SHORT STATURE - A PSYCHOSOCIAL BURDEN REQUIRING GROWTH-HORMONE THERAPY

Background. Changes in the diagnosis of endocrine-based growth disorde rs and the advent of biosynthetic growth hormone have altered the long -standing policy of treating only those individuals with ''classic'' g rowth hormone deficiency. One justification for treating short childre n is to improve their psychosocial adaptation. The present investigati on assessed the positive and negative behavioral adaptation, self-perc eptions of domain-specific competencies, and global self-worth of a la rge, diagnostically heterogeneous sample of children and adolescents r eferred to pediatric endocrinologists for a growth evaluation. Methods . All patients seen in a pediatric endocrine clinic (180 boys and 78 g irls; 4 to 18 years) with a height at the fifth percentile or lower we re included. Parents of all participating children completed the Child Behavior Checklist. Patients 8 years and older completed the Self-Per ception Profile and those 11 years and older, in addition, completed t he Youth Self Report. Short-stature (SS) subjects were compared with n ormative and psychiatric samples. Results. The SS boys were described by parents as being significantly less socially competent and showing more behavioral and emotional problems than a normative sample selecte d for mental health. However, they were significantly more socially co mpetent and showed fewer psychopathologic symptoms than a psychiatric referred sample of comparable age. The SS boys described themselves as less socially active but did not report more behavior disturbance tha n the normative sample. The SS boys' self-perceptions of domain-specif ic competencies and global self-worth were comparable to a normative c omparison group with the exception that older subjects (13 years or ol der) described their athletic abilities more positively and their work competence more negatively. The SS girls were, with few exceptions, i ndistinguishable from the normal comparison groups on both parent- and self-report measures of social competency and behavior disturbance. Y ounger SS girls (ages 8 to 12 years) described their athletic competen ce and behavioral conduct more positively than the comparison group on the self-esteem questionnaire. Patient height deficit was unrelated t o scores on the three questionnaires. Finally, no statistically signif icant differences in psychosocial functioning were detected between ch ildren with ''normal-variant'' SS and those with pathologic growth dis orders. Conclusions. Short-stature girls show more adaptive psychosoci al functioning than SS boys. In either sex, SS does not appear to be a ssociated with clinically significant psychosocial morbidity. Severity of the height deficit does not correlate with the level of behavioral adaptation. These observations challenge the justification of providi ng growth hormone therapy for all short children to improve their psyc hosocial functioning.