Paula M. Duke

Sexual development age and dating: a comparison of biological and social influences upon one set of behaviors.

Data from the U.S. National Health Examination Survey of 12-17-year-old youths were used to determine whether the development of the social behavior of dating is more closely linked to the level of sexual maturation or to the progression through age grades without reference to sexual maturation. Regression analyses and partial correlations show that individuals levels of sexual maturation add very little to the explained variance in dating after age had been taken into account. It appears that social pressures, based on behavior considered typical and appropriate at various ages, determines the onset of dating in adolescents. Individual rates of sexual maturation that deviate from the norm for that age have little impact on dating. These findings show how social standards can reduce dramatically the impact of individual biological processes on institutionalized forms of behavior.

Educational correlates of early and late sexual maturation in adolescence

From the National Health Examination Survey data, 4,735 Caucasian males and females, 12 to 17 years, were classified by age and stage of sexual maturation (Tanner). Early and late maturers were each compared to all other youth of comparable age and sex, in eight education-related categories: youth and parental aspirations and expectations concerning the level of education which would be achieved by the student, teacher reports of intellectual ability and academic achievement, and test scores (WISC and WRAT). Except at age 12, late maturing boys received significantly lower ratings than mid maturers in all these areas, and early maturing males received higher ratings. For females, no differences persisted across age groups. In advising male adolescents, physicians should be alert to the possibility that school functioning may be linked to maturational processes.

The Effect of Early Versus Late Physical Maturation on Adolescent Behavior

Are the behavioral effects of early versus late maturation short-term or do they influence the whole course of adult life? Cross-sectional and longitudinal studies that have probed these interrelationships are reviewed, and stimulating questions posed for future research.

HEIGHT AND INTELLECTUAL DEVELOPMENT

We analyzed data from the National Health Examination Survey (Cycle III), a representative sample of non-institutionalized US youth (3545 males (M), 3223 females (F), 12-17 yr of age), to examine the relationship between the height (normalized for age) (H) and measures of: intellectual development (WISC), academic achievement (WRAT), evaluations by teachers, and the educational aspirations and expectations of subjects and their parents. Parental education and income were used as measures of socio-economic status (SES); sexual maturation (by Tanner score) was categorized by age into early, mid, and late-maturers. WISC and WRAT scores were both significantly correlated with H (r=0.22 & 0.20 white M; r=0.22 & 0.22 white F; p<0.0001). Parental expectations that their child would finish college were higher for adolescents above the 50th percentile of height for age. (43% vs 33%, M; 30% vs 24%, F). Adolescent expectations that they would finish college were likewise higher in the taller group (48% vs 39%, M; 38% vs 29%, F). Teachers ranked the taller adolescents in the upper third of their class more frequently then the shorter adolescents (25% vs 18%, M; 33% vs 25%, F). These findings persist in both blacks and whites, in the lower and middle SES groups and when subjects with early and late maturation are excluded. These data demonstrate a consistent and statistically significant, although modest, correlation between H and these measures of intellectual and academic performance, as well as educational expectations of both the adolescent and parent.

The Role of the Pediatrician in the Adolescent’s School

Whether the setting for medical care delivery is the pediatricians office or the school itself, successful school health models call for good communication and interaction between educators and physicians. In addition, parents and peers can be influential transmitters of health education to teenagers.

CYTOMEGALOVIRUS (CMV) INFECTIONS: INFANT DEVELOPMENT VS. DAY CARE CENTERS

CMV causes congenital infection in 0.5-2% of births and may be the leading cause of congenital deafness in the U.S. Personnel in centers for developmentally delayed infants and toddlers are concerned that admission of children known to have CMV may increase the transmission of CMV to pregnant staff and the risk of subsequent congenital infection. Despite lack of data to warrant this assumption, children are denied services because they shed CMV. We studied CMV shedding in urine and saliva in children 0-3 yrs. in day care (DCC) and infant development centers (IDC) and the CMV immunity of the staff (58 staff in 6 DCC and 72 staff in 10 IDC). 59% of DCC and 42% of IDC staff were seropositive. Among staff, seropositivity did not differ by center type, age, or socioeconomic status (SES). There was no positive correlation between seropositivity and length of employment. Among 100 children in 4 DCC and 62 children in 7 IDC, 21% and 22% respectively had CMV urinary shedding. There were no significant differences by age, center type, ambulatory status, or center SES. Thus, CMV urinary shedding is common in these settings. Since 48% of the staff under 35 are seronegative, rates of shedding among the children are of concern. Seroconversion rates among staff working with young children need to be established and more learned about transmission of CMV. Nevertheless, we found no difference between DCC and IDC; thus, staff in IDC are no more likely to have acquired CMV than DCC staff, and there is no indication for excluding known CMV shedders from IDC.

ASSESSMENT OF TEENAGE PARENTING

The adolescent mother and her child are a pediatric dyad at high risk medically, socially, and psychologically. A number of studies in the literature characterize the teenage mother in negative terms in regard to her maternal behavior. However, many of these studies are limited by small sample size or by use of subjective measures of parenting behavior. In the present study, we examine the interaction of 73 teenage mother/child pairs utilizing the NCATS Scales (Nursing Child Assessment Teaching Scale). This is a behavioral observation instrument which has been standardized with older mothers. The parental scores with this instrument have been demonstrated to be predictive of a childs latter cognitive functioning.The teenagers studied ranged in age from 13 to 17 years (mean age 15.8 years). Of this group 66% of the mothers were Hispanic 24% were White and 10% were Black. The mean parenting scores achieved by the teenagers differed significantly from the average score attained in adult mothers in the normative sample (p<05). However when educational level was controlled, there was no difference between the adolescent mothers and the older mothers. Adult mothers with less than a high school education had a mean score comparable to our adolescent sample. This suggests that parenting in the adolescent may be related more to educational level than to age.

PSYCHOSOCIAL CORRELATES OF SHORT STATURE

Prior studies associating short stature in adolescence with difficulties in the areas of self esteem, peer interaction, and acaaemic performance have been inconclusive. We collected questionnaire data on parental perception of their childs health, growth, ease of making friends, and grade placement, and the youths self esteem, and satisfaction with growth in 42 consecutive male endocrine clinic patients (ages 12-17) for whom short stature was identified as the presenting problem. Self esteem was measured by the Rosenberg Self Esteem Scale. All other responses were compared with answers of National Health Examination Survey (NHES) participants comparable for age and SES (Cycle III, 1966-1970). Compared to short (<5th percentile) NHES adolescents, our parents: 1) more often rated their childs general health as poor or fair (14% vs. 0); 2) felt their children make friends less easily (34 vs. 14%); and 3) were much more dissatisfied with the youths height and weight (50 vs. 30%) and rate of physical growth (90 vs. 30%). Both our adolescents and the short NHES youth were similar in their marked dissatisfaction with their height (92 and 83%). There was no difference on the self esteem measure. These data indicate that pediatricians must be aware of the increased frequency of concern among parents whose adolescents present with short stature and the differences observed between our referral population and the NHES sample demonstrate that data derived from a referral population cannot be extrapolated to snort children in general.

GROWTH EXPECTATIONS AMONG PARENTS AND PATIENTS PRESENTING WITH SHORT STATURE

Concerns regarding growth and adult stature are frequent pediatric complaints. To evaluate patient and parental estimates of current and expected stature among children presenting with a chief complaint of short stature to our pediatric endocrine clinic, we mailed a questionnaire to 101 consecutive families (patients 1-18 yr, 23 female, 78 male). Patients 11 yr and older (57) completed a similar questionnaire. When indicated, bone ages were obtained (47) and adult heights predicted (PAH). Parent and patient estimates of the childs current height (H) were very accurate (parent, r=0.99; patient, r=0.90) and their assessments of the childs H percentile (%ile) for age were moderately accurate (parent r=0.42; patient r=0.70). Parental estimates of the lower limit of normal adult H averaged 167.4±6.5 cm (±SD) for males and 154.5±8.0 cm for females (both at the 11th %ile for normal adult H) while estimates by the patient were somewhat lower at 165.6±11.3 cm for males (7th %ile) and 147.3±14.6 cm for females (1st %ile). The H desired for the child, expressed by parent or patient, clustered near the average normal adult H. Parent and patient estimates of the childs final adult H did not correlate with the PAH, however, with more parents underestimating final adult H then overestimating it. In general, both parents and patients accurately estimate the childs current H and appear to have an appropriate perception of normal H. However, their expectations of ultimate H are distorted, indicating the need for counseling on the range of normal growth patterns.

9 LINEAR GROWTH DURING PUBERTY: IMPACT OF PUBERTAL DEVELOPMENT

Short stature is a frequent complaint of adolescent males. The pediatricians ability to interpret this concern is largely dependent upon use of standard growth curves. These curves are based only on chronological age and do not reflect the impact of sexual maturation on height. Accordingly, we undertook to revise these curves to enhance their usefulness.Using National Health Examination Survey data from 3,000 male adolescents, ages 12 to 17, we constructed height curves for each stage of sexual maturation and age. The resulting graphs depict estimated percentiles for height at each stage of sexual maturation from ages 12 to 17.Applications: a 145 cm 13 year old boy with a Sex Maturity Rating (S.M.R.) of 1, is later in sexual maturation and shorter than his age mates with his height measuring below the 10th percentile on standard height charts. When compared with other S.M. R. 1, 13 year old males, his height is at almost the 25th percentile. For the 150 cm 14 year old boy with a S.M.R. of 2, his percentile moves from 5th-10th percentile on the standard growth curve to approximately the 20th percentile on the curves adjusted for stage of sexual maturation.Our data provide pediatricians with a more precise way of evaluating adolescent male height and may offer information potentially reassuring to the short, late-maturing adolescent male and his parents.