Regular Article
The psychosocial consequences of short stature: a review of the evidence

https://doi.org/10.1053/beem.2002.0211Get rights and content

Abstract

The advent of biosynthetic growth hormone (GH) has been accompanied by a transformation in the clinical management of youths with short stature. An important – if not always explicitly stated – goal of endocrine therapies is an improvement in the psychological adaptation of individuals with short stature. Negative stereotypes regarding short stature constitute a potential source of psychosocial stress for the affected child and, in turn, the entire family. Nevertheless, studies have demonstrated that the psychological adaptation of individuals who are shorter than average is largely indistinguishable from others, whether in childhood, adolescence or adulthood. ‘Short stature’ as an isolated physical characteristic appears to hold little value as a predictor of the individual's psychological adaptation or quality of life. In order to avoid the unwarranted medicalizing of healthy short stature, clinicians would be well advised to incorporate factors beyond auxology in the decision-making algorithm when selecting and preparing patients for possible growth-promoting therapies.

References (101)

  • JM Tanner et al.

    Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty

    Archives of Disease in Childhood

    (1976)
  • JV Freeman et al.

    Cross sectional stature and weight reference curves for the UK, 1990

    Archives of Disease in Childhood

    (1995)
  • MB Ranke

    Towards a consensus on the definition of idiopathic short stature

    Hormone Research

    (1996)
  • P Saenger et al.

    Fifth International Symposium on Turner Syndrome. Recommendations for the diagnosis and management of Turner syndrome

    Journal of Clinical Endocrinology & Metabolism

    (2001)
  • P DK Lee et al.

    Consensus statement—Prader–Willi syndrome: Growth hormone (GH)/insulin–like growth factor axis deficiency and GH treatment

    Endocrinologist

    (2000)
  • P Hindmarsh et al.

    The relationship between height velocity and 24 growth hormone secretion in children

    Clinical Endocrinology

    (1987)
  • Pharmacia International Growth Database, Report No. 18. Biannual Report

    (March 2001)
  • ML Vance et al.

    Growth hormone therapy in adults and children

    New England Journal of Medicine

    (1999)
  • DE Sandberg

    Should short children who are not deficient in growth hormone be treated?

    Western Journal of Medicine

    (2000)
  • LF Martel et al.

    Stature and Stigma: the Biopsychosocial Development of Short Males

    (1987)
  • EC Lechelt

    Occupational affiliation and ratings of physical height and personal esteem

    Psychological Reports

    (1975)
  • PR Wilson

    Perceptual distortion of height as a function of ascribed status

    Journal of Social Psychology

    (1968)
  • R Clopper

    Height and children's stereotypes

  • JS Gillis

    Too Tall, Too Small

    (1982)
  • E Ekwo et al.

    The effect of height on family income

    American Journal of Human Biology

    (1991)
  • B Stabler et al.

    Psychological effects of growth delay

  • LE Underwood

    The social cost of being short: societal perceptions and biases

    Acta Paediatrica Scandinavica

    (1991)
  • L Cuttler et al.

    Short stature and growth hormone therapy. A national study of physician recommended patterns

    Journal of the American Medical Association

    (1996)
  • DE Sandberg

    Short stature: intellectual and behavioral aspects

  • RM Lerner et al.

    Body build identification, preference and aversion in children

    Developmental Psychology

    (1969)
  • HC Steinhausen et al.

    Negative impact of growth hormone deficiency on psychological functioning in dwarfed children and adolescents

    European Journal of Pediatrics

    (1977)
  • H FL Meyer-Bahlburg

    Short stature: psychological issues

  • M Kusalic et al.

    Psychodynamic aspects of dwarfism. Response to growth hormone treatment

    Canadian Psychiatric Association Journal

    (1972)
  • CS Holmes et al.

    Parents and teachers differing views of short children's behaviour

    Child: Care, Health and Development

    (1982)
  • D Olweus

    Bully/victim problems among school children: basic facts and effects of a school based intervention program

  • LD Voss et al.

    The short ‘normal’ child in school: self-esteem, behaviour and attainment before puberty (The Wessex Growth Study)

  • DE Sandberg et al.

    Quality of life (QOL) among formerly treated child-onset growth hormone-deficient (GHD) adults: a comparison with unaffected siblings

    Journal of Clinical Endocrinology & Metabolism

    (1998)
  • K Lagrou et al.

    Age-related perception of stature, acceptance of therapy, and psychosocial functioning in human growth hormone-treated girls with Turner's syndrome

    Journal of Clinical Endocrinology & Metabolism

    (1998)
  • PW Drash

    Psychologic counselling in dwarfism

  • GD Zimet et al.

    Psychological adjustment of children evaluated for short stature: a preliminary report

    Journal of Developmental and Behavioral Pediatrics

    (1995)
  • A Apter et al.

    Self-image in adolescents with delayed puberty and growth retardation

    Journal of Youth and Adolescence

    (1981)
  • VG Lewis et al.

    Idiopathic pubertal delay beyond age fifteen: psychologic study of twelve boys

    Adolescence

    (1977)
  • CS Holmes et al.

    Social and school competencies in children with short stature. Longitudinal patterns

    Journal of Developmental and Behavioral Paediatrics

    (1985)
  • A Sartorio et al.

    The social outcome of adults with constitutional growth delay

    Journal of Endocrinological Investigation

    (1990)
  • G Zimet et al.

    Psychosocial functioning of adults who were short as children

  • EC Crowne et al.

    Final height in boys with untreated constitutional delay in growth and puberty

    Archives of Disease in Childhood

    (1990)
  • EC Crowne et al.

    Final height in girls with untreated constitutional delay of growth and puberty

    European Journal of Pediatrics

    (1991)
  • R Rosenthal et al.

    The Volunteer Subject

    (1975)
  • D Skuse et al.

    Psychosocial assessment of children with short stature: a preliminary report

    Acta Paediatrica Scandinavica

    (1994)
  • J Gilmour et al.

    Short stature--the role of intelligence in psychosocial adjustment

    Archives of Disease in Childhood

    (1996)
  • Cited by (0)

    f1

    *Correspondence to: Pediatric Psychiatry & Psychology, Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY 14222, USA.

    View full text