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. 2017 Jul:186:172-178.e3.
doi: 10.1016/j.jpeds.2017.03.050. Epub 2017 Apr 21.

Validity of Self-Assessed Sexual Maturation Against Physician Assessments and Hormone Levels

Jorge E Chavarro  1 , Deborah J Watkins  2 , Myriam C Afeiche  3 , Zhenzhen Zhang  4 , Brisa N Sánchez  5 , David Cantonwine  6 , Adriana Mercado-García  7 , Clara Blank-Goldenberg  8 , John D Meeker  2 , Martha María Téllez-Rojo  7 , Karen E Peterson  9
Affiliations

Validity of Self-Assessed Sexual Maturation Against Physician Assessments and Hormone Levels

Jorge E Chavarro et al. J Pediatr. 2017 Jul.

Abstract

Objective: To compare self-report and physician assessments of sexual maturation against serum hormone markers to evaluate the hypothesis that the validity of self-assessed sexual maturation is underestimated in traditional validation studies.

Study design: We adapted a self-assessment instrument that 248 Mexican children and adolescents, aged 8-13 years, completed. The participants were examined by a trained pediatrician and provided fasting blood samples for measurement of reproductive hormones (eg, testosterone, estradiol, sex hormone-binding globulin, inhibin B) and other hormones (eg, C-peptide, insulin-like growth factor 1, leptin, dehydroepiandrosterone sulfate) known to change during adolescence. Spearman correlations (r) were calculated among the average rank of all hormones and self-assessed and physician-assessed Tanner stage. The method of triads was used to assess the validity of self-reports by estimating correlations between self-assessments and true but unobservable sexual maturation based on all available data. Bootstrap sampling was used to construct 95% CIs.

Results: The validity of self-reported genitalia staging for boys was modest (r = 0.50; 95% CI, 0.31-0.65) and inferior to physician assessment (r = 0.75; 95% CI, 0.56-0.93). Breast stage was well reported (r = 0.89; 95% CI, 0.79-0.97) and superior to physician assessment (r = 0.80; 95% CI, 0.70-0.89). Pubic hair stage reported by boys (r = 0.91; 95% CI, 0.79-0.99) and girls (r = 0.99; 95% CI, 0.96-1.00) was superior to physician assessment (r = 0.79; 95% CI, 0.57-0.97 and r = 0.91; 95% CI, 0.83-0.97, respectively).

Conclusion: Self-assessment can be validly used in epidemiologic studies for evaluating sexual maturation in children; however, physician assessment may be necessary for accurate assessment of genitalia development in boys.

Keywords: biomarkers; epidemiology; puberty; reproductive hormones; validation.

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Figures

Figure 1
Figure 1
online. Method of Triads Overview
Figure 2
Figure 2
online. Sexual Maturation Self-Assessment Tool
Figure 3
Figure 3
online. Formulas for Calculating Sensitivity, Specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) for Self-Assessed Tanner Staging.
See this image and copyright information in PMC

Comment in

  • Do it yourself.
    Welch TR. Welch TR. J Pediatr. 2017 Jul;186:3. doi: 10.1016/j.jpeds.2017.05.013. J Pediatr. 2017. PMID: 28648279 No abstract available.

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