Short Stature in a Population-Based Cohort: Social, Emotional, and Behavioral Functioning

PEDIATRICS Vol. 124 No. 3 September 2009, pp. 903-910 (doi:10.1542/peds.2008-0085)

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ARTICLE

Short Stature in a Population-Based Cohort: Social, Emotional, and Behavioral Functioning

Joyce M. Lee, MD, MPH^a, Danielle Appugliese, MPH^b, Sharon M. Coleman, MS, MPH^b, Niko Kaciroti, PhD^c, Robert F. Corwyn, PhD^d, Robert H. Bradley, PhD^e, David E. Sandberg, PhD^f and Julie C. Lumeng, MD^c,f

 

^a Pediatric Endocrinology, Child Health Evaluation and Research Unit
^c Center for Human Growth and Development
^f Child Behavioral Health, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
^b Data Coordinating Center, School of Public Health, Boston University, Boston, Massachusetts
^d Department of Psychology
^e Family and Human Dynamics Research Institute, Arizona State University, Tempe, Arizona

ABSTRACT

OBJECTIVE: The goal was to determine whether there were significant differences between children of normative versus short stature in behavioral functioning and peer relationships, according to teacher and child reports.

METHODS: The study included 712 boys and girls in the sixth grade, from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Main outcome measures included Achenbach Teacher’s Report Form internalizing, externalizing, and total scores; Children’s Depression Inventory scores (child report); Life Orientation Test-Revised scores (child report); Child Behavior with Peers questionnaire asocial with peers, excluded by peers, and peer victimization subscale scores (teacher report); peer social support and victimization scores (child report); and relationships with peers score (teacher report). In bivariate comparisons, these outcomes were compared for children of relatively short (height of <10th percentile) versus nonshort (height of 10th percentile) stature, and effect sizes were calculated. Multivariate linear regression models adjusted for maternal education, income/needs ratio, race, and gender.

RESULTS: Effect sizes ranged from 0.00 to 0.35. Short children reported marginally higher levels of self-perceived peer victimization, compared with their nonshort peers. There were no significant differences in the rest of the outcomes for children of short versus nonshort stature, in either unadjusted or adjusted models.

CONCLUSION: Although short children from a population-based sample reported marginally higher levels of self-perceived peer victimization, they did not differ from their nonshort peers in a range of social, emotional, and behavioral outcomes.

 

 

Key Words: short stature • quality of life • child

 

Abbreviations: GH—growth hormone • TRF—Teacher’s Report Form • ITN—income/needs

Monitoring of linear growth during childhood represents one of the most important tasks for pediatric providers, with the American Academy of Pediatrics recommending measurement of a child’s height and weight 20 times from birth through middle childhood.¹ Children with growth that falls outside the normative values for stature, particularly children with short stature, defined as a height ranging from <3rd percentile to <10th percentile,² raise concerns for both pediatric providers and parents. When the child is healthy, parental concern about height often is rooted in the perception that shorter children experience more problems in social, emotional, and behavioral functioning. However, parents may be misattributing these difficulties to short stature when actually they are related to other stressors.³

Previous studies reported that short children have higher rates of behavioral difficulties and lower social competency, compared with children of normal stature.^4–6 However, interpretation of those studies was limited by several factors. Some studies included children with growth hormone (GH) deficiency or other syndromes, which made it unclear whether the underlying pathologic condition or short stature are responsible for the difficulties in psychosocial adjustment.^5–7 Other studies lacked details regarding subject recruitment and subject nonresponse rates,^4,7 which led to uncertainty regarding the representativeness of the samples.⁸ More recent studies have suggested that short children have normal psychosocial adjustment and the behavioral or social difficulties identified might have been attributed inappropriately to the short stature.^9–11 Behavioral and peer-relationship ratings from most studies were mostly self- or parent- reported^10–12 or were based on populations from a single medical center.^5,10,11 Finally, previous studies included cohorts of children with heights of <3rd percentile. Pediatric providers, however, are confronted more commonly with families concerned about their children with less-extreme short stature (eg, height of <10th percentile), a population that is seeking evaluation for short stature in the pediatric specialty clinic setting^13,14 but for which there are relatively few data regarding potential differences in behavioral and social functioning.

We are unaware of studies that have evaluated the relationship between psychosocial adaptation and stature among children of diverse socioeconomic status drawn from a variety of geographic areas. Furthermore, few studies have used both teacher reports and child reports. We sought to test the hypothesis that there would be no significant differences in social, emotional, and behavioral functioning between children of short stature (defined as <10th percentile) and those of nonshort stature in a recent, large, population-based cohort of children of diverse socioeconomic status drawn from 10 geographic regions in the United States.

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