Biomedical subjects
B Stabler
Publications and source records attributed to B Stabler.
Short children: height is not the only problem.
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Behavior change after growth hormone treatment of children with short stature.
OBJECTIVES: To measure the prevalence of behavioral and learning problems among children with short stature and to assess the effect of growth hormone (GH) treatment on such problems. STUDY DESIGN: A total of 195 children with short stature (age range 5 to 16 years, mean age 11.2 years) were tested for intelligence, academic achievement, social competence, and behavior problems before beginning GH therapy and yearly during 3 years of treatment. Children were classified as having growth hormone deficiency (GHD) when GH responses to provocative stimuli were <10 ng/mL (n = 109) and as having idiopathic short stature (ISS) when >10 ng/mL (n = 86). A normal-statured matched comparison group was tested at the baseline only. RESULTS: Seventy-two children in the GHD group and 59 children in the ISS group completed 3 years of GH therapy and psychometric testing. Mean IQs of the children with short stature were near average. IQs and achievement scores did not change with GH therapy. Child Behavior Checklist scores for total behavior problems were higher (P < .001) in the children with short stature than in the normal-statured children. After 3 years of GH therapy these scores were improved in patients with GHD (P < .001) and ISS (P < .003). Also, there was improvement in the scores of children in the GHD group in the internalizing subscales (withdrawn: P < .007; somatic complications, P < .001; anxious/depressed, P < .001) and on the 3 components of the ungrouped subscales (attention, social problems, and thought problems, each P = .001). Larger effects were observed in the GHD group than in the ISS group. CONCLUSIONS: Many referred children with short stature have problems in behavior, some of which ameliorate during treatment with GH.
The psychological consequences of Turner syndrome and review of the National Cooperative Growth Study psychological substudy.
OBJECTIVE: To present longitudinal data on the psychological profile of a cohort of girls with and without Turner syndrome (TS) treated for 3 years with growth hormone (GH). METHODS: Among a sample of 283 children with short stature, 37 girls with TS were recruited at 27 US medical centers. Of the original cohort, 22 girls with TS, 13 girls with isolated growth hormone deficiency (GHD), and 12 girls with idiopathic short stature were followed through 3 years of GH therapy. All were school-age, were below the 3rd percentile for height, had low growth rates, and were naive to GH therapy. Psychological tests (the Wide Range Achievement Test and the Slosson Intelligence Test) were administered to the clinical groups within 24 hours of their first GH injection and yearly thereafter. Control subjects were 25 girls with normal stature matched for age and socioeconomic status, who were tested only at baseline. One parent of each subject also completed the Child Behavior Checklist for that subject. RESULTS: At baseline, the clinical groups had more internalizing behavioral problems, had fewer friends, and participated in fewer activities than did the control subjects. The groups did not differ in mean IQ or academic achievement, but the TS group did have more problems in mathematics achievement. Height and growth rate significantly increased in the clinical groups over the 3 years of GH therapy, but IQ and achievement scores did not. Significant linear reductions were noted in both Internalizing and Externalizing Behavior Problems after GH treatment, with the TS group having fewer behavior problems before and after GH treatment than did the GHD-idiopathic short stature group. Decreases in specific Child Behavior Checklist subscales, including attention, social problems, and withdrawal, also were seen in the clinical groups after GH therapy. CONCLUSIONS: The comprehensive treatment of girls with TS should include educational and behavioral interventions in addition to traditional medical therapies.
Evidence for social phobia and other psychiatric disorders in adults who were growth hormone deficient during childhood.
We assessed the psychiatric status of 21 growth hormone deficient (GHD) adults who had been treated with growth hormone (GH) for short stature during childhood. Eight individuals (38%) were found to have undiagnosed social phobia. On a psychometric battery, the scores of GHD subjects with social phobia corresponded closely to those of a matched group of psychiatric patients with social phobia. Because these psychiatric symptoms have deleterious effects on quality of life, social function, and productivity, the physician should be alert to obtain psychiatric assessment of patients with GHD.
Links between growth hormone deficiency, adaptation and social phobia.
Children referred for growth hormone (GH) treatment have increased school achievement problems, lack appropriate social skills and show several forms of behavior problems. A multicenter study in the United States has revealed that many GH-impaired children exhibit a cluster of behavioral symptoms involving disorders of mood and attention. Anxiety, depression, somatic complaints and attention deficits have been identified. These symptoms decline in frequency over a period of 3 years, beginning shortly after GH replacement therapy is started. Many of the patients who have received GH and had good growth responses show lower than average quality of life in young adulthood after treatment is completed. GH-deficient adults placed on GH therapy report improvement in psychological well-being and health status, suggesting that GH might have a central neuroendocrine action. Among a group of adults who were GH deficient as children, we find a high incidence of social phobia, a psychiatric disorder linked to GH secretion and usually accompanied by poor life quality. An ongoing study of non-GH-deficient short individuals suggests that short stature is not the cause of this outcome. We conclude that the origins of psychiatric comorbidities, such as social phobia and depression, in GH deficient adults are likely to be neuroendocrine as well as psychosocial.
Academic achievement and psychological adjustment in short children. The National Cooperative Growth Study.
Limited information is available on the educational and behavioral functioning of short children. Through 27 participating medical centers, we administered a battery of psychologic tests to 166 children referred for growth hormone (GH) treatment (5 to 16 years) who were below the third percentile for height (mean height = -2.7 SD). The sample consisted of 86 children with isolated growth-hormone deficiency (GHD) and 80 children with idiopathic short stature (ISS). Despite average intelligence, absence of significant family dysfunction, and advantaged social background, a large number of children had academic underachievement. Both groups showed significant discrepancy (p < .01) between IQ and achievement scores in reading (6%), spelling (10%), and arithmetic (13%) and a higher-than-expected rate of behavior problems (GHD, 12%, p < .0001; ISS, 10%, p < .0001). Behavior problems included elevated rates of internalizing behavior (e.g., anxiety, somatic complaints) and externalizing behavior (e.g., impulsive, distractable, attention-seeking). Social competence was reduced in school-related activities for GHD patients (6%, p < .03). The high frequency of underachievement, behavior problems, and reduced social competency in these children suggests that short stature itself may predispose them to some of their difficulties. Alternately, parents of short, underachieving children may be more likely to seek help. In addition, some problems may be caused by factors related to specific diagnoses.
On the role of patient.
Modern, highly technical health care systems increasingly remove patients from active participation in managing their own medical treatment. This is particularly true when serious or life-challenging illness occurs. Health psychology has much to contribute in the debate over the degree of patient self-determination necessary to achieve optimal treatment outcomes. Psychologists may directly influence this process through their professional contact with medical patients and their families. Through researching the behavioral skills of medical consumership, identifying the elements of effective patient-physician interaction, and encouraging physicians-in-training to adopt a propatient partnership attitude, psychology adds new dimensions to the provision of health care. This paper reviews some of the issues faced by patients with life-challenging illnesses through the writer's personal experience, and seeks to identify the requisite actions for informed, participatory involvement on the part of patients.
Reactivity to stress and psychological adjustment in adults with pituitary insufficiency.
OBJECTIVE: Hypopituitary adults who were affected during childhood have a below-average rate of marriage, a rate of unemployment that exceeds national norms, and often indicate dissatisfaction with their life circumstances. We undertook the present study to determine the effects of short stature versus those of pituitary hormone deficiency. DESIGN AND PATIENTS: We compared hypopituitary adults (n = 25) with normal short adults (n = 25) who were matched for height, sex, age and socioeconomic status. MEASUREMENTS: In these two groups of subjects, we compared the physiological responses to a simulated social stressor, a public speaking task, and we measured the psychometric attributes that are indicators of social assertiveness and extraversion. RESULTS: Before, during and after the stress of public speaking, patients with multiple pituitary hormone deficiencies (n = 20) had lower mean systolic and diastolic blood pressures than controls, while patients with isolated growth hormone deficiency (n = 5) were equivalent to controls. The reactivity to stress, assessed using delta scores based on changes in blood pressure and heart rate, was also decreased in multiple hormone deficient patients. Psychometric test results indicated that patients with multiple hormone deficiencies showed lower openness, lower assertiveness, greater neuroticism and a tendency towards less extraversion than did controls. The responses of patients with isolated GH deficiency on the psychometric tests were not statistically different from controls, but the number of subjects in this group (n = 5) was too small to draw conclusions. CONCLUSIONS: The impaired cardiovascular responses to stress in patients with multiple hormone deficiencies, compared to short control subjects and to patients with GH deficiency leads us to conclude that factors other than stature and GH are responsible for these observations. The differences might be related to insufficiency of catecholamines or cortisol in the patients with multiple hormone deficiencies. These hormonal deficiencies might also account for the socially inhibited behaviour of these patients. Our results suggest that more attention needs to be directed at preparing hypopituitary patients for the challenges of adulthood. Also, these patients may be helped by more intensive efforts at hormonal replacement in adulthood.
Stress buffering effect of psychological support in a diabetic camp.
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Growth hormone for short children.
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Psychological impact of significantly short stature.
These baseline data confirm that many children with significantly short stature are vulnerable to diverse developmental, social and educational problems, and substantiate the importance of a multidisciplinary treatment approach that includes a comprehensive psychological and medical assessment. The psychological assessment should focus on the early detection of problems in academic achievement and psychosocial development, in order that appropriate educational and counselling interventions can be provided. The paediatrician can also foster a positive relationship with patients and their families to facilitate treatment compliance and improve overall outcome in several ways. These include a simple explanation of the aetiology of the child's short stature and how the diagnosis was made, a review of the treatment protocol that includes information about potential side-effects and suggestions for minimizing conflicts about injections, and an open discussion of prognosis to help families develop realistic expectations. It is further suggested that paediatricians stress that treatment outcome should be assessed in psychological terms, such as increased responsibility, as well as physical growth. These anticipatory interventions will help to ensure that the eventual outcome of comprehensive treatment is an optimally functioning young adult.
Growth hormone insufficiency during childhood has implications for later life.
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Growth hormone deficiency in children has psychological and educational co-morbidity.
Growth delay caused by growth hormone deficiency (GHD) is a condition presented with increased frequency to pediatricians. Recent evidence suggests these patients should be evaluated developmentally for behavioral and educational problems. Such assessment would assure a comprehensive approach to treatment and increase the likelihood of a satisfactory outcome in young adulthood. This article briefly reviews what is known about the behavioral and educational difficulties experienced by growth hormone deficient patients. Specific recommendations for educational assessment and anticipatory guidance are presented.
Type A behavior pattern and chronic glycemic control in individuals with IDDM.
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Growth delay from a psychologic perspective.
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Facilitating patient understanding in the treatment of growth delay.
Effective physician-patient communication is often critical to the success of therapy of an illness. It has been shown that childrens' understanding of their illness is related to their stage of cognitive development, emotional maturity, and the level of communication between doctor and patient. Using a simple visual technique, we have demonstrated that nearly 45 percent of growth delayed children and their families overestimated their height in relation to peers and nearly 80 percent have unrealistic expectations of hGH therapy. This could be corrected to a significant degree by using the same visual aid in combination with family conferences. The results of this study have implications for the nature of physician-patient communications in other disorders.
Program considerations in comprehensive care of chronically ill children.
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