How did high school athletes become a professional focus?
Honestly, working with youths was not my primary intention at all. I started my career in college athletics and was able to develop the first sports psychology clinic at the University of New Mexico, working with the young-adult population, 18 to 25. But mid-major financial troubles and the cutting of multiple team sports is what led me to Johns Hopkins and this next shot in the profession. While I never really intended to work with the youth athlete population, it has been one of the most influential and impactful experiences that I’ve had in my career. I’m just really so grateful for it.
What are the warning signs that a high school athlete might be experiencing mental health issues?
We’re looking for any kind of behavioral change. Those warning signs are really signals of stress or distress, and how those appear can be changes of mood, whether there is a more depressed mood or more anxious mood. There might be behavioral changes such as more avoidance of activities or social avoidance. There may be changes in their performance, whether that is decreased performance in academics or in athletics. We might see physical changes in weight or appearance. There are many signs that are observable to even the lay person, and certainly I think our gatekeepers [coaches and athletic directors] are now getting better able to recognize what those signs are.
Does the developing brain of an adolescent make high school athletes particularly susceptible to mental health challenges?
It makes adolescents, whether they’re athletes or not, susceptible. After the first five years of life, this next stage of adolescence — from 12 to 25 — is the next most significant or risky period, because there’s so much change going on, not only in the brain, but obviously in the body and socially. It’s all these changes that just put on additional layers of stress.
Much attention —and some might say lip service — has been paid to collegiate student-athletes and their mental health, particularly in this new era of conference realignment, cross-country travel, sleep deprivation, etc. Can you describe how the stress facing high school athletes might differ from their counterparts at the college level?
It depends on the level of support. At the collegiate level, we expect at this point that they are usually out of the family home, and so they hopefully have developed more of these strategies to be able to effectively manage themselves, their emotions or their attention to navigate some of these stressors and have appropriate help-seeking behaviors. For adolescents, they usually don’t have these skillsets honed yet. Not to say that all college student-athletes do, either, but high school athletes probably have even less of these skills, so they’re leaning more on their family support systems to be able to help with that.
It’s been said that the traditional structure of a school day might not be an ideal match for the sleep patterns of teenagers, and that extracurriculars are what dictate early start times for classes. Would there be any potential mental health benefit for adolescents, in general, and student-athletes if their school day was structured differently?
The structure at IMG and other sports academies looks very different to support these opposing needs for attention, time, effort. A day is split into basically two four-hour blocks, and whether it’s morning or afternoon, one of those blocks is dedicated to the classroom and the other block is dedicated to the training of one sport. And that works really well for those people who are highly motivated to continue their sport at the highest level. As far as structures, this is tricky, because there’s not a one-size-fits-all model, but we create that for efficiency.
Are there different mental stresses on a high school athlete who specializes in a given sport year-round compared to a four-sport letter-winner?
Definitely. I mean, in the specialization model, all eggs are in one basket, so to speak. So that identity development really becomes quite sticky in terms of whether the performance outcome is going well or not. At the end of the day, this is really what often is behind a lot of these crises — the distress and stress around sport, and this overattachment to and overidentification with outcomes.
Is it, in your opinion, just a healthier approach for a high school athlete to play several different sports than to focus on one, or is that too broad a generalization?
Oh, man, I often wonder this question for myself, Paul. There’s sort of the generalist model versus the specialist model. They both have their own costs and benefits. I can’t speak to one being better than the other. They’re just different.
With revenue-sharing and budget issues at the college level, we’re already seeing a detrimental impact on Olympic sports sponsorship. If someone who’s competing in an Olympic sport at the high school level sees opportunities dwindling at the college level, does that in itself create a stressor for the high school athlete who was aspiring to continue competing once they graduate high school and enter college?
Absolutely. This landscape has been changing so fast just in these last three or four years around that, and that’s really trickled down. That’s certainly what I’ve seen in a lot of the Olympic sport athletes I worked with. These windows are shrinking. This has been the single-minded goal for the last eight years plus, and the families are all in financially, emotionally and also in their own kind psyche. Now this window is getting smaller, and so with that comes much more fear, and we’re never really at our best when we’re responding from a fear mindset.
Another sort of trickle-down aspect from college to high school is name, image and likeness compensation. Do you think that allowing high school students to pursue NIL deals, as many states now do, is good for a high school student-athlete’s mental wellbeing?
Definitely not. And I’m really not for that in the collegiate space, either. But I think, especially for youths, it just creates more of a problem with overidentification in a time of life when they don’t have a self yet. So, it makes it even more turbulent, and they may strive for potential maladaptive ways to cope. It’s just a — I mean, this maybe isn’t the right word — delusion of what is really important in this stage of development.
It’s inherently a stressful situation if someone is so uncomfortable in their own mind and body that they wish to change their gender identity. Where do you stand personally and professionally on the transgender bans in high school sports participation that we’re seeing spread nationwide?
I don’t know, Paul. I really don’t. I just feel like I don’t understand it enough myself to really be able to have any kind of recommendation on it. It sure does get people hot. There’s some real aversion on this topic, which I find fascinating. And maybe that’s a better question: What is that anger really about?
There have been some on the concussion front who support the idea that youths should not be allowed to play tackle football until their freshman year of high school — roughly age 14 — in the interest of brain health. Do you agree with that?
No. It’s too general. Now, if we know that there is a history of concussion, how we go about mitigating post-concussion syndrome in that critical age and time of development, that’s something else. A sport neuropsychologist would be the one you want to speak to about that, but in my opinion, I think that’s a little bit too much of an overreach.
Youth football benefits outweigh the risks.
All sport benefits outweigh the risks. Look at the risk of concussion in women’s soccer and hockey, which are probably more risky from a concussion standpoint than football. We have to really look at context.
Do you have any recommendations for high schools or high school athletic departments in terms of how they go about promoting the mental health of their student-athletes?
Get licensed, qualified people in their schools to be able to really train up the gatekeepers and make sure that there’s mental health promotion and that there are clear pathways to treatment as needed. When it comes to the student-athlete, the most important gatekeeper is the coach, especially when it’s an athlete who is at a sports academy and their single focus is to pursue their sport at the highest level.
Are we talking licensed psychologists at the high school level?
I think most schools right now at the high school level have some kind of licensed mental health provider. They might not have a psychologist, but they might have someone who is qualified enough to really be able to assist with that recognition and response, and that referral to a more specialized level of care.
