Published online February 1, 2005
PEDIATRICS Vol. 115 No. 2 February 2005, pp. 515-516 (doi:10.1542/peds.2004-2207)

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Height and Social Adjustment

Stephen F. Kemp, MD, PhD
Department of Pediatrics
University of Arkansas for Medical Sciences
Arkansas Children's Hospital
Little Rock, AR 72202

To the Editor.—

There continues to be debate about whether short children suffer psychological stress from their short stature. Sandberg et al¹ have reported that extremes of stature have minimally detectable impact on peer perceptions of social behavior, friendship, or acceptance in a general population of school children. This research was supported in part by a grant from the Human Growth Foundation, a nonprofit organization dedicated to research, education, advocacy, and support for people with growth disorders. We believe that this research is important, because most reported studies on the psychological effect of short stature have been conducted in the population of children who have been referred for medical evaluation of their short stature. We hope to be able to support similar studies in the future.

It is of interest that these observations differ from what is seen in patients referred to growth clinics or in terms of the concerns of parents who seek information and support from organizations such as the Human Growth Foundation. Stabler et al² reported that academic underachievement, behavior problems, and reduced social competency are overrepresented in the population of short children (heights –2.7 SD) who are being treated with growth hormone. As many as 40% had some form of psychosocial adjustment problem. It is probable that children referred for short stature represent a different population than those who are not referred for medical evaluation. In fact, it has been reported that those short children not referred for evaluation do not experience psychological problems.^3,4 Lindsay et al⁵ evaluated children in Salt Lake City (Utah) schools and reported that although 1 in 3500 children met the criteria for the diagnosis of growth hormone deficiency, only half of them were actually being evaluated or treated. Another striking difference between the children in the Sandberg article and the children we see in our clinics or at the Human Growth Foundation is the degree of short stature. Although Sandberg et al tried to evaluate children with heights >2.25 SD below the mean, the number of subjects in this height range were too few for meaningful analysis. By contrast, the heights of patients who have been treated for idiopathic short stature or growth hormone deficiency followed by postmarketing studies have had average heights of –2.7 to –3.2 SD. An additional issue is that Sandberg et al examined their study population with specific instruments with a limited number of endpoints. It is not clear that these instruments have been validated appropriately. There may be other instruments that would identify issues that have are not seen in this report.

Sandberg et al¹ suggest that children or parents of children concerned about psychological problems associated with short stature may be exhibiting a focusing illusion. Stabler et al⁶ have shown that children with short stature treated for 3 years with growth hormone demonstrated improvement in behavior problems (whether they had growth hormone deficiency or idiopathic short stature), suggesting that the behavior problems may not simply represent a focusing illusion and that treatment of the short stature, at least in some cases, seems to address the behavioral issues.

The study shows no significant drawbacks in socialization of the shorter (but normal-statured) children. However, it does not and cannot examine what it may have taken for the shorter children to develop their adaptive or coping strategies to allow them to fit in with their peers. In fact, the authors have some data contradicting their own conclusions. The shorter children were perceived as looking younger, which was correlated with small increases in emotional sensitivity, victimization and passive withdrawal, and small decreases in physical and verbal aggression and dominance. These findings are minimized by the authors but could nevertheless be relevant to the individual patients who present to the clinic and to the group of significantly shorter children not examined in the study. It is possible, as these authors suggest, that short stature may not cause psychological problems for all short children, and there may be many short children who may not benefit from growth hormone therapy. However, there is also a body of data indicating that very short children who seek medical attention for their short stature may be experiencing academic underachievement, behavior problems, and reduced social competency. It would be a mistake to deny medical evaluation or growth hormone therapy (when appropriate) to these children.

REFERENCES

1. Sandberg DE, Bukowski WM, Fung CM, Noll RB. Height and social adjustment: are extremes a cause for concern and action? Pediatrics. 2004;114 :744 –750[Abstract/Free Full Text]
2. Stabler B, Clopper RR, Siegel PT, Stoppani C, Compton PG, Underwood LE. Academic achievement and psychological adjustment in short children. J Dev Behav Pediatr. 1994;14 :1 –6
3. Sandberg DE, Brook AE, Campos SP. Short stature: a psychosocial burden requiring growth hormone therapy? Pediatrics. 1994;94 :832 –840[Abstract/Free Full Text]
4. Voss LD. Growth hormone therapy for the short normal child: who needs it and who wants it? The case against growth hormone therapy. J Pediatr. 2000;136 :103 –106[CrossRef][Web of Science][Medline]
5. Lindsay R, Feldkamp M, Harris D, Robertson J, Rallison M. Utah Growth Study: growth standards and the prevalence of growth hormone deficiency. J Pediatr. 1994;125 :29 –35[CrossRef][Web of Science][Medline]
6. Stabler B, Siegel PT, Clopper RR, Stoppani CE, Compton PG, Underwood LE. Behavior change after growth hormone treatment of children with short stature. J Pediatr. 1998;133 :366 –373[CrossRef][Web of Science][Medline]

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PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

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Height and Social Adjustment: In Reply

William M. Bukowski, Robert B. Noll, Caroline Fung, and David E. Sandberg
Pediatrics 2005 115: 516-517. [Extract] [Full Text]  

This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Related articles in Pediatrics Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kemp, S. F. Search for Related Content PubMed PubMed Citation Articles by Kemp, S. F. Related Collections Endocrinology Social Bookmarking                         What's this?