addict
Behav 2010; 35:399–407; doi: 10.1016/j.addbeh.2009.12.032.
53. Terry-McElrath YM, O’Malley PM. Substance use and exercise participation
& among young adults: parallel trajectories in a national cohort-sequential study.
Addiction 2011; 106:1855–1865; doi: 10.1111/j.1360-0443.2011.
03489.x.
This study examined the trajectories of smoking, drug, and alcohol use among
11 741 graduating high school students. Increased participation in sport, athletics
or exercising was associated with lowered substance use frequency and pre-
valence during early adulthood; however, the authors argue for targeted alcohol
prevention strategies for high school team sports.
54. Davies FM, Foxall GR. Involvement in sport and intention to consume alcohol:
an exploratory study of UK adolescents. J Appl Soc Psychol 2011; 41:2284–
2311. doi: 10.1111/j.1559-1816.2011.00806.x.
55. Zelli A, Lucidi F, Mallia L. The relationships among adolescents’ drive for
muscularity, drive for thinness, doping attitudes, and doping intentions. J Clin
Sport Psychol 2010; 4:39–52.
56. Goulet C, Valois P, Buist A, Côté M. Predictors of the use of performance-
& enhancing substances by young athletes. Clin J Sport Med 2010; 20:243–
248.
This study used the Theory of Planned Behavior to examine athletes’ motivation to
use (or not use) performance-enhancing substances (including alcohol, chocolate,
creatine, soft drinks, recovery drinks, vitamin supplements, etc.). Behavioral
intention was the strongest predictor of substance use; sportspersonship, attitude,
subjective norm, pressure to gain weight, and perceptions of facilitating factors
and perceived moral obligations also predicted athletes’ motivation regarding the
use or nonuse of performance-enhancing substances.
57. Humphreys BR, Ruseski JE. Socio-economic determinants of adolescent use
& of performance enhancing drugs: evidence from the YRBSS. J Socioecon
2011; 40:208–216; doi: 10.1016/j.socec.2011.01.008.
This study used longitudinal data collected over 15 years to examine socio-
economic determinants of steroid uses among adolescents. Single-sport athletes
were less likely to use steroids than multisport athletes; within cohorts (e.g.,
freshman, sophomore, junior, and senior high school students) older athletes were
more likely to use steroids than younger athletes. The authors suggest these
findings may be because of economic motivations and expectations of rewards
associated with sport achievement, such as athletic scholarship opportunities.
58. Thorlindsson T, Halldorsson V. Sport, and use of anabolic androgenic steroids
& among Icelandic high school students: a critical test of three perspectives.
Subst Abuse Treat Prev Policy 2010; 5:1–11; doi: 10.1186/1747-597X-5-32.
Tested three perspectives to explain steroid use among 11 031 adolescents.
Findings suggest that substance use among adolescents is related to the social
context outside sport and should be considered as a public policy and social health
issue, rather than a sport-specific issue.
59. Dunn M, White V. The epidemiology of anabolic-androgenic steroid use
among Australian secondary school students. J Sci Med Sport 2011;
14:10–14; doi: 10.1016/j.jsams.2010.05.004.
60. Holt NL, editor. Positive youth development through sport. London: Routle-
dge; 2008.
61. Papacharisis V, Goudas M, Danish SJ, Theodorakis Y. The effectiveness of
teaching a life skills program in a sport context. J Appl Sport Psychol 2005;
17:247–254; doi: 10.1080/10413200591010139.
Volume 25
Number 4
July 2012