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      Management of Idiopathic Short Stature: Psychological Endpoints, Assessment Strategies and Cognitive-Behavioral Intervention

      review-article
      Hormone Research in Paediatrics
      S. Karger AG
      Cognitive-behavioral therapy, Short stature, Growth hormone therapy, Quality of life

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          Abstract

          Background: In 2007, a Conference on Idiopathic Short Stature (ISS) endorsed the definition of ISS as a statistical (auxologic) rather than a medical (pathologic) deviation from the norm. Consequently, the ultimate criteria for evaluation of treatment in ISS shift from medical to psychological endpoints. Objective: This review synthesizes empirical evidence of psychological outcomes in treated and untreated subjects with ISS, recommendations from the recent ISS Consensus Conference, theoretical concepts from pediatric psychology and rationales used for various intervention strategies to better evaluate and manage psychological endpoints in ISS in accordance with the Consensus Conference definition. Methods: Different measures of psychological outcome in ISS are reviewed to explain apparent heterogeneity among empirical study findings. Key issues include: (1) adaptation to major stressors associated with short stature (e.g., bullying, peer relations) and the correlation of adaptation failure with low socioeconomic status and impaired quality of life in adulthood; (2) development of valid and sensitive assessment tools; (3) clinical decision-making based on psychological assessment, ethical principles concerning informed consent and expectation of benefit from psychological treatment and (4) intervention approaches including counselling, cognitive-behavioral therapy, assertiveness training and growth hormone therapy. Conclusions: There are different but complementary strategies for medical and psychological enhancement of psychosocial outcome in subjects with ISS.

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          Most cited references18

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          Psychological adaptation in children with idiopathic short stature treated with growth hormone or placebo.

          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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            Towards a Consensus on the Definition of Idiopathic Short Stature

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              Quality of life and self-esteem in children treated for idiopathic short stature.

              Changes in health-related quality of life (HRQOL) and self-esteem were studied in children with idiopathic short stature (ISS) participating in a study on the effect of growth hormone treatment. Prepubertal children (n = 36) with ISS were randomly assigned to a treatment or control group. Children with ISS, their parents, and the pediatrician completed HRQOL and self-esteem questionnaires 3 times in 2 years. At the start, children with ISS did not have lower scores than the norm population, except for social functioning HRQOL. The pediatrician reported an improvement of HRQOL in the treatment group, the parents reported no change, and the children in the treatment group reported the same, or sometimes even worse, HRQOL or self-esteem than the control group. Changes related to the child's satisfaction with height and hardly to growth itself. The assumption that growth hormone treatment improves HRQOL in children with ISS could not be supported in this study.
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                Author and article information

                Journal
                HRE
                Horm Res Paediatr
                10.1159/issn.1663-2818
                Hormone Research in Paediatrics
                S. Karger AG
                978-3-8055-9073-0
                978-3-8055-9074-7
                1663-2818
                1663-2826
                2009
                January 2009
                21 January 2009
                : 71
                : Suppl 1
                : 75-81
                Affiliations
                Department of Pediatrics, Pediatric Psychology, University of Bonn, Bonn, Germany
                Article
                178044 Horm Res 2009;71:75–81
                10.1159/000178044
                19153512
                aec16e34-ecc4-4433-a889-b7550850a7c1
                © 2009 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Page count
                Figures: 3, References: 23, Pages: 7
                Categories
                Pediatric Workshop 2

                Endocrinology & Diabetes,Neurology,Nutrition & Dietetics,Sexual medicine,Internal medicine,Pharmacology & Pharmaceutical medicine
                Growth hormone therapy,Short stature,Cognitive-behavioral therapy,Quality of life

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