1 September 1998

Short Kids More Likely To Be Misfits

One of the largest and most comprehensive studies of behavior ever done in short children has uncovered a strong link between shortness and behavioral adjustment problems, say researchers at the University of North Carolina at Chapel Hill (UNC-CH). Growth hormone treatment, however, not only boosted growth in the children studied, but in many cases also improved their conduct and relations with other people.

"These findings are important in part because of a lingering controversy over the possible psychological effects of short stature," said Dr. Brian Stabler, of the UNC-CH School of Medicine.

Starting about a decade ago, researchers from more than 25 US universities and medical organizations began planning a study of the question. They tested a national sample of 195 short children for intelligence, academic achievement, social skills and behavior problems before starting them on growth hormone therapy and examined them again annually for three years during treatment. Of the group, 109 were found to be growth hormone deficient, while 86 others, who had normal or nearly normal hormone levels, were classified as short for unknown reasons. Subjects ranged in age from 5 to 16 and averaged about 11 years.

Seventy-two growth hormone deficient subjects and 59 of the others completed therapy and testing. Scientists found that as a group, the short children had near average IQs and that neither IQ nor achievement test scores changed with treatment. About a third of those with short stature demonstrated some form of learning disability. Researchers also found a significant incidence of emotional and psychological problems associated with anxiety, depression and attention deficit, as well as lower grades in school.

Initially, short children scored worse on a measure of behavior problems than did a control group of children of average height, Stabler said. After hormone therapy, behavior scores improved for both groups of short children.

Subjects' scores also improved on measures of openness, health, anxiety-depression, attention and social and thought problems, he said. Children classified as growth hormone deficient showed slightly larger positive effects of hormone treatment than did those whose shortness was unexplained.

"There are several possible explanations for the improvements, one that growth hormone therapy boosts brain chemicals and neurotransmitters that didn't work as well as they would have if hormone secretion had been normal," Stabler said. "Behavior problems in the short children improved quickly with six months of hormone replacement therapy. That could not be due to growth alone since height increases so slowly."

"Short stature or growth delay in children should not be overlooked because it can relate to significant life quality and overall functioning problems besides the obvious height difficulty," Stabler said. "The therapy, which is expensive, is definitely not simply cosmetic."