Psychological adjustment and quality of life in impaired growth

Abstract

Living with growth retardation may entail significant risks for psychological development and quality of life in both pathological and idiopathic conditions. The following five methodological differences concerning study design and methods have contributed to heterogeneity among study findings on adjustment to short stature: 1. Definition of endpoint (short stature-associated stress impact, sub-clinical indicators of maladaptation such as low self-esteem and psychopathology), 2. Sample selection (clinically referred patients versus population-based samples), 3. Source of report (parents versus children versus teachers), 4. Assessment instruments (specific short stature-related instruments versus generic, global psychological assessment instruments), 5. Controlling for socio-economic-status as a confounder of adjustment difficulties in short stature. Besides methodological sources of variance, there is a broad "true" inter-individual variance concerning coping abilities and protective resources. Some individuals fail and others succeed to master the challenges of growth retardation effectively. Equifinality means that four different individual patients suffering from different growth disorders (e.g. Turner syndrome, ISS, GHD and SGA) may take a similar developmental path of adaptation and come up with a very similar developmental outcome (e.g. comparable impairments in quality of life). Multifinality, on the other hand, means that four patients suffering from the very same condition (e.g. idiopathic short stature) may take very dissimilar developmental paths of adaptation, resulting in very different developmental outcomes ranging from (a) clinical psychopathology, (b) discrete impairments in quality of life, (c) no difference to normal controls or (d) development of resilience, i.e. the stimulation of personal psychological maturation. A key factor for adjustment failure refers to distorted cognitions about the personal meaning and implications of short stature. Individuals with strong adjustment problems frequently think that (a) their short stature makes them look completely unattractive and (b) this unattractive outer appearance makes them completely unlovable. Clinical guidelines for psychological assessment, counselling and intervention in growth retardation include the following: - Clinical assessment of growth retardation should always include a brief psychosocial examination and supportive counselling by the physician. - Assessment has to disentangle if a given psychological dysfunction is in fact a result of severe and persistent failure of adaptation to short stature or represents a sign of some psychopathological comorbidity, which is etiologically independent of growth retardation, thus requiring a mental health intervention addressing the actual causes of psychological dysfunction. - In cases of more severe dysfunction, cognitive-behavioural therapy (CBT) provides techniques to modify distorted dysfunctional schemata and belief systems concerning the importance of stature for physical appearance and personal self-esteem. - Assertiveness training strengthens adequate behavioural coping strategies for critical situations (e.g. stigmatization and infantilization). Adjustment and quality in growth retardation represents a promising example for research and clinical practice integrating both medical and psychological aspects in chronic health conditions.