Precocious Sexual Development in Girls: The Emotional Impact on the Child and Her Parents

Abstract

The emotional impact of isolated early development of breasts (thelarche) or pubic hair (adrenarche) has not previously been reported. The psychological assessment of 16 girls with the endocrine diagnosis of precocious thelarche, adrenarche, or puberty consisted of a parent interview and a clinical psychological assessment of the child in a playroom setting which included psychological testing. It is suggested that all three conditions may represent potential developmental interferences for the girl, both directly through bodily changes and indirectly through parental reactions. Strikingly, girls with precocious puberty as a group appeared to have coped more successfully, accepted their bodies more, and had a better self-image than those with thelarche or adrenarche. Similarly, parents seemed to have more difficulty dealing with precocious thelarche and adrenarche than with precocious puberty. Therefore, it appears that medically benign conditions may at times have greater psychological impact than those which need ongoing medical attention. The importance of the child's age at the time of onset and of the medical/genital examinations, as well as of the assessment of the premorbid psychological development of the child and the nature of the parent-child relationship is discussed.