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• Vertical Challenge
  S Fountain-Polley
  Published on: 22 March 2016
• Stature and personality function
  Jan-Maarten Wit
  Published on: 22 March 2016

• Published on: 22 March 2016

  Vertical Challenge

  • S Fountain-Polley, Specialist Registrar Paediatrics

  Dear Editor

  Being vertically challenged myself, it was affirming to read a paper that revealed some evidence that being short does not necessarily confine you to social and functional underacheivement compared to your peers.[1]

  In medical school sociology lectures we were reliably informed that shortness is a disadvantage in the world. In the ancient past, when only the strongest survived, this may have bee...

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  Dear Editor

  Being vertically challenged myself, it was affirming to read a paper that revealed some evidence that being short does not necessarily confine you to social and functional underacheivement compared to your peers.[1]

  In medical school sociology lectures we were reliably informed that shortness is a disadvantage in the world. In the ancient past, when only the strongest survived, this may have been the case; but in the modern meritocratic world, small people can metaphorically stand shoulder-to- shoulder with anyone.

  What this study also reveals to us about society is its preoccupation with outward appearances. That a study like this is being carried out signifies a feeling that we need to prove the null hypothesis amongst people who are placed differently along the bell-shaped curve of normality. Maybe this study is as useful as a commentary on societies attitudes to variation as it is evidence that height does not affect the gradient of development.

  Reference

  1. Ulph et al. Personality Functioning: the influence of stature, Arch Dis Child. 2004; 89: 17-21.

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  Conflict of Interest:
  None declared.

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• Published on: 22 March 2016

  Stature and personality function

  • Jan-Maarten Wit, Professor of Paediatrics
  • Other Contributors:
    • Hanneke Visser-van Balen, Friedo W.Dekker

  Dear Editor

  We have read with much interest the article entitled "Personality functioning: the influence of stature" of Ulph et al.[1] It elegantly describes the effect of short stature in childhood as well as in young adulthood on personality functioning in a population-based study. The paper concludes that "no evidence was found that stature per se significantly affected the psychosocial functioning of t...

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  Dear Editor

  We have read with much interest the article entitled "Personality functioning: the influence of stature" of Ulph et al.[1] It elegantly describes the effect of short stature in childhood as well as in young adulthood on personality functioning in a population-based study. The paper concludes that "no evidence was found that stature per se significantly affected the psychosocial functioning of the participants". These results can play a role in the discussion about the use of growth hormone (GH) in short children without classical GH deficiency, particularly children with "idiopathic short stature" and persistent short stature after born small for gestational age.

  We wish to raise several issues which in our opinion should lead the authors to modify their conclusions to some extent.

  First, we wonder whether the authors have tried to circumvent information bias. In earlier papers from this group, the authors have concluded that the psychosocial effects of short stature are minimal. As the data for the present study are fully dependent on interviews, utmost care should be taken to prevent information bias, for example by blinding the interviewers for at least childhood height.

  Second, the likelihood of selection bias may be greater than the authors suggest. The original study group (106 short normal (SN) and 119 controls (C), a total of 225) was brought down to 76 SN+94 C = 170 at the beginning of this phase, due to attrition and an earlier recruitment of short subjects into a GH study. The authors mention a percentage of 61%, but we calculated that this would be 170/225=76%. Of these subjects, only 114 (48 SN, 66 C) were interviewed, which brings the study group down to 114/225=51% of the original sample. The SN group was even smaller (45%). In their assessment whether the 114 participants were representative of the original population-based group, the authors only compared the interviewed and not-interviewed subjects in the available sample and not with the original sample.

  It is noteworthy that in the SN group the difference between interviewed and not-interviewed subjects approached the usual cut-off for statistical significance (p=0.078). As in the short normal individuals who were not approached at all for the interview (n=106-76= 30), a lower SES is probably overrepresented, we assume that the interviewed SN subjects are biased toward higher SES.

  Third, the authors do not provide data about the gender distribution in the 19 individuals who had an adult height <-2 SDS. As the effect of gender is quite great, as the authors found in their study, this may greatly influence the validity of their conclusion about the importance of adult short stature in the two genders. In any case one should realize that the conclusion on the absence of effect of adult short stature on psychosocial functioning, is only based on approximately 10 subjects per gender.

  Fourth, the statistical analysis of the scores on ADAPFA versus childhood height is now limited to a comparison between the two groups. We would be interested whether childhood height SDS correlates with the ADAPFA score, uncorrected as well as corrected for gender and SES.

  Fifth, there is a disturbing error in Table 4, where the ADAPFA total score of the individuals with a height > 0 SD is printed as 1.06, while it should be a figure close to 11.09 (the figures resulting from adding up the subscores).

  Finally, the authors suggest that their findings indicate that there is no effect of shortness in childhood or in adulthood on psychosocial function. We agree that in this cohort short stature in childhood is apparently not associated with psychosocial problems in young adulthood. In spite of the comments made above, the number of subjects and the small size of the encountered differences warrants such conclusion. However, we disagree about the effect of adult stature. The very small number of short individuals interviewed, far lower than the number needed for a study with sufficient power, makes it impossible to draw any conclusion on the effect of adult stature.

  Reference

  1) Ulph F, Betts P, Mulligan J, Stratford RJ. Personality functioning: the influence of stature. Arch Dis Child 2004;89:17-21

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  Conflict of Interest:
  None declared.

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