Behavioral problems and idiopathic central precocious puberty: Fact or fiction?

Idiopathic central precocious puberty (ICPP) has long been thought to place affected children at risk for significant behavior problems. A review of the available literature since 1961 reveals that these concerns are not fully substantiated. Girls with ICPP were found to have positive self-esteem, were intellectually within normal limits (with verbal IQ being slightly higher than spatial IQ), and were not at increased risk of psychopathology. Findings were mixed for internalizing and externalizing behaviors. Psychosexual milestones occurred slightly earlier than expected but within the normal range for age. Selected articles on early-normal maturing girls suggest that precocious puberty may only become a risk factor for psychosocial problems in the setting of other environmental risks. The avoidance of presumed negative psychological consequences of precocious puberty may not be justified as the primary indication for medical intervention. A psychological evaluation along with the standard endocrine assessment can assist the pediatric endocrinologist in determining which children might benefit from simple education and reassurance, or more focused behavioral treatment with or without the use of gonadotropin-releasing hormone agonists (GnRHa).