Psychological Adaptation in Children with Idiopathic Short Stature Treated with Growth Hormone or Placebo

Abstract

The influence of short stature on psychological adaptation in childhood and adolescence is controversial. GH is currently used to treat children with idiopathic short stature (ISS, also known as non-GH-deficient short stature). This study represents the first double-blind, placebo-controlled trial of the effects of GH on the psychological adaptation of children and adolescents with ISS, treated with GH until adult height was attained.Sixty-eight children (53 males, 15 females), 9-16 yr old, with marked ISS (measured height or predicted adult height -2.5 sd or less) received either GH 0.074 mg/kg or placebo sc three times per week until height velocity decreased to less than 1.5 cm/yr. Parents completed the Child Behavior Checklist (CBCL) and children the Self-Perception Profile (SPP) and Silhouette Apperception Technique at baseline and annually thereafter. Baseline behavioral/emotional adjustment (CBCL) and self-concept (SPP) scores for children with ISS were within the normative range. The two study groups exhibited similar behavioral and self-concept profiles (CBCL) during the first 2 yr of the study. However, CBCL behavior problems (internalizing, externalizing, and total problems) appeared to decline, in yr 3 and 4, in the GH-treated group relative to the placebo-treated group. Group differences in CBCL competency domains and the SPP were not observed at any point during the study. Short stature among children with ISS enrolled in this long-term, placebo-controlled study was not associated with problems in psychological adaptation or self-concept with the psychological instruments employed. GH treatment was associated with a trend toward improvement in problem behaviors, as measured by questionnaires (CBCL) completed by study participants' parents. It remains to be determined whether GH treatment significantly impacts adaptation, psychosocial function, or quality of life in children with ISS.

Is short stature a problem? The psychological view

“…In the only randomised, double blind, placebo controlled study of the psychosocial effects of GH in ISS, the psychosocial adaptation and self esteem of the GH-treated youngsters were comparable to that of the placebo group at baseline (74). Interestingly, relatively taller children showed more emotional problems at baseline than the very shortest, replicating an earlier finding by this group (52).…”

Clinical Dilemmas in Evaluating the Short Child

“…On average, treating children who have idiopathic short stature with growth hormone has not been shown to improve psychosocial functioning. 22 The psychosocial impact of short stature is a complex interplay of the child's functioning, temperament, cultural stereotypes, and adaptation to stress. The coping strategies of the child and family affect how the child emotionally deals with any teasing or bullying he or she may experience.…”

“…The coping strategies of the child and family affect how the child emotionally deals with any teasing or bullying he or she may experience. 22 Assessment of other stressors on the family and child, such as financial problems, major life events, or learning difficulties can help determine to what extent further emotional stress will impact the child. When counseling parents about their child's growth, determining if there are other significant social stressors will help the physician decide what additional support, if any, is needed.…”

Growth Hormone Treatment of Short Stature: Status of the Quality of Life Rationale

“…In the sole randomized, double-blind, placebo-controlled study of the psychosocial effects of rhGH treatment in ISS, the psychosocial adaptation and self-esteem of youths in the treated and placebo groups were comparable to the general population prior to treatment initiation [54]. However, relatively taller children exhibited more emotional problems at baseline than shorter youths.…”