Annotation: the impact of puberty

Psychological effects of gonadotropin-releasing hormone agonist treatment in girls with central precocious puberty

Objective This study was done to evaluate the emotional and behavioral status of precocious puberty patients and analyze the effect of gonadotropin-releasing hormone agonist (GnRHa) treatment. Methods Sixty-six female precocious puberty patients were enrolled prospectively for the study at Kangdong Sacred Heart Hospital of Hallym University Medical Center from September 2011 to December 2012 and self-administered questionnaire was completed during the GnRHa treatment initiation period and after 12 months from the first injection. The patients were evaluated using the Korean version of Child Behavior Checklist (K-CBCL) and Children's Depression Inventory (CDI). Results A total of 30.3% (n = 20) of the patients scored within the clinical range for one or more scales of K-CBCL at the initiation of GnRHa treatment, but only 10.6% (seven patients) were within the clinical range after 1 year of treatment. Average CDI scores of the patients decreased from baseline 6.5 ± 6.0 to 4.9 ± 4.7 after GnRHa therapy. Conclusions This study shows that both K-CBCL and CDI scores improved from baseline score ranges after 1 year of GnRHa treatment in female central precocious puberty patients while significant psychological problems of clinical range amongst them were not noted.

The Relationship between Body Image and Depressed Mood in Adolescence: A 5-year Longitudinal Panel Study

Much research interest has been devoted to reveal the psychosocial processes associated with the development of depressive symptoms during adolescence. One of the important factors that has been studied is body image. In a 5-year longitudinal investigation, we revealed and discussed the relationship between body image and depressed mood in a cohort of adolescents at ages 13, 15 and 18. Girls reported on average higher depressed mood levels and more negative body image than boys at all ages. However, the correlations between the variables were nearly as strong for boys as for girls. Structural equation modelling revealed that body image predicted change in depressed mood both for boys and girls, but at different ages. In contrast, we did not find any support for the existence of causal effects of depressed mood upon body image.

Availability of convenience stores and adolescent alcohol use in Taiwan: a multi-level analysis of national surveys

AIM

To examine the association between alcohol in school environments and adolescent alcohol use over the previous 6 months.

DESIGN

A multi-level logistic regression analysis was performed of cross-sectional surveys conducted in 2004, 2005 and 2006.

PARTICIPANTS AND SETTING

A total of 52 214 students aged 11-19 years from 387 middle or high schools were selected from a nationally representative, multi-stage, stratified probability sampling across Taiwan.

MEASUREMENTS

Information on socio-demographic features and substance use experiences was collected using self-administered questionnaires. The alcohol in the environment was measured using the availability of convenience stores surrounding the schools. Using geographical information systems, the weighted numbers of convenience stores within 1 km, a 12-15-minute walk, of a school were calculated. The schools were later categorized into three subgroups via the tertile of nearby convenience stores.

FINDINGS

Considering the compositional characteristics, the availability of convenience stores was found to account for 1.5% of the school-level variance of youthful drinking. The odds ratios (95% confidence interval) of alcohol use over the previous 6 months among youth attending schools with medium and high availability were 1.04 (0.96-1.13) and 1.08 (1.00-1.17), respectively, with a P-value of 0.04 in the trend test.

CONCLUSION

The greater availability of convenience stores near a school is associated with an increased risk of alcohol use among adolescents over the previous 6 months.

Early puberty and childhood social and behavioral adjustment

PURPOSE

Early puberty has been linked to higher rates of mental health problems in adolescence. However, previous studies commencing after the initiation of puberty have been unable to explore whether early puberty is preceded by higher rates of these problems. In a large national study, we aimed to determine whether difficulties in behavior and psychosocial adjustment are evident before as well as during the early pubertal transition.

METHODS

The Longitudinal Study of Australian Children recruited a nationally representative cohort of 4,983 children at age 4-5 years in 2004. This analysis includes 3,491 of these children (70.1%) followed up at ages 6-7, 8-9, and 10-11 years, with a completed parent report of stage of pubertal maturation at age 8-9 years. Parents reported behavior difficulties (Strengths and Difficulties Questionnaire) and psychosocial adjustment (Pediatric Quality of Life Inventory) at all four waves from ages 4-5 to 10-11 years.

RESULTS

Both boys and girls who entered puberty early (i.e., by age 8-9 years) also experienced poorer psychosocial adjustment at this age. These psychosocial differences were already evident at ages 4-5 and 6-7 years, and persisted to at least age 10-11 years. Similar patterns were evident for behavior difficulties, but only for boys; early puberty was not related to behavior difficulties in girls.

CONCLUSIONS

Children with early puberty have different patterns of behavior and social adjustment from the preschool years through early adolescence. At least in part, the association between early-onset puberty and poor mental health appears to result from processes under way well before the onset of puberty.

Pubertal timing and depressive symptoms in late adolescence: The moderating role of individual, peer, and parental factors

This longitudinal study examined personal-accentuation and contextual-amplification models of pubertal timing. In these models, individual and contextual risk factors during childhood and adolescence can magnify the effects of early or late puberty on depression symptoms that occur years later. The moderating role of prepubertal individual factors (emotional problems in late childhood) and interpersonal factors (deviant peer affiliation, early dating, perceived peer popularity, and perceived parental rejection during adolescence) were tested. A representative sample of 1,431 Canadian adolescents between 10–11 and 16–17 years of age was followed biannually. In line with the personal-accentuation model, early puberty has been shown to be a predictor for depression in both girls and boys who presented emotional problems in childhood. This effect was also noted for late maturing boys. Consistent with the contextual-amplification model, early puberty predicted later depression in youth who perceived greater parental rejection. Interpersonal experiences such as early dating in girls and deviant peer affiliation in boys predicted depression in early maturers as well. For girls, early dating was also found to be amplified by childhood emotional problems. In line with biopsychosocial models, results indicate that the effect of pubertal timing on depressive symptoms must be conceptualized through complex interactions between characteristics of adolescents' interpersonal relationships and prepubertal vulnerabilities.

A systematic review of the relationships between family functioning, pubertal timing and adolescent substance use

AIMS

Experiences linked to poor family functioning and pubertal timing have each been associated with increased risk of substance misuse in adolescence. However, it remains unclear to what extent family functioning and pubertal timing combine to put adolescents at particular risk.

METHOD

A systematic review was planned, undertaken and reported according to the 27 items of the PRISMA statement. Databases World of Knowledge, PsycINFO and PubMed were searched. Fifty-eight papers were retained and are discussed in this review after screening titles, abstracts and full papers against pre-established exclusion criteria.

RESULTS

The combination of off-time pubertal timing and poor parent-adolescent relationship quality has been related to higher levels of substance use. However, this is an under-studied area of research and the evidence is less strong for boys than girls.

CONCLUSIONS

Adolescents experiencing both poor parent-adolescent relationship quality and off-time pubertal timing may represent a high-risk group that can benefit from approaches aimed at reducing risk of substance misuse.

Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS)

Background

Physical activity (PA) shows a marked decline during adolescence. Some studies have pointed to pubertal status or timing as possible PA determinants in this age group. Furthermore, it was supposed that the impact of pubertal changes on PA might be mediated by psychological variables like body dissatisfaction (BDS).

Methods

The 11- to 17-year-old subsample of the German Health Interview and Examination Survey (KiGGS) was used (n = 6 813; 51.3% male, response rate = 66.6%). Through sex-specific sequential multinomial logistic regressions we analysed the univariate and independent associations of chronological age, absolute pubertal status, relative pubertal timing, and BDS with the frequency of PA.

Results

Chronological age showed a significantly negative association with PA in both sexes, independent of puberty. The odds of inactivity in contrast to nearly daily PA increased about 70% in boys and 35% in girls for each year of age, respectively. Adjusted for age and other possible confounders, inactivity was significantly less likely for boys in late pubertal stages (OR = 0.27, 95% CI = 0.09-0.78). The risk of inactivity was more than doubled in boys maturing earlier than peers in terms of relative pubertal timing (OR = 2.20, 95% CI = 1.36-3.56). No clear significant puberty effects were found in girls, but the inactivity was more likely for those with irregular menstruation (OR = 1.71, 95% CI = 1.06-2.75). BDS also contributed to the prediction of PA in both sexes. It partially mediated puberty effects in boys but not in girls.

Conclusions

Overall, chronological age was a far more important predictor of PA in German adolescents than absolute pubertal status or relative pubertal timing. Further possible explanatory variables like sociocultural influences, social support or increasing time requirements for education should be analysed in conjunction with chronological age in future studies.

Early pubertal timing and girls' problem behavior: integrating two hypotheses

Girls' early pubertal timing has been linked in many studies to behavioral problems such as delinquency and substance use. The theoretical explanations for these links have often involved the girls' peer relationships, but contexts have also been considered important in some explanations. By integrating two theoretical models, the peer-socialization and the contextual-amplification hypotheses, we propose a contextual framework for explaining the link between early pubertal timing and external problem behavior in girls. We hypothesize that early developing girls engage in unhealthy, dangerous, and risky behavior under contextual conditions that promote access to older friends and opposite-sex relationships. Under other conditions it is less likely. We tested this integrated hypothesis in two studies conducted in Sweden. The first was a cross-sectional study with information about school and free-time friends in a community sample (N = 284). Early pubertal timing was linked to having older, more normbreaking friends outside of school, but not in school, thus suggesting that the school context interferes early-developing girls' selection of older peers. The second study involved both a longitudinal (N = 434) and a cross-sectional sample of girls (N = 634), where we examined a leisure setting that is known to attract delinquent youth. Results showed that early pubertal timing was most strongly linked to delinquency for girls who spent time in this context and were heavily involved with boys and peers. In sum, results from both studies supported our predictions that certain contexts would amplify the peer-socialization effect. Overall, we conclude that the integrated peer-socialization/contextual-amplification model satisfactorily explains the link between pubertal timing and external problem behavior.

The Moderating Effects of Pubertal Timing on the Longitudinal Associations Between Parent-Child Relationship Quality and Adolescent Substance Use

This prospective, longitudinal study investigated the moderating role of pubertal timing on reciprocal links between adolescent appraisals of parent-child relationship quality and girls' (N=1335) and boys' (N=1203) cigarette and alcohol use across a twelve-month period. Reciprocal effects were found between parent-child relations and on-time maturing boys and girls' cigarette and alcohol use, after estimating stability in these constructs across time. Parent-child relationship quality was associated with increased alcohol use twelve months later for early maturing girls. Cigarette and alcohol use were associated with increased problems in the parent-child relationship for late maturing girls. No off-time effects were observed for off-time maturing boys in the pathways between parent-child relationship quality and substance use. Pubertal timing moderated the pathway linking parent-child relationship quality with cigarette use one year later such that the association was stronger for late maturing girls compared to early and on-time maturing girls. The findings indicate interplay between the psychosocial aspects of maturation, family relationships and adolescent substance use and highlight possible gender-specific influences.

Effects of attractiveness and social status on dating desire in heterosexual adolescents: an experimental study

The present study examined to what extent adolescent dating desire is based on attractiveness and social status of a potential short-term partner. Further, we tested whether self-perceived mate value moderated the relationship between dating desire and attractiveness of a potential partner. Data were used from a sample of 1,913 adolescents aged 13-18. Participants rated the importance of various characteristics of a potential partner and also participated in an experimental vignette study in which dating desire was measured with either low or high attractive potential partners having either a high or low social status. The results showed that boys rated attractiveness as more important than girls, while social status was rated as relatively unimportant by both sexes. In addition, in the experimental vignette study, it was found that attractiveness was the primary factor for boys' dating desire. Only when a potential partner was attractive, social status became important for boys' dating desire. For girls, on the other hand, it appeared that both attractiveness and social status of a potential partner were important for their dating desire. Finally, boys and girls who perceived themselves as having a high mate value showed more dating desire toward an attractive potential partner compared to adolescents who perceived themselves as having a low mate value. The present results extend previous research by showing that attractiveness of a potential partner is important to both adolescent boys and girls, but social status does not strongly affect dating desire during this particular age period.

Pubertal timing and its link to behavioral and emotional problems among 'at-risk' African American adolescent girls

Using an 'at-risk' sample of African American girls, the present study examined the link between girls' retrospective reports of pubertal timing, girls' perceived relative pubertal timing, and their behavioral and emotional problems as rated by the girls themselves (N=102; 11-17 years), as well as teachers and parents. Structural equation modeling results indicated that the girls' retrospective reports of menarche were significantly related to their perceived relative menarche, whereas the girls' retrospective reports of development of their breasts were not related to their perceived relative development of breasts. Girls who perceived their breasts developing early relative to their peers were more likely to engage in delinquent behaviors according to teacher report. Significant effects of teacher reported adolescent internalizing problems also were found for girls who retrospectively reported either early or late development of breasts. The study's findings underscore the importance of teasing apart the effects of different indicators of girls' pubertal development on psychosocial adjustment and including teachers' reports of girls' emotional and behavioral problems, particularly among girls with the additional risks associated with residing in an economically disadvantaged urban setting.

The influence of puberty onset, body mass index, and pressure to be thin on disordered eating behaviors in children and adolescents

The main objective of this study is to verify the hypothesis that pubertal development, obesity, body satisfaction, as well as family and peer influences predict unhealthy eating habits in children and adolescents. A randomized stratified sample of young Quebecers aged 9, 13, and 16 years on March 31, 1999 [608 children aged of 9 years (325 girls and 283 boys) and 662 adolescents aged of 13 and 16 years (349 girls and 313 boys)] were used. Children's weight, height, and Body Mass Index (BMI) were recorded. Questionnaires were administered to children and a parent (usually the mother). Among 9-year-old children, this study found that weight loss or weight control behaviors were predicted mainly by the onset of puberty, lower maternal abusive control, and the level of peer pressure. Among adolescents, mother's BMI, income, peer pressure, and negative comments about the child's weight most strongly predicted behaviors to control weight, strategies to lose weight and the frequency of such behaviors. The findings suggest that both parents and children need to understand the impact of comments on a child's behavior.

Depression in female adolescents: an IPA analysis

Six female adolescents participated in open-ended interviews regarding their experiences of depression. The transcripts of their interviews were explored using Interpretative Phenomenological Analysis (Smith, 1991). The analysis revealed three inter-connected super-ordinate themes which were: communication, hurt self, and difference. These themes centred on communication processes in participants' families and with peers, issues relating to shifts in identity through adolescence, and feelings of being damaged, distressed, and hurt. Amongst a range of potentially relevant perspectives, an attachment theory (Bowlby, 1969) orientation was found to be particularly relevant and helpful in interpreting the themes that captured these young women's experiences. Some implications for clinical practice are discussed.

A critical review of the empirical literature on the relation between anxiety and puberty

The current paper critically reviews the empirical literature focused on the association between puberty and anxiety. A detailed review of more than 45 empirical articles is provided. There is some evidence that among girls, but not boys, a more advanced pubertal status (controlling for age) is associated with higher reported anxiety symptoms. Also among girls, earlier pubertal timing is linked to higher anxiety scores. It is unclear whether early puberty may lead to increased anxiety or if high anxiety influences pubertal timing. With respect to hormones, there were relatively few significant associations for girls, although this literature is very small. Among boys, several studies reported positive associations between both gonadal and adrenal hormones and anxiety. The direction of effect for these finding is also unstudied. The primary limitation of the hormone-anxiety literature pertains to the absence of pubertal measures in samples of youth in which hormones are measured. The paper concludes with a comprehensive examination of the methodological strengths and weaknesses of the literature and recommendations for future work.

Predicting female depression across puberty: a two-nation longitudinal study

OBJECTIVE

To prospectively examine the relation between pubertal stage and the onset and course of depressive symptoms.

METHOD

The design was a three-wave longitudinal study of health and social development using statewide community samples in Washington, United States, and Victoria, Australia. Approximately 5,769 students initially ages 10 to 15 years were assessed for depressive symptoms with the Short Mood and Feelings Questionnaire. Pubertal status was assessed using a self-report version of the Pubertal Development Scale.

RESULTS

Advancing pubertal stage carried higher risks for depressive symptoms in female subjects in all of the three study waves. The pubertal rise in female depressive symptoms was due to both higher risk for incident cases and an even greater effect on risks for persistence of depressive symptoms. Report of poor emotional control 12 months earlier carried a twofold higher risk for incident depressive symptoms and largely explained the pubertal rise in female incident cases. High family conflict and severity of bullying also predicted persistence of depressive symptoms. Preexisting depressive symptoms were not associated with later increases in the rate of pubertal transition.

CONCLUSIONS

Advancing pubertal stage carries risks for both the onset and persistence of depressive symptoms in females. Social adversity around puberty predicts the persistence of symptoms but does not account for a pubertal rise in female depression. A report of poor emotional control may be a useful marker of girls at risk for depressive symptoms and as a target for preventive intervention.

Body image in adolescents with disorders of steroidogenesis

AIM

Little is known about body image in children with endocrine conditions. We evaluated body image in children with congenital adrenal hyperplasia (CAH), familial male precocious puberty (FMPP), and Cushing's syndrome (CS).

STUDY DESIGN

We compared 67 patients (41 CAH, 12 FMPP, 14 CS) age 8-18 years with 55 age-matched controls.

RESULTS

Patients expressed more weight unhappiness than controls (females: p < 0.001; males: p = 0.01). This difference remained for females after adjusting for body mass index (BMI) (p = 0.03), but not for males (p = 0.12). Unhappiness with height and age of appearance was similar between groups. In female patients, higher BMI was a significant predictor of weight unhappiness (p = 0.01).

CONCLUSION

Adolescents with CAH, FMPP, and CS are at risk for negative body image regarding weight, but not height or age of appearance. Weight unhappiness is partially related to greater weight, but factors unrelated to physical findings seem to contribute to negative body image in female patients.

Dieting behaviors, body shape perceptions, and body satisfaction: cross-cultural differences in Argentinean and Swedish 13-year-olds

This exploratory study represents a cross-cultural effort to examine differences in dieting practices and weight loss attempts, perceived body shape, and body satisfaction between young Argentinean and Swedish adolescents. The study group consisted of 358 Argentinean (193 girls, 165 boys) and 874 Swedish (474 girls, 400 boys) 13-year-olds. A main finding was that Argentinean and Swedish adolescents did not differ on body satisfaction, although girls in both countries displayed greater body dissatisfaction than did boys. Dieting and weight loss attempts were more prevalent among the Argentinean adolescents, especially among girls, and did not appear to depend on overweight or perception of body shape. The samples also differed in their perceptions of body shape and the effect those perceptions had on their body satisfaction, with Swedish adolescents suffering more from negative body shape perceptions.

Pubertal stage and deliberate self-harm in adolescents

OBJECTIVE

To ascertain the association between pubertal stage and deliberate self-harm.

METHOD

Cross-sectional survey of 12- to 15-year-olds in 300 secondary schools in the U.S. state of Washington in February-April 2002 and the Australian state of Victoria in June-August 2002. A total of 3,332 students in grades 7 and 9 provided complete data on episodes of deliberate self-harm in the previous 12 months and pubertal stage. Pubertal stage was assessed with the Pubertal Development Scale.

RESULTS

The prevalence of deliberate self-harm was 3.7% with a more than twofold higher rate in females. Late puberty was associated with a more than fourfold higher rate of self-harm (odds ratio 4.6, 95% confidence interval 1.5-14) after adjustment for age and school grade level. In contrast age had a protective association (odds ratio 0.7, confidence interval 0.4-1.0). The sharpest rises in prevalence across puberty were for self-laceration and self-poisoning in females. Higher rates of depressive symptoms, frequent alcohol use, and initiation of sexual activity largely accounted for the association between self-harm and pubertal stage in multivariate models.

CONCLUSIONS

Puberty is associated with changes in the form and frequency of self-harm. For adolescents with a gap between puberty and brain development, risk factors such as early sexual activity and substance abuse may be particularly potent.

Pubertal transitions in health

Puberty is accompanied by physical, psychological, and emotional changes adapted to ensure reproductive and parenting success. Human puberty stands out in the animal world for its association with brain maturation and physical growth. Its effects on health and wellbeing are profound and paradoxical. On the one hand, physical maturation propels an individual into adolescence with peaks in strength, speed, and fitness. Clinicians have viewed puberty as a point of maturing out of childhood-onset conditions. However, puberty's relevance for health has shifted with a modern rise in psychosocial disorders of young people. It marks a transition in risks for depression and other mental disorders, psychosomatic syndromes, substance misuse, and antisocial behaviours. Recent secular trends in these psychosocial disorders coincide with a growing mismatch between biological and social maturation, and the emergence of more dominant youth cultures.

Ten-year-old girls' and boys' body composition and peer victimization experiences: prospective associations with body satisfaction

This study examined prospective associations between 10-year-olds' weight and height, their perception of shape and stature, frequent experiences of peer victimization, and different aspects of body esteem at age 13. Participants were 474 girls and 400 boys participating in a two-wave longitudinal questionnaire study. Main results were that whereas actually being heavier built at age 10 was associated with girls' increments in body dissatisfaction, the mere perception of being too heavy was associated with boys' poorer body satisfaction. Also, boys who believed that they were too short were more dissatisfied at follow-up. Whereas frequent peer victimization had long-term associations with girls' weight-esteem, teasing targeted towards appearance was associated with boys' more negative beliefs about what others think about their appearance. Finally, participants had become significantly more dissatisfied at age 13, suggesting that this is a time in life when both girls and boys risk becoming increasingly critical towards their appearance.

Precocious puberty in adolescent girls: a biomarker of later psychosocial adjustment problems

We have investigated the hypothesis that stress condition will accelerate pubertal maturation in adolescent girls and that faster maturing girls will display more behavioral problems than their on-time or late-maturing peers during pubertal development. Longitudinal data were collected yearly from 1986 to 1997. Parents of 1039 French-speaking Canadian girls completed a questionnaire about their characteristics as well as those of their family. To predict onset of puberty by time and cumulative risk factors, a Hierarchical Regression Analysis and a Survival Regression Analysis were conducted. Results revealed that: (1) anxiety at 8 years old, lower level of anxiety a year earlier and more adverse family condition predict a younger age at first menses; and (2) Body Mass Index, conflicts, and sleep disturbances significantly predict the onset of puberty. Complementary standard regression analyses demonstrated that situational stress mediated the effect of these variables. We concluded that precocious puberty could be an indicator of stress in a child, thus, allowing professionals to intervene early and to prevent later problems in psychosocial adjustment.

The interaction role of obesity and pubertal timing on the psychosocial adjustment of adolescent girls: longitudinal data

OBJECTIVE

The objective of the study was to verify the hypothesis that obesity is associated with pubertal timing, as both factors interact to predict psychosocial adjustment problems in girls.

SUBJECTS

We selected 811 girls who had participated in a longitudinal study on a representative sample of French Canadian children from 1986 to 1997.

METHOD

Only data collected between 1993 and 1996 were analyzed. We classified the participants into three weight categories (normal, overweight, and obese) and pubertal timing (early, on-time, or late-maturing) and compared their internalized and externalized problem behavior and conflict as well as their socioeconomic status.

RESULT

We found that (1) early and late-maturing girls are more at risk of being overweight during the whole period of pubertal development as demonstrated by the increasing rate of obesity in these two groups between 11 and 13 y old, and (2) there was an interaction effect between pubertal timing and obesity in predicting problem behavior and conflict. Overweight and obese girls who developed faster or slower than their peers displayed more adjustment problems at 11 and 12 y old. At 13 y old, obesity predicted adjustment problems separately without regard to pubertal timing. Our results suggest that puberty timing is a risk factor for obesity and that both pubertal timing and being overweight predict adjustment problems during all the courses of pubertal development, supporting partially our hypothesis.

CONCLUSION

Programs and interventions must take into account these two factors and adolescents should be monitored throughout all the periods of pubertal development.

Early puberty and adolescent pregnancy: the influence of alcohol use

OBJECTIVE

Early pubertal timing predicts deleterious outcomes for young girls, including substance use, risky sexual behavior, and pregnancy. In turn, adolescent pregnancy predicts long-term negative consequences such as reduced educational attainment and income-earning potential. Despite evidence of the direct links between early puberty and negative outcomes, this study is the first to examine the role that alcohol plays in the timing of sexual intercourse and pregnancy among early-maturing females.

DESIGN

Participants were 666 females, aged 18 to 22 years, from 4 major ethnic groups in Arizona (non-Hispanic white, black, Latino, and Native American). All women included in the sample had experienced a pregnancy in their teens or early 20s. Participants completed a self-administered questionnaire that inquired about their timing of menarche, sexual initiation, first alcohol use, and age at first pregnancy. A mediating model predicting age at pregnancy was tested by using path modeling.

RESULTS

Early puberty was found to be associated with earlier age of alcohol use and sexual initiation, which in turn predicted early pregnancy. Age at first sexual intercourse and age at first substance use significantly mediated the relation between age at menarche and age at first pregnancy. The results did not vary by ethnic group.

CONCLUSIONS

Girls who mature early are more likely to engage in early substance use and sexual intercourse, which in turn puts them at greater risk for adolescent pregnancy. It is important that health care providers are sensitive to the risks associated with early maturation among young girls and provide preventive screening, education, and counseling related to alcohol use and sexual initiation for this group.

Psychosocial Functioning of Adolescents with Idiopathic Short Stature or Persistent Short Stature Born Small for Gestational Age during Three Years of Combined Growth Hormone and Gonadotropin-Releasing Hormone Agonist Treatment

AIM

To examine psychosocial functioning of medically referred adolescents with idiopathic short stature (ISS) or persistent short stature born small for gestational age (SGA) during 3 years of combined growth hormone (GH) and gonadotropin-releasing hormone agonist (GnRHa) treatment.

METHODS

Thirty-eight adolescents participated in a controlled trial with GH/GnRHa treatment or no intervention. Each year the adolescents and their parents completed questionnaires and structured interviews. Multilevel analysis was used to analyze data.

RESULTS

The adolescents of the treatment group showed a worse outcome than the adolescents of the control group on 3 of 16 variables: perceived competence of scholastic (p < 0.01) and athletic ability (p < 0.05) and trait anxiety (p < 0.05). Adolescents in both the treatment and control groups perceived improved current height (p < 0.001) and self-appraisal of physical appearance (p < 0.05). The parents did not report changes in their children during treatment.

CONCLUSION

The observation of some adverse psychological consequences as experienced by the adolescents indicates that it is useful to monitor psychosocial functioning during a combined GH/GnRHa treatment in adolescents with ISS or SGA. It is uncertain whether the hypothesized positive effects of the expected gain in final height by adulthood can sufficiently counterbalance possible short-term negative effects.

Geschlechtsunterschiede im Auftreten von psychischen und Verhaltensstörungen im Jugendalter

Zusammenfassung. Im vorliegenden Beitrag werden die wichtigsten Geschlechtsunterschiede im Auftreten von psychischen und Verhaltensstörungen vom Einsetzen der Pubertät bis ins Heranwachsendenalter hinein dargestellt und mögliche Erklärungen für diese Unterschiede diskutiert. Exemplarisch werden zwei Formen von Problemverhalten dargestellt, deren Prävalenz sich in dieser Entwicklungsphase stark verändert: depressive Symptome und Störungsbilder, und externalisierendes Problemverhalten, im Speziellen Aggression und Delinquenz, sowie der Konsum verschiedener psychoaktiver Substanzen. Diese Störungen und die entsprechenden Geschlechtsunterschiede werden in Zusammenhang mit der Lösung von zentralen Entwicklungsaufgaben des Jugendalters gebracht. Abschließend werden Implikationen für die Prävention und die Forschung formuliert.

Gender intensification of peer socialization during puberty

Gender differences are a provocative subject with good reason: they are implicated as contributors to important societal problems. Gender differences in math achievement contribute to limited career options for women (Center for Early Adolescence, 1984; Stipp, 1992), which may in turn affect their economic self-sufficiency. Gender differences in social norms about competition and closeness contribute to power and communication problems in female-male relationships, with consequences for family stability and domestic violence (Leaper, 1994). Understanding the origins of gender differences, therefore, has important societal implications.

Puberty and the onset of substance use and abuse

OBJECTIVE

Substance abuse remains one of the major threats to adolescent health in Western cultures. The study aim was to ascertain the extent of association between pubertal development and early adolescent substance use.

METHODS

The design was a cross-sectional survey of 10- to 15-year-old subjects in the states of Washington, United States, and Victoria, Australia. Participants were 5769 students in grades 5, 7, and 9, drawn as a 2-stage cluster sample in each state, and the questionnaire was completed in the school classrooms. The main outcomes of the study were lifetime substance use (tobacco use, having been drunk, or cannabis use), recent substance use (tobacco, alcohol, or cannabis use in the previous month), and substance abuse (daily smoking, any binge drinking, drinking at least weekly, or cannabis use at least weekly).

RESULTS

The odds of lifetime substance use were almost twofold higher (odds ratio [OR]: 1.7; 95% confidence interval [CI]: 1.4-2.1) in midpuberty (Tanner stage III) and were threefold higher (OR: 3.1; 95% CI: 2.4-4.2) in late puberty (Tanner stage IV/V), after adjustment for age and school grade level. Recent substance use was moderately higher (OR: 1.4; 95% CI: 1.0-1.9) in midpuberty and more than twofold higher (OR: 2.3; 95% CI: 1.7-3.3) in late puberty. The odds of substance abuse were twofold higher (OR: 2.0; 95% CI: 1.2-3.2) in midpuberty and more than threefold higher (OR: 3.5; 95% CI: 2.2-5.4) in late puberty. Reporting most friends as substance users was more likely in the later stages of pubertal development, a relationship that accounted in part for the association found between later pubertal stage and substance abuse.

CONCLUSIONS

Pubertal stage was associated with higher rates of substance use and abuse independent of age and school grade level. Early maturers had higher levels of substance use because they entered the risk period at an earlier point than did late maturers. The study findings support prevention strategies and policies that decrease recreational substance use within the peer social group in the early teens.

Developmental, gender, and ethnic group differences in moods and ambulatory blood pressure in adolescents

BACKGROUND

Adolescence is characterized by profound changes in physical, psychological, and social functioning thought to be accompanied by intense and varying moods.

PURPOSE

Within a psychophysiological framework, this study examined the prevalence of 12 self-reported mood states of adolescents; investigated associations between specific mood states and ambulatory blood pressure readings; and explored effects of interactions among moods, gender, ethnic group, and maturation on ambulatory blood pressures.

METHODS

The sample included 371 African American, European American, and Hispanic American adolescents 11 to 16 years old. Systolic (SBP) and diastolic (DBP) blood pressures were measured every 30 min with an ambulatory monitor and were synchronized with electronic activity monitoring and moods self-recorded during waking hours in a checklist diary.

RESULTS

Moods differed significantly by gender, ethnic group, and maturation. Controlling for height, maturation, gender, ethnic group, mother's education, position, location, activity, other moods, and interactions of moods with other variables in a multilevel, random coefficients regression model, both positive and negative mood states were associated with higher levels of SBP and DBP; being relaxed or bored, or having a feeling of accomplishing things were associated with lower SBP and DBP. There were significant interaction effects of moods with physical maturity, gender, and ethnic group on ambulatory SBP and DBP.

CONCLUSIONS

Further study of the modifying effects of gender, ethnic group, and stage of development on reports of moods, and their associations with cardiovascular responses is recommended.

The normative development of child and adolescent problem behavior

The aim of this study was to identify normative developmental trajectories of parent-reported problems assessed with the Child Behavior Checklist (CBCL; T. M. Achenbach, 1991) in a representative sample of 2,076 children aged 4 to 18 years from the general population. The trajectories were determined by multilevel growth curve analyses on the CBCL syndromes in a Longitudinal multiple birth-cohort sample that was assessed 5 times with 2-year intervals. Most syndromes showed a linear increase or decrease with age or a curvilinear trajectory, except for thought problems. Trajectories for most syndromes differed for boys versus girls, except those for withdrawn, social problems, and thought problems. These normative developmental trajectories provide information against which developmental deviance in childhood and adolescence can be detected.

It's about timing and change: pubertal transition effects on symptoms of major depression among African American youths

Effects of early physical maturation and accelerated pubertal changes on symptoms of major depression were examined in 639 African American children. Three rival hypotheses, early timing, off-time, and stressful change, were tested using 2 waves of data (mean ages = 11 and 13 years). The pubertal effect operates differently according to children's gender and age. For girls, early maturation was consistently associated with elevated levels of depressive symptoms. For boys, early maturers manifested elevated levels of depression only at age 11, but these symptoms subsided by age 13. Boys who experienced accelerated pubertal growth over time displayed elevated symptom levels. Results support the early timing hypothesis for girls and the stressful change hypothesis for boys. Time at assessment is critical when examining boys' pubertal transition.

Explaining the gender difference in self-reported suicide attempts: a nationally representative study of Norwegian adolescents

Predictors of self-reported suicide attempts were studied cross-sectionally and prospectively in order to discern which variables may account for the gender difference in such reports. A representative sample of Norwegian students (N= 9,679) in grades 7-12 were followed from 1992 to 1994. More girls (10.4%) than boys (6.0%) reported a previous attempt and more girls (3.3%) than boys (1.9%) reported an attempt during the study period. The gender difference in previous suicide attempts was significantly reduced when depressed mood was controlled, and was no longer significant when disordered eating was included. There was no gender difference in future attempts when previous attempts, depressed mood, physical appearance, pubertal timing, and romantic involvement were controlled. Girls' higher level of risk factors may account for their higher level of self-reported nonfatal suicidal behavior.

Blood pressure and sexual maturity in adolescents: the Heartfelt Study

This study investigates sexual maturity as a predictor of resting blood pressures independent of other known predictors, in 179 boys and 204 girls 11-16 years of age from the Heartfelt Study. The sample included youth of African (n = 140), Mexican (n = 117), and European and "other" (n = 126) backgrounds. Sexual maturity was assessed during clinical examination of three standard indicators for each sex. Systolic and diastolic blood pressures were higher in children of maturity stages IV and V, compared to stages I-III, in each gender/ethnic group (P < 0.01 in almost all groups). Boys and girls advanced in sexual maturity for their age group, had significantly higher systolic blood pressures (but not diastolic) than the less advanced in linear models that included height, body mass index (BMI), ethnicity, and age as co-predictors. Diastolic blood pressures were predicted by height in boys and by age and the BMI in girls. This analysis, using a very conservative approach, suggests that sexual maturity provides important and independent information on systolic blood pressure in adolescents. Further investigation of its role in 24-hr blood pressures and in blood pressures taken during physical and emotional stress, is recommended.

Pubertal transition, stressful life events, and the emergence of gender differences in adolescent depressive symptoms

This study examined the role of both pubertal and social transitions in the emergence of gender differences in depressive symptoms during adolescence. This study generated the following findings: (a) Gender differences in depressive symptoms emerged during 8th grade and remained significant through 12th grade. (b) Pubertal status in 7th grade was related to adolescent depressive symptoms over time. (c) Early-maturing girls represented the group with the highest rate of depressive symptoms. (d) Depressive symptoms measured in 7th grade predicted subsequent symptom levels throughout the secondary school years. (e) Recent stressful life events were associated with increased depressive symptoms. (f) Early-maturing girls with higher levels of initial symptoms and more recent stressful life events were most likely to be depressed subsequently. The findings demonstrate the importance of the interaction between the pubertal transition and psychosocial factors in increasing adolescent vulnerability to depressive experiences.

Social cognitions associated with pubertal development in a sample of urban, low-income, African-American and Latina girls and mothers

PURPOSE

To assess girls' acquisition of new sex-related social cognitions at puberty and the social meanings they attribute to changes in their primary social relationships.

METHODS

As part of a larger study assessing sociosexual cognitions of urban girls, 57 African-American and Latina mothers and 57 girls (aged 10-13 years) participated in one of 16 focus groups. Thematic analyses were conducted on transcripts of the mothers' and daughters' focus group sessions.

RESULTS

Analyses revealed four major themes related to pubertal development: (1) physical maturation provides new social status of maturity; (2) puberty is associated with changes in sexual expectations and roles; (3) girls develop social meanings to feelings of sexual arousal; and (4) puberty prompts changes in mother-daughter relationship control. Representative quotations are used to illustrate each of these themes.

CONCLUSIONS

Our analyses provide insight into the ways in which late childhood and early adolescent urban girls interpret sexuality and sexual relations, perceive changes in their social relationships, and develop expectations regarding their roles in sexual and romantic relationships.

Childhood stress, behavioural symptoms and mother-daughter pubertal development

Belsky, Steinberg and Draper (Child Development 1991, 62, 647-670) predicted that early childhood stress or conflict in the family environment would be associated with childhood behavioural symptoms, early puberty and early, less discriminate sexual behaviour. Their theory was tested in a retrospective self-report survey in 28 daughters (aged 12 to 15) and 21 mothers. In daughters, earlier menarche correlated with more family stress in a late childhood (age 7 to 11); more conflict with mother in early childhood (birth to age 6); more rejection from and less closeness to mother throughout childhood (birth to age 11); more anxiousness and internalizing symptoms (anxiousness/depression) in late childhood (age 7 to 11); earlier age at dating boys; and more boyfriends. An alternative interpretation is considered based on genetic transmission of maternal characteristics.