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Psychological Adaptation in Children with Idiopathic Short Stature Treated with Growth Hormone or Placebo

Department of Pediatrics (J.L.R.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; A. I. DuPont Hospital for Children (J.L.R.), Wilmington, Delaware 19899; Departments of Psychiatry and Pediatrics (D.E.S.), University at Buffalo, The State University of New York, Buffalo, New York 14222; Developmental Endocrinology Branch (E.W.L., J.B.), National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892; Department of Endocrinology (S.R.R.), Cincinnati Children’s Hospital Medical Center and The University of Cincinnati, Cincinnati, Ohio 45229; Institute of Maternal and Child Research (F.G.C.), University of Chile, Santiago, Chile; and Eli Lilly and Co. (C.A.Q., J.J.C., B.J.C., G.B.C., K.R.), Indianapolis, Indiana 46285

Address all correspondence and requests for reprints to: Judith L. Ross, M.D., Thomas Jefferson University, Department of Pediatrics, 1025 Walnut Street, Philadelphia, Pennsylvania 19107. E-mail: judith.ross{at}mail.tju.edu.

The influence of short stature on psychological adaptation in childhood and adolescence is controversial. GH is currently used to treat children with idiopathic short stature (ISS, also known as non-GH-deficient short stature). This study represents the first double-blind, placebo-controlled trial of the effects of GH on the psychological adaptation of children and adolescents with ISS, treated with GH until adult height was attained.

Sixty-eight children (53 males, 15 females), 9–16 yr old, with marked ISS (measured height or predicted adult height –2.5 SD or less) received either GH 0.074 mg/kg or placebo sc three times per week until height velocity decreased to less than 1.5 cm/yr. Parents completed the Child Behavior Checklist (CBCL) and children the Self-Perception Profile (SPP) and Silhouette Apperception Technique at baseline and annually thereafter.

Baseline behavioral/emotional adjustment (CBCL) and self-concept (SPP) scores for children with ISS were within the normative range. The two study groups exhibited similar behavioral and self-concept profiles (CBCL) during the first 2 yr of the study. However, CBCL behavior problems (internalizing, externalizing, and total problems) appeared to decline, in yr 3 and 4, in the GH-treated group relative to the placebo-treated group. Group differences in CBCL competency domains and the SPP were not observed at any point during the study.

Short stature among children with ISS enrolled in this long-term, placebo-controlled study was not associated with problems in psychological adaptation or self-concept with the psychological instruments employed. GH treatment was associated with a trend toward improvement in problem behaviors, as measured by questionnaires (CBCL) completed by study participants’ parents. It remains to be determined whether GH treatment significantly impacts adaptation, psychosocial function, or quality of life in children with ISS.

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