Children With GHD Experience Low Self-Esteem, Impaired Psychosocial Functioning, Study Shows

Early identification of psychosocial problems and psychotherapeutic care are critical in mitigating issues of low self-esteem and psychosocial maladjustment in children with growth hormone deficiency (GHD).

A study examining psychosocial functioning and self-esteem among children with growth hormone deficiency (GHD) revealed that this population experiences psychosocial maladjustment, reduced self-esteem, and conceptualization of internalizing problems. Study findings were reported in Frontiers in Pediatrics.

To the best of the researchers’ knowledge, the current study is the first to investigate psychosocial problems and self-esteem in the context of psychosocial adaptation in children with GHD.

The study enrolled 46 prepubescent children with GHD and measured their psychosocial functioning using Goodman’s Strengths and Difficulties Questionnaire (SDQ) at a hospital in Ukraine. The SDQ scored 20 items across 4 scales: emotional problems, behavioral problems, hyperactivity/inattention, and peer problems.

Scores for internalizing were calculated by adding the emotional and peer problems scores, while the results for externalizing were calculated by adding the behavioral problems and hyperactivity/inattention scores.

The study employed the Dembo-Rubinstein method to measure levels of self-esteem.

Findings showed:

  • Children with GHD experienced more internalizing problems and lower self-esteem
  • Children with GHD reported higher scores and frequency of assessment in the abnormal score for total difficulties, emotional problems, and peer problems
  • The SDQ score and the frequency of assessment in the abnormal score for all SDQ scales in children with more pronounced growth deficit (height SDS < –3) did not exceed the same indicators in children with less growth retardation (–3 < height SDS < –2)
  • Children with GHD exhibited a reduced level of assertions, low self-esteem, and a weak discrepancy between the level of assertions and self-esteem
  • Some sociodemographic determinants (male gender, age < 9 years, and low family income) and clinical determinants (low compliance and suboptimal growth response after 1 year of recombinant growth hormone therapy) affected the overall assessment of psychological problems in children with GHD

While there remains ongoing discourse about the relationship between children with GHD and their psycho-emotional problems and behavior, the current study indicates that children with GHD experience psychosocial maladjustment and lower self-esteem and are at greater risk for internalizing problems, the authors note. The study also shows that therapy with optimal growth response is an effective method of care, as it helps to reduce problems of internalizing and improve psychosocial functioning in children with GHD.

Identical assessments of psychosocial problems and frequency of assessment in the abnormal score for all SDQ scales among children with isolated GHD and multiple pituitary hormone deficiency suggests that a common psychological support program may be valuable to patients with varying forms of GHD.

Early identification of psychosocial problems among children with GHD and timely delivery of psychotherapeutic care are critical for improving management of GHD, they authors concluded.


Aryayev, M, Senkivska, L, Lowe, J.B, et al. Psycho-emotional and behavioral problems in children with growth hormone deficiency. Front Pedatr. Published online September 23, 2021. doi:10.3389/fped.2021.707648