Sport-related performance anxiety in young athletes: a clinical practice review.

Performance anxiety is characterized by intense feelings of emotional distress before, during, or after performing in front of others. In pediatric patients who participate in organized, competitive athletics, this can manifest with somatic, cognitive, and behavioral symptoms such as activation of the sympathetic nervous system and avoidance behaviors. Performance anxiety may now be classified as a psychiatric disorder if symptoms have been longstanding and cause significant emotional distress and/or functional impairment. Participation in competitive sports can confer many benefits to pediatric patients, but these benefits may go unrealized if performance anxiety is not addressed and leads to attrition from athletics. This review provides up-to-date information on prevalence and risk factors of performance anxiety in young athletes (generally speaking, school-age children, adolescents, and young adults). The clinical presentation, assessment considerations including differential diagnosis, and several standardized measures of performance anxiety are overviewed. We also review comprehensive management of sports performance anxiety in pediatric populations, with an emphasis on psychological interventions. Presently, cognitive behavioral therapy dominates the literature as an effective treatment for this condition, and special considerations in adapting this intervention to pediatric populations are considered. Recent research in the area of mindfulness as an effective intervention for sports performance anxiety is explored. In addition, careful consideration is given to appropriate pharmacological treatment, including propranolol, hydroxyzine, and benzodiazepines.