Self-Concept before and after Two Years of Growth Hormone Treatment in Intrauterine Growth-Retarded Children

Abstract

The objective of this study was to assess self-concept in children with short stature after intrauterine growth retardation (IUGR), before and after 2 years of growth hormone (hGH) treatment. We assessed 25 children before treatment, and 40 children after a 2-year treatment period. Seventeen of the 25 children of whom we had pretreatment data, were reassessed after 2 years of hGH treatment. All children had a birth length below the 3rd percentile, and did not show catch-up growth (current height < P3). We compared the self-concept measures (Self-Perception Profile for Children; SPPC) of the IUGR group with similar measures of a Dutch school sample. Four of the six SPPC mean scale scores of the IUGR group prior to treatment were significantly lower than mean scores of the school sample. Mean scale scores of the group children, assessed after 2 years of hGH treatment, did not differ significantly from those of the school sample. In the group of 17 children who were assessed before as well as after 2 years of treatment, the mean scale scores of ‘social acceptance’ and ‘general self-worth’ were significantly higher at the second assessment (t = -5.93, p < 0.001 and t = -4.36, p < 0.001, respectively). From the present study we can hypothesize that short stature after IUGR and a low self-concept are related.

Effect of 2 years of high-dose growth hormone therapy on cognitive and psychosocial development in short children born small for gestational age

“…Furthermore, the change of test instrument during the study could also have favored the positive evolution of IQ scores in the untreated group since a higher number had a change of test instrument, which was found to be related to a significant increase in PIQ scores. The absence of a beneficial effect of GH therapy on IQ scores in our study is in contradiction with the data of two other studies, reporting a significant increase in performance IQ scores in short SGA children after 2 and 8 years of GH therapy respectively (10,12). Some caution is, however, needed when comparing our results with these two studies, since they were both uncontrolled and included children of an older age range.…”

“…This percentage might be an underestimation given the use of rather older test instruments in our study, as mean scores on IQ tests increase each decade (known as the Flynn effect). The findings of lower intellectual capacities and recurrent health problems are consistent with those reported in several other publications on the cognitive development of SGA children (3,10,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). It is somewhat surprising that none of these previous studies referred to the need of specialized help in these children, which was noted to be provided in one-third of the patients in the present study, excluding, however, children with severe mental retardation, but including some children with minor dysmorphisms.…”

“…Both a direct effect by binding to specific brain GH receptors as well as an indirect effect of GH can be incriminated by increasing the brain IGF's, which are important brain growth-promoting hormones, by affecting brain neurotransmitters and thyroxin levels, or eventually by promoting a more efficient vascular transport of nutrients to the brain (9). Positive effects of GH therapy on cognitive development and psychosocial functioning of short SGA children have been reported, but these studies are flawed by the lack of an untreated control group, the attrition of patients during follow-up and the use of abbreviated measures (10)(11)(12). We therefore, studied, prospectively over 2 years, the changes in intellectual abilities (assessed by age-appropriate Wechsler scales) and behavioral profile (parents completed the Child Behavior Checklist) in 34 young (3-8 years), short SGA children, equally distributed among an untreated or GH-treated group.…”

Growth Hormone Treatment in Children with Short Stature Born Small for Gestational Age: 5-Year Results of a Randomized, Double-Blind, Dose-Response Trial

“…A 2-yr psychosocial evaluation in the children of our study showed a beneficial effect on behavioral and emotional problems and on the self-concept of the children (43,44). Further psychosocial research will be performed to confirm this improvement.…”

Growth hormone therapy and Quality of Life: possibilities, pitfalls and mechanisms

“…The influence of these short-term gains on final adult height has not been established, although an improvement in final height prognosis (based on height standard deviation scores for bone age) has been observed in IUGR (Hokken-Koelega 1999, Mehta & Hindmarsh 2002. Although QoL has not been measured in IUGR using specific tests, deficits in IQ, attention and selfconcept (Hokken-Koelega 1999) have been documented, and attention, peer acceptance and self-worth have been shown to be improved by GH therapy ( Van der Reijden et al 1996. QoL has not been examined in most other childhood conditions associated with impaired growth.…”