Study challenges early age intervention with human growth hormone

A new study counters the prevailing belief that children and adolescents who are extra short have social adjustment problems and fewer friends than children of average height, challenging one rationale for intervening at an early age with human growth hormone treatment.

In the first study of its kind conducted in a general population, researchers at the University at Buffalo assessed students across the full range of heights in the classroom setting. The students were unaware that height was a factor being studied. The study was conducted in grades six through 12 in a public school system in Western New York.

The findings, published in the September issue of Pediatrics, show that height plays no role in the number of friendships extra-short or extra-tall children have, the number of classmates who identified them as friends, their peer acceptance, height of their friends or their social adjustment in general.

The one characteristic associated with height was perceived age: Shorter students were thought to look younger that their age, but this association diminished in later grades.

"All of our current thinking concerning social adjustment problems associated with short stature is based on experiences of children and adolescents who come to pediatric endocrinologists for an evaluation of growth," said lead researcher David E. Sandberg, Ph.D., associate professor of psychiatry and pediatrics in the UB School of Medicine and Biomedical Sciences. "Those receiving such an evaluation might not be representative of children who are just as short, or shorter, but who do not receive such an evaluation.

"To learn about the social experiences of youths with short stature, independent of whether they are being medically evaluated, we have to leave the clinic or hospital setting and move our research to the community. In that setting, we also can learn about the social adjustment of kids with short stature from those who have a lot to say about it -- their peers," he said. "Peers are very good at identifying those among them who are likely to experience future mental-health or social problems."

Adolescence can be a stressful time for many children, Sandberg noted, and most children are teased or picked on. He said parents and clinicians should be careful not to misattribute significant social adjustment problems to height. By doing so, he cautioned, they may risk missing the true cause of the difficulties: Instead of addressing these factors, the child would be exposed to a long-term, invasive and expensive growth-hormone treatment that does not produce the desired social benefits.

The current study involved 965 students from 45 classrooms, all of which had at least one student with a height that fell at or below the fifth percentile for age and gender-specific norms. Students' social functioning was assessed through three types of questionnaires.

In the first, each student listed his or her best friends among their participating classmates. In the second, they rated each classmate on a five-point scale, from "don't like" to "like a lot." The third questionnaire contained a list of 28 personality characteristics, or "roles." The students were instructed to pretend they were casting a play, and were to select a person from both genders who best fit each of the 28 roles. They also were asked to select those roles for which they thought they were best suited.

The list included such roles as: "is a good leader," "loses temper easily," "has many friends" and "gets picked on." This tool is designed to assess what a child is like in the eyes of peers, said Sandberg.

Results of these assessments showed that student height was unrelated to how well students were liked by others, what others thought of them, their own perceptions of their reputation or their social adaptation within their peer group.

"Despite the social stereotypes that abound regarding the disadvantages of short stature, systematic research using sensitive tools to assess social adjustment provides little support for the notion that extremes of height -- either short or tall -- threaten healthy social adjustment," Sandberg stated. "In other words, if significant problems of social adjustment are detected among short youths, then factors other than height should be considered as contributory."

Co-authors on the study are William M. Bukowski, Ph.D., of Concordia University; Carolyn M. Fung, program assistant in the UB Department of Psychiatry, and Robert B. Noll, Ph.D., of Children's Hospital of Pittsburgh, University of Pittsburgh.

The research was supported by the Human Growth Foundation, Genentech Foundation for Growth and Development and Children's Growth Foundation.