Validity of Self-Assessment of Pubertal Maturation

Abstract

BACKGROUND AND OBJECTIVES: Studies of adolescents often use self-assessment of pubertal maturation, the reliability of which has shown conflicting results. We aimed to examine the reliability of child and parent assessments of healthy boys and girls.METHODS: A total of 898 children (418 girls, 480 boys, age 7.4-14.9 years) and 1173 parents (550 daughters, 623 sons, age 5.6-14.7 years) assessed onset of puberty or development of breasts, genitals, and pubic hair according to Tanner stages by use of a questionnaire and drawings. Physicians' assessments were blinded and set as the gold standard. Percentage agreement, k, and Kendall's correlation were used to analyze the agreement rates.RESULTS: Breast stage was assessed correctly by 44.9% of the girls (k = 0.28, r = 0.74, P , .001) and genital stage by 54.7% of the boys (k = 0.33, r = 0.61, P , .001). For pubic hair stage 66.8% of girls (k = 0.55, r = 0.80, P , .001) and 66.1% of boys (k = 0.46, r = 0.70, P , .001) made correct assessments. Of the parents, 86.2% correctly assessed onset of puberty in girls (k = 0.70, r = 0.71, P , .001) and 68.4% in boys (k = 0.30, r = 0.37, P , .001). Children who underestimated were younger and children who overestimated older than their peers who made correct assessments. Girls and their parents tended to underestimate, whereas boys overestimated their pubertal stage.CONCLUSIONS: Pubertal assessment by the child or the parents is not a reliable measure of exact pubertal staging and should be augmented by a physical examination. However, for large epidemiologic studies self-assessment can be sufficiently accurate for a simple distinction between prepuberty and puberty.WHAT'S KNOWN ON THIS SUBJECT: Many population-based studies including pubertal children are based on self-assessment of pubertal maturation, the reliability of which is uncertain.WHAT THIS STUDY ADDS: Self-assessment is not reliable for precise pubertal staging. Simple distinctions between prepuberty and puberty showed moderate agreement with clinical examinations. Parents and girls tended to underestimate and boys to overestimate pubertal development by up to 50% and 30%, respectively.

Comparison of Clinical, Maternal, and Self Pubertal Assessments: Implications for Health Studies

“…These κ values were slightly higher than those reported in other studies, where estimates have ranged from 0.67 to 0.90, indicating substantial agreement, 20,21,32,33,39 with some exceptions. 40 We found that almost three-quarters of mothers accurately assessed breast Tanner stage compared with the clinical assessment.…”

“…40,43,[45][46][47] Previous studies have shown a wide range of accuracy for self-assessed pubic hair staging, 40,45,47,48 although 2 studies that also examined mother report suggest that self-staging may be more reliable than maternal staging for pubic hair development. 33,41 We found that girls were more likely to report a higher stage of pubic hair development than their mothers.…”

“…40,42,43 In our study, girls tended to underreport their own breast development, perhaps as a result of embarrassment about bodily changes and breast development during puberty. 44 The literature on bias in self-assessment has been inconsistent, 32,33,43 but there is some evidence that suggests that age and stage of development influence the direction of bias, with younger, less developed girls more likely to overestimate breast development and older, more developed girls more likely to underestimate breast development. 43,45,46 We observed that girls aged ≥11 years were more accurate compared with the clinical gold standard than their mothers.…”

“…31 To interpret data across studies, it is important to determine whether pubertal development information differs by source, which can only be examined within the few cohorts that collect pubertal data from multiple sources. [32][33][34] It is also important to determine whether factors such as age, family history of breast cancer, BMI, and race/ethnicity affect measurements to assess whether there could be any differential bias in pubertal assessment by source of Tanner staging (eg, clinical, maternal, or self). We report results from reliability and validity analyses comparing maternal and self-assessment to clinical staging in a large study of girls' health and development.…”

Effect of Physical Activity on Cardiometabolic Markers in Adolescents: Systematic Review

“…However, the reliability self-assessment of pubertal maturation has shown conflicting results. According to Ramussen et al 1 the pubertal assessment by the child or the parents is not a reliable measure of exact pubertal staging and should be augmented by a physical examination.…”