Management of idiopathic short stature: psychological endpoints, assessment strategies and cognitive-behavioral intervention.
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.
Noeker
Meinolf
M
Department of Pediatrics, Pediatric Psychology, University of Bonn, Bonn, Germany. m.noeker@uni-bonn.de
D000465:Algorithms; D015982:Bias; D015415:Biomarkers / Q000032:analysis*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D023381:Endpoint Determination / Q000379:methods*; D006130:Growth Disorders / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D018579:Patient Selection; D011581:Psychological Tests; D016896:Treatment Outcome
D015415:Biomarkers; D019382:Human Growth Hormone