Stature and Psychosocial Adjustment in Adulthood
© 2004 Prime Health Consultants, Inc.
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.
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 
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- 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.