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The Wessex Growth Study in the United Kingdom is a
prospective, longitudinal school-based study that followed the physical and
psychosocial development of short healthy students, and their average stature classmates
from school until 18 to 20 years of age. This report represents the third in a
series; the prior studies occurred when subjects were 7 to 9 and 11 to 13 years
of age. The objective was to ascertain whether any psychosocial sequelae of
short stature (during childhood or at the time of follow-up) could be detected
in young adulthood. The short stature group (<–2 SDs score for height) was
compared to classmates of average height (10 – 90th percentiles).
There were 48 short normal (SN) and 66 control (C) subjects; these were
statistically indistinguishable on multiple sociodemographic variables. Ulph
and colleagues used the Adolescent to Adult Personality Functioning Assessment
(ADAPFA) to measure social and interpersonal role performance in 6 domains:
education and employment; love relationships; friendships; coping; social
contacts; and negotiations. Critical behaviors related to education received
beyond school, employment status, relationships with a partner, parenthood,
drug taking, drinking, and involvement with violence—referred to as activities
of daily living—were also assessed. The data were analyzed with respect to both
height at recruitment (ages 7–9) and as adults (ages 18–20). The participants
were classified into 3 height groups: <2nd percentile (n=19); 2nd–50th
percentile (n=61); and >50th percentile (n=34). The middle group
consisted of both initial SN and C participants.
Height at recruitment was not associated with ADAPFA
scores. The mean ADAPFA scores on 3 domains were (nonsignificantly) higher in
the SN group, indicating poorer adaptation. (Gender and SES were significant
predictors of several domain scores validating ADAPFA sensitivity.) There was
no effect of adult height on outcome measures, nor was there a significant
difference in the proportion of 3 adult height groups that received scores
falling within the clinical range. ADAPFA score was highest in the shortest
group and for 2 specific domains. The measure of activities of daily living did
not differentiate participants by recruitment or adult height. The authors
conclude that healthy short stature adults did not have compromised
psychological, social, or educational adaptation when sociodemographic
variables were taken into account.
Ulph F, Betts P, Mulligan J, Stratford RJ. Personality functioning: the influence of stature. Arch Dis Child. 2004;89:17–21.
Editor’s Comment:
The Wessex Growth Study is the first and only
prospective longitudinal study of social, educational and psychological
adaptation of physically healthy short children from a community sample that
employs a methodologically sophisticated approach. Because study participants
were selected from schools, the referral bias that stems from recruitment
through pediatric endocrinology clinics was obviated. Previous findings
demonstrated that stature was not a statistically significant predictor of
self-concept, behavioral or emotional functioning, or academic performance,
although those with short stature were less satisfied with their height.1,2
These earlier observations were reinforced by the current findings that adult
stature was not a predictor of psychosocial adaptation. Importantly,
statistical analyses in all waves of the study controlled for the influence of
sociodemographic variables that are well-recognized predictors of
quality-of-life outcomes, and which can be confounded with stature.
The authors conspicuously failed to mention that
this cohort had also been examined during adolescence.3 At that
time, short boys reported being more than twice as likely as average stature
boys to be the object of teasing, and much more likely to say that this upset
them and that they spent break time alone. Short stature may thus place the
individual at increased risk for psychosocial stress. However, the association
between negative experiences (teasing or juvenilization) and validated measures
of behavioral and emotional functioning is relatively weak. Another study has
shown the overall level of psychosocial adaptation of short youths derived from
a clinic sample was comparable to that of the general population.4
It can be inferred that, on average, short youths exposed to negative
experiences adaptively cope so that signs of impairment do not emerge.
David E. Sandberg, PhD
References - (linked to  )
- Voss LD, Mulligan J. The short 'normal' child in school: self-esteem, behavior and attainment before puberty (The Wessex Growth Study). In: Stabler B, Underwood LE, eds. Growth, Stature and Adaptation. Chapel Hill, NC: UNC at Chapel Hill Press; 1994:47-64.
- Downie AB, Mulligan J, Stratford RJ, Betts PR, Voss LD. BMJ. 1997;314:97-100.
- Voss LD, Mulligan J. BMJ. 2000;320:612–613.
- Sandberg DE, Bukowski WM, Fung CM, Noll RB. Pediatrics. 2004;114:744-750.
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Current GGH - Vol. 24 No. 1
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