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Psychosocial Outcome of Children Evaluated for Short Stature

Psychosocial Outcome of Children Evaluated for Short Stature Abstract Objective: To assess the psychosocial functioning of adults who were evaluated as children for short stature and were not treated with human growth hormone. Design: Inception cohort study. Setting: Hospital-based pediatric endocrinology clinic. Participants: From 1975 to 1980, medical record review indicated that 181 of the children referred to our clinic for concerns about short stature were non–growth hormone deficient. In 1992 and 1993, we were able to recruit 35 of these patients for a follow-up study. Eligible subjects were at least 18 years of age at the time of follow-up. Main Outcome Measures: Standardized self-report questionnaires assessed various domains of psychosocial adjustment. Also, a brief test of intellectual functioning was administered and subjects underwent a semistructured in-person interview to evaluate pragmatic functioning and experiences associated with short stature. Results: Few significant differences between the study sample and standardization samples were found on measures of psychosocial and intellectual functioning. Withingroup childhood height during the first evaluation appointment was not significantly associated with most adult measures of psychosocial adjustment. Shorter adult stature was significantly associated with lower educational achievement, lower self-esteem, and greater emotional distress. Conclusions: The absence of significant psychosocial distress or impairment in these subjects brings into question one basis for hormonal treatment for non–growth hormone deficient short stature; that short stature in childhood is likely to lead to psychological dysfunction in adulthood. The results, however, also suggest that shorter stature in adulthood may constitute a psychosocial stressor, increasing vulnerability across several domains.Arch Pediatr Adolesc Med. 1997;151:1017-1023 References 1. Cara JF, Johanson AJ. Growth hormone for short stature not due to classic growth hormone deficiency . Pediatr Clin North Am . 1990;37:1229-1254. 2. Cuttler L. Evaluation of growth disorders in children . Pediatrician . 1987;14:109-120. 3. Rosenfeld RG, Albertsoon-Wikland K, Cassorla F, et al. Diagnostic controversy: the diagnosis of childhood growth hormone deficiency revisited . J Clin Endocrinol Metabol . 1995;80:1532-1540. 4. Underwood LE, Rieser PA. Is it ethical to treat healthy short children with growth hormone? Acta Paediatr Scand Suppl . 1989;362:18-23.Crossref 5. Crowne EC, Shalet SM, Wallace WHB. Eminson DM. Price DA. Final height in boys with untreated constitutional delay in growth and puberty . Arch Dis Child . 1990;65:1109-1112.Crossref 6. Bjork S, Jonsson B, Westphal O, Levin JE. Quality of life of adults with growth hormone deficiency: a controlled study . Acta Paediatr Scand Suppl . 1989;356: 55-59.Crossref 7. Clopper RR, MacGillivray MH, Mazur T, Voorhess ML, Mills BJ. Post-treatment follow-up of growth hormone deficient patients: psychosocial status . In: Stabler B, Underwood LE, eds. Slow Grows the Child: Psychosocial Aspects of Growth Delay . Hillsdale, NJ: Lawrence Erlbaum; 1986:83-96. 8. Dean HJ, McTaggart TL, Fish DG, Friesen HG. The educational, vocational, and marital status of growth hormone-deficient adults treated with growth hormone during childhood . AJDC . 1985;139:1105-1110. 9. Galatzer A, Aran O. Beit-Halachmi N, et al. Rehabilitation status of young adults with hGH deficiency after termination of therapy . Pediatr Adolesc Endocrinol . 1987; 16:257-267. 10. Mitchell CM, Joyce S, Johanson AJ, et al. A retrospective evaluation of psychosocial impact of long-term growth hormone therapy . Clin Pediatr . 1986;25:17-23.Crossref 11. Rosen T, Wiren L, Wilhelmsen L, Wiklund I, Bengtsson B. Decreased psychological well-being in adult patients with growth hormone deficiency . Clin Endocrinol . 1994;40:111-116.Crossref 12. Rikken B, van Busschbach J, le Cessie S, et al. Impaired social status of growth hormone deficient adults as compared to controls with short or normal stature . Clin Endocrinol . 1995;43:205-211.Crossref 13. Stabler B, Turner JR, Girdler SS, Light KC, Underwood LE. Reactivity to stress and psychological adjustment in adults with pituitary insufficiency . Clin Endocrinol . 1992;36:467-473.Crossref 14. Sartorio A, Morabito F, Conti A, Gaglia G. The social outcome of adults with constitutional growth delay . J Endocrinol Invest . 1990;13:593-595.Crossref 15. Sandberg DE, Brook AE, Campos SP. Short stature: a psychosocial burden requiring growth hormone therapy? Pediatrics . 1994;94:832-840. 16. Zimet GD, Cutler M, Litvene M, Dahms W, Owens R, Cuttler L. Psychological adjustment of children evaluated for short stature: a preliminary report . J Dev Behav Pediatr . 1995;16:264-270.Crossref 17. Stabler B. Clopper RR, Siegel PT, Stoppani C, Compton PG. Academic achievement and psychological adjustment in short children . J Dev Behav Pediatr . 1994; 15:1-6.Crossref 18. Young-Hymen DL. Psychosocial functioning and social competence in growth hormone deficient, constitutionally delayed and familial short-stature children and adolescents . In: Holmes CS, ed. Psychoneuroendocrinology . New York, NY: Springer-Verlag; 1990:40-55. 19. Zimet GD, Cutler M, Owens R, Dahms W, Litvene M, Cuttler L. Psychosocial functioning of adults who were short as children . In: Stabler B, Underwood LE, eds. Growth, Stature, and Adaptation . Chapel Hill, NC: University of North Carolina; 1994:73-82. 20. Hollingshead AB, Redlich FC. Social Class and Mental Illness . New York, NY: John Wiley; 1958. 21. Myers JK, Bean LL. A Decade Later: A Follow-up of Social Class and Mental Illness . New York, NY: John Wiley; 1968. 22. Weinberger DA, Schwartz GE. Distress and restraint as superordinate dimensions of self-reported adjustment: a typological perspective . J Pers . 1990;58: 381-417.Crossref 23. Weinberger DA. Distorted self-perceptions: divergent self-reports as statistical outliers in the multimethod assessment of children's social-emotional adjustment . J Pers Assess . 1996;66:126-143.Crossref 24. Messer B, Harter S. Manual for the Adult Self-Perception Profile . Denver, Colo: University of Denver; 1986. 25. Harter S. The Perceived Competence Scale for Children . Child Dev . 1982;53:87-97.Crossref 26. Harter S. Manual for the Self-Perception Profile for Adolescents . Denver, Colo: University of Denver; 1988. 27. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The Multidimensional Scale of Perceived Social Support . J Pers Assess . 1988;52:30-41.Crossref 28. Dahlem N, Zimet GD, Walker RR. The Multidimensional Scale of Perceived Social Support: a confirmation study . J Clin Psychol . 1991;47:756-761.Crossref 29. Kaufman AS, Kaufman NL. Manual for the Kaufman Brief Intelligence Test . Circle Pines, Minn: American Guidance Service; 1990. 30. Boulton TJC, Dunn SM, Quigley CA, Taylor JJ, Thompson L. Perceptions of self and short stature: effects of two years of growth hormone treatment . Acta Paediatr Scand Suppl . 1991;377:20-27. 31. Borenstein M, Cohen J. Statistical Power Analysis: A Computer Program . Hillsdale, NJ: Lawrence Erlbaum; 1988. 32. Underwood LE. The social cost of being short: societal perceptions and biases . Acta Paediatr Scand Suppl . 1991;377:3-8. 33. Martel LF, Biller HB. Stature and Stigma: The Biopsychosocial Development of Short Males . Lexington, Mass: DC Heath and Company; 1987. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Psychosocial Outcome of Children Evaluated for Short Stature

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References (40)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1997.02170470051010
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Abstract

Abstract Objective: To assess the psychosocial functioning of adults who were evaluated as children for short stature and were not treated with human growth hormone. Design: Inception cohort study. Setting: Hospital-based pediatric endocrinology clinic. Participants: From 1975 to 1980, medical record review indicated that 181 of the children referred to our clinic for concerns about short stature were non–growth hormone deficient. In 1992 and 1993, we were able to recruit 35 of these patients for a follow-up study. Eligible subjects were at least 18 years of age at the time of follow-up. Main Outcome Measures: Standardized self-report questionnaires assessed various domains of psychosocial adjustment. Also, a brief test of intellectual functioning was administered and subjects underwent a semistructured in-person interview to evaluate pragmatic functioning and experiences associated with short stature. Results: Few significant differences between the study sample and standardization samples were found on measures of psychosocial and intellectual functioning. Withingroup childhood height during the first evaluation appointment was not significantly associated with most adult measures of psychosocial adjustment. Shorter adult stature was significantly associated with lower educational achievement, lower self-esteem, and greater emotional distress. Conclusions: The absence of significant psychosocial distress or impairment in these subjects brings into question one basis for hormonal treatment for non–growth hormone deficient short stature; that short stature in childhood is likely to lead to psychological dysfunction in adulthood. The results, however, also suggest that shorter stature in adulthood may constitute a psychosocial stressor, increasing vulnerability across several domains.Arch Pediatr Adolesc Med. 1997;151:1017-1023 References 1. Cara JF, Johanson AJ. Growth hormone for short stature not due to classic growth hormone deficiency . Pediatr Clin North Am . 1990;37:1229-1254. 2. Cuttler L. Evaluation of growth disorders in children . Pediatrician . 1987;14:109-120. 3. Rosenfeld RG, Albertsoon-Wikland K, Cassorla F, et al. Diagnostic controversy: the diagnosis of childhood growth hormone deficiency revisited . J Clin Endocrinol Metabol . 1995;80:1532-1540. 4. Underwood LE, Rieser PA. Is it ethical to treat healthy short children with growth hormone? Acta Paediatr Scand Suppl . 1989;362:18-23.Crossref 5. Crowne EC, Shalet SM, Wallace WHB. Eminson DM. Price DA. Final height in boys with untreated constitutional delay in growth and puberty . Arch Dis Child . 1990;65:1109-1112.Crossref 6. Bjork S, Jonsson B, Westphal O, Levin JE. Quality of life of adults with growth hormone deficiency: a controlled study . Acta Paediatr Scand Suppl . 1989;356: 55-59.Crossref 7. Clopper RR, MacGillivray MH, Mazur T, Voorhess ML, Mills BJ. Post-treatment follow-up of growth hormone deficient patients: psychosocial status . In: Stabler B, Underwood LE, eds. Slow Grows the Child: Psychosocial Aspects of Growth Delay . Hillsdale, NJ: Lawrence Erlbaum; 1986:83-96. 8. Dean HJ, McTaggart TL, Fish DG, Friesen HG. The educational, vocational, and marital status of growth hormone-deficient adults treated with growth hormone during childhood . AJDC . 1985;139:1105-1110. 9. Galatzer A, Aran O. Beit-Halachmi N, et al. Rehabilitation status of young adults with hGH deficiency after termination of therapy . Pediatr Adolesc Endocrinol . 1987; 16:257-267. 10. Mitchell CM, Joyce S, Johanson AJ, et al. A retrospective evaluation of psychosocial impact of long-term growth hormone therapy . Clin Pediatr . 1986;25:17-23.Crossref 11. Rosen T, Wiren L, Wilhelmsen L, Wiklund I, Bengtsson B. Decreased psychological well-being in adult patients with growth hormone deficiency . Clin Endocrinol . 1994;40:111-116.Crossref 12. Rikken B, van Busschbach J, le Cessie S, et al. Impaired social status of growth hormone deficient adults as compared to controls with short or normal stature . Clin Endocrinol . 1995;43:205-211.Crossref 13. Stabler B, Turner JR, Girdler SS, Light KC, Underwood LE. Reactivity to stress and psychological adjustment in adults with pituitary insufficiency . Clin Endocrinol . 1992;36:467-473.Crossref 14. Sartorio A, Morabito F, Conti A, Gaglia G. The social outcome of adults with constitutional growth delay . J Endocrinol Invest . 1990;13:593-595.Crossref 15. Sandberg DE, Brook AE, Campos SP. Short stature: a psychosocial burden requiring growth hormone therapy? Pediatrics . 1994;94:832-840. 16. Zimet GD, Cutler M, Litvene M, Dahms W, Owens R, Cuttler L. Psychological adjustment of children evaluated for short stature: a preliminary report . J Dev Behav Pediatr . 1995;16:264-270.Crossref 17. Stabler B. Clopper RR, Siegel PT, Stoppani C, Compton PG. Academic achievement and psychological adjustment in short children . J Dev Behav Pediatr . 1994; 15:1-6.Crossref 18. Young-Hymen DL. Psychosocial functioning and social competence in growth hormone deficient, constitutionally delayed and familial short-stature children and adolescents . In: Holmes CS, ed. Psychoneuroendocrinology . New York, NY: Springer-Verlag; 1990:40-55. 19. Zimet GD, Cutler M, Owens R, Dahms W, Litvene M, Cuttler L. Psychosocial functioning of adults who were short as children . In: Stabler B, Underwood LE, eds. Growth, Stature, and Adaptation . Chapel Hill, NC: University of North Carolina; 1994:73-82. 20. Hollingshead AB, Redlich FC. Social Class and Mental Illness . New York, NY: John Wiley; 1958. 21. Myers JK, Bean LL. A Decade Later: A Follow-up of Social Class and Mental Illness . New York, NY: John Wiley; 1968. 22. Weinberger DA, Schwartz GE. Distress and restraint as superordinate dimensions of self-reported adjustment: a typological perspective . J Pers . 1990;58: 381-417.Crossref 23. Weinberger DA. Distorted self-perceptions: divergent self-reports as statistical outliers in the multimethod assessment of children's social-emotional adjustment . J Pers Assess . 1996;66:126-143.Crossref 24. Messer B, Harter S. Manual for the Adult Self-Perception Profile . Denver, Colo: University of Denver; 1986. 25. Harter S. The Perceived Competence Scale for Children . Child Dev . 1982;53:87-97.Crossref 26. Harter S. Manual for the Self-Perception Profile for Adolescents . Denver, Colo: University of Denver; 1988. 27. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The Multidimensional Scale of Perceived Social Support . J Pers Assess . 1988;52:30-41.Crossref 28. Dahlem N, Zimet GD, Walker RR. The Multidimensional Scale of Perceived Social Support: a confirmation study . J Clin Psychol . 1991;47:756-761.Crossref 29. Kaufman AS, Kaufman NL. Manual for the Kaufman Brief Intelligence Test . Circle Pines, Minn: American Guidance Service; 1990. 30. Boulton TJC, Dunn SM, Quigley CA, Taylor JJ, Thompson L. Perceptions of self and short stature: effects of two years of growth hormone treatment . Acta Paediatr Scand Suppl . 1991;377:20-27. 31. Borenstein M, Cohen J. Statistical Power Analysis: A Computer Program . Hillsdale, NJ: Lawrence Erlbaum; 1988. 32. Underwood LE. The social cost of being short: societal perceptions and biases . Acta Paediatr Scand Suppl . 1991;377:3-8. 33. Martel LF, Biller HB. Stature and Stigma: The Biopsychosocial Development of Short Males . Lexington, Mass: DC Heath and Company; 1987.

Journal

Archives of Pediatrics & Adolescent Medicine – American Medical Association

Published: Oct 1, 1997

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