Sandberg D E, Brook A E, Campos S P
Division of Child and Adolescent Psychiatry, Children's Hospital of Buffalo, NY 14222.
Pediatrics. 1994 Dec;94(6 Pt 1):832-40.
Changes in the diagnosis of endocrine-based growth disorders and the advent of biosynthetic growth hormone have altered the long-standing policy of treating only those individuals with "classic" growth hormone deficiency. One justification for treating short children is to improve their psychosocial adaptation. The present investigation assessed the positive and negative behavioral adaptation, self-perceptions of domain-specific competencies, and global self-worth of a large, diagnostically heterogeneous sample of children and adolescents referred to pediatric endocrinologists for a growth evaluation.
All patients seen in a pediatric endocrine clinic (180 boys and 78 girls; 4 to 18 years) with a height at the fifth percentile or lower were included. Parents of all participating children completed the Child Behavior Checklist. Patients 8 years and older completed the Self-Perception Profile and those 11 years and older, in addition, completed the Youth Self Report. Short-stature (SS) subjects were compared with normative and psychiatric samples.
The SS boys were described by parents as being significantly less socially competent and showing more behavioral and emotional problems than a normative sample selected for mental health. However, they were significantly more socially competent and showed fewer psychopathologic symptoms than a psychiatric referred sample of comparable age. The SS boys described themselves as less socially active but did not report more behavior disturbance than the normative sample. The SS boys' self-perceptions of domain-specific competencies and global self-worth were comparable to a normative comparison group with the exception that older subjects (13 years or older) described their athletic abilities more positively and their work competence more negatively. The SS girls were, with few exceptions, indistinguishable from the normal comparison groups on both parent- and self-report measures of social competency and behavior disturbance. Younger SS girls (ages 8 to 12 years) described their athletic competence and behavioral conduct more positively than the comparison group on the self-esteem questionnaire. Patient height deficit was unrelated to scores on the three questionnaires. Finally, no statistically significant differences in psychosocial functioning were detected between children with "normal-variant" SS and those with pathologic growth disorders. SS and those with pathologic growth disorders.
Short-stature girls show more adaptive psychosocial functioning than SS boys. In either sex, SS does not appear to be associated with clinically significant psychosocial morbidity. Severity of the height deficit does not correlate with the level of behavioral adaptation. These observations challenge the justification of providing growth hormone therapy for all short children to improve their psychosocial functioning.
基于内分泌的生长障碍诊断的变化以及生物合成生长激素的出现，改变了长期以来仅治疗那些患有“典型”生长激素缺乏症个体的政策。治疗身材矮小儿童的一个理由是改善他们的心理社会适应能力。本研究评估了一大组因生长评估而转诊至儿科内分泌科医生处的诊断异质性儿童和青少年样本的积极和消极行为适应、特定领域能力的自我认知以及总体自我价值。
纳入所有在儿科内分泌门诊就诊的患者（180名男孩和78名女孩；4至18岁），其身高处于或低于第五百分位数。所有参与儿童的父母完成儿童行为量表。8岁及以上的患者完成自我认知量表，11岁及以上的患者还需完成青少年自我报告。将身材矮小（SS）受试者与正常样本和精神科样本进行比较。
父母描述SS男孩的社交能力明显低于为心理健康选取的正常样本，且表现出更多行为和情绪问题。然而，与年龄相仿的精神科转诊样本相比，他们的社交能力明显更强，心理病理症状更少。SS男孩认为自己社交活动较少，但与正常样本相比，并未报告更多行为障碍。除了年龄较大的受试者（13岁及以上）对自己运动能力的描述更积极、工作能力的描述更消极外，SS男孩对特定领域能力和总体自我价值的自我认知与正常对照组相当。在社交能力和行为障碍的父母报告及自我报告测量方面，SS女孩与正常对照组几乎没有差异，只有少数例外。在自尊问卷上，年龄较小的SS女孩（8至12岁）对自己运动能力和行为表现的描述比对照组更积极。患者身高缺陷与三份问卷的得分无关。最后，在“正常变异”SS儿童和病理性生长障碍儿童之间，未检测到心理社会功能的统计学显著差异。
身材矮小的女孩比身材矮小的男孩表现出更具适应性的心理社会功能。无论男女，身材矮小似乎与临床上显著的心理社会发病率无关。身高缺陷的严重程度与行为适应水平无关。这些观察结果对为所有身材矮小儿童提供生长激素治疗以改善其心理社会功能的理由提出了挑战。
