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Idiopathic Short Stature: Psychosocial Development and GH Treatment« Back to Volume 22, Issue 3, September 2006 - Table of Contents Visser-van Balen and colleagues presented a metanalysis of available research on the psychosocial functioning of medically referred children with idiopathic short stature (ISS) and the effects of growth hormone (GH) treatment. Specifically, the authors asked whether or not subgroups of medically referred children with ISS have specific risks and different outcomes when treated. Their search used the Medline and PsycInfo databases and included 11 studies that assessed psychosocial functioning. The results showed that according to parents, short children have lower social competence and more social problems than children with normal stature. The intelligence of the ISS children was within the normal range; however, they functioned on average between normal and below normal. Admittedly, the effect sizes were very small in these studies. Studies on the consequences of being short on psychosocial functioning in adulthood were inconclusive, as none of the adults in the studies had received GH. Two studies reported a relatively low percentage of marriages and relatively high percentage of unemployment and self-reported problems in social functioning among short adults. Other studies have not shown this effect. Of note, most of the studies among children only examined parental records. Studies using teachers and peers did not show lower social competence. Children’s own reports regarding self esteem showed relatively few indications of psychosocial problems. The interpretation was that either these children are too young to give an adequate assessment of their own functioning, or they lack time perspective. There were no studies in which similar concepts were studied by both parents and children. The authors speculated that it was possible that medically referred children with ISS had psychosocial problems because they were short. It is also possible that children with psychosocial problems, who were also short, may be referred relatively often. Their conclusion was that medically referred children with ISS had on average more psychosocial problems than children with normal stature. The review suggested that some risk factors for maladaptation in children with ISS include being teased, being juvenilised, being a boy, having a low intelligence, having a younger but taller sibling, and being part of a low socioeconomic status family. Further studies on the impact of the degree of shortness did not find an effect. This may be because it was not actual height, but perceived height which was crucial in terms of psychosocial risk factors. Finally, the effects of GH treatment on psychosocial factors were assessed in 9 studies in which the children had a mean height gain of at best 7 cm. On average, GH treatment did not improve psychosocial functioning and only a few studies showed improvement in problem behaviors. Although these pre- to post-treatment assessments with standardized questionnaires did not reveal changes in psychosocial functioning, a retrospective perception of GH treatment by parents and children was generally positive with parents reporting a positive change regarding social functioning and self-esteem of their children. The 3 main conclusions of this review included: (1) parents of medically referred children with ISS ranked the behavior of their children on average between normal and below normal with more psychosocial problems, (2) some risk factors influencing adaptation in children with ISS have been found, and (3) GH treatment is a means to gain height, but not a means to solve psychosocial problems. First Editor’s CommentThis is a very interesting metanalysis, which is probably the first of many subsequent reports to be written concerning ISS and psychosocial functioning. There are many justifiable critiques of the data presented including the lack of control groups, lack of randomization, variable ages at initiation of therapy, and variable duration of treatment. These variables suggest the need for long-term prospective studies in children with ISS for whom treatment is initiated and for whom treatment is not given. It is hoped that one of the GH registries will initiate such a study and that sufficient numbers of children can be obtained to be able to adequately assess the influence of these variables on adult psychosocial functioning and adjustment. William A. Clarke, MD Second Editor’s CommentThis review of the psychosocial development of medically-referred youths with ISS and the response to GH therapy is notable in that studies are summarized in the context of psychological theory—the disability-stress-coping model.1 A theory-driven analysis offers the promise of accounting for variability in the experiences of youths with ISS. Most importantly, this strategy generates testable hypotheses regarding the relationship between short stature and quality of life which could be employed in the development of psychosocial treatments serving as an alternative (or adjunct) to medical intervention. Underscoring this point, the authors stated that “hormone treatment is a means to gain height, but not a means to solve psychosocial problems.” As noted by the authors, the rigor of the research designs employed in assessing the psychosocial adaptation of short youths prior or subsequent to GH treatment is highly variable. Because of this, the studies conducted to date do not support firm conclusions regarding “risk factors” moderating the influence of short stature on psychosocial adaptation. Elements of research design pertinent to psychological studies of short stature have been discussed in this journal.2 David E. Sandberg, PhD References - (linked to
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Volume 26 Number 1
September 2010
www.GGHjournal.com
ISSN 1932-9032
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