Girls To Women

by Diana Zuckerman, Ph.D.

    There are new guidelines for pediatricians that are guaranteed to shock: girls who start to develop breasts and pubic hair at age six or seven are not necessarily "abnormal." In fact, by age eight, 48 percent of African American girls and 15 percent of white girls are showing clear signs of puberty.

    The new guidelines, published in Pediatrics, the journal of the American Academy of Pediatrics, are based on several studies.¹ The most important is Marcia Herman-Giddens’ study of 17,000 girls between the ages of three and 12 who were patients in more than 200 pediatricians’ offices across the country.² Previous standards of "normal puberty" were set more than 30 years ago, based on a study of fewer than 200 girls in a British orphanage in the 1960s.

Redefining "normal"

    If early puberty is not abnormal, does that mean there is nothing to worry about? What are the implications for young girls in early elementary school who are developing breasts and pubic hair at a time when they are still playing with dolls and Junior Monopoly?

    The pediatricians were relieved to find that girls with early signs of puberty did not necessarily start menstruating early. (The average age of first menstruation is similar to what it was a generation ago: 12.1 years old for African Americans and 12.8 for white girls.) Since girls’ growth is slowed after puberty, pediatricians had been concerned about the girls’ height, and these concerns were alleviated when they learned that girls with early breast and pubic hair development grew to normal heights. As a result of these normal developmental milestones, the pediatricians seemed content to redefine normal development.

    Parents and other health care professionals have a different perspective. There are reasons for their concerns: Research suggests that early puberty may have negative implications for girls’ mental health and their quality of life.

    There are few well-designed studies, and most evaluate the experiences of girls who menstruate at an early age, rather than the larger number of girls who are developing breasts and pubic hair at an early age. Although common sense would suggest that a nine- or ten-year-old girl who looks like a teenager might feel self-conscious or have trouble making friends with classmates, researchers are only beginning to study these girls. Much remains unknown; however, the data suggest potentially serious problems:

• Girls who started menarche (menstruation) earlier tend to begin dating and having sexual intercourse younger than their classmates, according to a national study of 1,800 girls between the ages of 15 and 19. Among white and Hispanic girls (but not African American girls), early menarche was associated with earlier marriage.³

Girls who matured early experienced more psychological stress, and were more vulnerable to deviant peer pressures and fathers’ hostile feelings, in a study of 200 adolescents.⁴

A study of 33 girls from six to 11 years of age who experienced precocious puberty (secondary sexual characteristics before age nine) found that they have more behavior problems than other girls. They were more likely to be depressed, aggressive, socially withdrawn, have sleeping problems, and report obsessive behavior.⁵

In a study of 1,700 high school students from Oregon, those who report that they matured earlier than their classmates were more likely to drink and smoke, and twice as likely to have had substance abuse and disruptive behavior disorders. They also tend to have lower self-esteem, poorer coping skills, miss more days of school, and were more likely to attempt suicide.⁶

    If starting menstruation at an early age is associated with so many problems for girls and adolescents, does that mean that early development of breasts and pubic hair will have a similar effect? We don’t know. For example, if such problems as being socially withdrawn are caused by feeling different from the other girls, this may not be a problem for a girl surrounded by classmates who are also experiencing early signs of puberty. It could, however, be a terrible problem for an early developing African American girl in a third grade class with later-developing white girls. If, on the other hand, problems like depression and aggression are caused by hormonal changes associated with early development, it will not matter as much to an early developing nine-year-old girl how many other classmates look just like her.

    Teenage pregnancy, sexually transmitted diseases, and the emotional trauma of sexual abuse are also serious concerns. Maturing young girls will have to cope with their own confusing sexual feelings as well as the impact that their appearance has on boys and men. Whether a 10-year-old girl becomes sexually active because hormonal changes influence her sexual interest, or because her appearance attracts older boys and men, the result could be the same. Young girls will need help to prevent them from being sexually abused or exploited, and from the risks of "consensual" sexual activity.

    In summary, more research is needed to learn about the consequences of early puberty, and to initiate strategies to prevent early puberty and help those who are already affected. The implications for girls’ mental health and the quality of their lives—as children and adults-- cannot be ignored.

GIRLS TO WOMEN, by Diana Zuckerman, Ph.D.

¹ Kaplowitz, PB, Oberfield, SE, The Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society, Reexamination of the age limit for defining when puberty is precocious in girls in the United States: Implications for evaluation and treatment, Pediatrics, 1999; 104: 936-941.

² Herman-Giddens, ME, Slora, EJ, Wasserman, RC, et al., Secondary sexual characteristics and menses in young girls seen in office practice: A study from the pediatric research in office settings network, Pediatrics, 1997; 99: 505-512.

³ Phinney, VG, Jensen, LC, Olsen, JA, and Cundick, B, The relationship between early development and psychosexual behaviors in adolescent females, Adolescence, 1990; 25: 321-332.

⁴ Ge, X, Conger, RD., Elder, Jr., GH, Coming of age too early: Pubertal influences on girls' vulnerability to psychological distress, Child Development, 1996; 67: 3386-3400.

⁵ Sonis, WA, Comite, F, Blue, J, et al., Behavior problems and social competence in girls with true precocious puberty, Journal of Pediatrics, 1985; 106: 156-160.

⁶ Graber, J, Lewinsohn, PM, Seeley, JR, Brooks-Gunn, J, Is psychopathology associated with the timing of pubertal development? Journal of the American Academy of Child & Adolescent Psychiatry, 1997; 36: 1768-1776.

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