Study Suggests Most Short Children Are Well Adjusted, Raises Questions About Treating Them With Growth Hormone

BUFFALO, N.Y. -- Most short children are well-adjusted and have no serious social or emotional problems, despite assumptions by some physicians and parents, a new study by researchers at the University at Buffalo and Children's Hospital of Buffalo has shown.

The research hits at the heart of the controversy over whether to treat short children who are not deficient in naturally occurring human-growth hormone with a synthetic version of the hormone to make them taller. One rationale for treatment in the past has been to improve psychosocial functioning.

"Shorter-than-normal children may be teased, and they may be treated as if they are younger than they are, but, despite that, they are doing pretty well," said David E. Sandberg, Ph.D., UB assistant professor of psychiatry and pediatrics, and lead investigator on the study.

"Previous reports had led us to believe these children were quite bad off."

The study is published in the December issue of Pediatrics.

"This paper is a little bit of a caution against treating kids who are not growth-hormone deficient," Sandberg noted. "Results show it would be a mistake to prescribe growth hormone to short children based on the assumption that they are experiencing significant life-adjustments problems."

The findings are based on data from 258 children referred to a pediatric endocrine clinic for evaluation because of shorter-than-normal stature. Parents completed the Child Behavior Checklist, a standard way of assessing social competence, and children 12 years of age and older completed a comparable questionnaire describing themselves.

The researchers compared these responses with results from normal children and from children referred for mental-health services.

Earlier studies had reported a variety of problems among children with moderate to severe short stature, including socialization according to height rather than age, stigmatization because of appearance, poor social skills, social isolation, low self-esteem and poor academic achievement. However, these data were gathered primarily from short children who had conditions such as underactive pituitary or a chromosomal anomaly, which can produce features that could cause adjustment problems.

The UB study showed that parents rated boys somewhat less socially competent and reported somewhat more behavior problems than the normal sample, but the results did not reveal major psychosocial problems. In addition, the short boys were rated as functioning distinctly better than the group referred for mental-health services.

Boys' ratings of themselves mirrored their parents' evaluations on social activity, but they didn't report having more behavior problems than seen in the general population. In a still more positive vein, short adolescent boys in the study rated themselves better athletically than other boys their age.

Short girls showed little difference in social functioning, behavior problems and self-esteem from girls in the general population, indicating they adapt better to their shortness than boys, the study showed. The girls also reported being better at athletics than the comparison group.

Sandberg said the results are pertinent and relevant to a wide population of short children because the sample was large, non-volunteer and ethnically and socioeconomically diverse.

"I think these findings indicate we should be treating growth failure, not short stature," Sandberg said. "It would seem that, by and large, these kids are fairly well-adjusted."

Researchers in involved in this study, in addition to Sandberg, were Amy E. Brook and Susana Campos, M.D., both from UB.