Validity of a Chinese Self-report Pubertal Development Scale

Abstract

Purpose and Background Tanner pubertal assessment questionnaire (PMQ) has been a golden standard in the assessment of sexual maturation status (SMS) in children. However, using the Tanner PMQ with its pictures or drawings of naked males and females, could raise objections from school principals and parents. It is also possible that completion of the scale in classroom situations could cause embarrassment for some students and this might deflect attention from the questionnaire itself. In response to such resistance by schools and parents, and to improve participation rates in studies involving pubertal assessment of children, a Pubertal Developmental Scale (PDS) was adopted to assist children to assess their own SMS without exposure of body that caused embarrassment. The purpose of the study was to validate a Chinese version of the self-reported PDS Methods A cross sectional study with 129 boys and 161 girls aged 8 to 18 years were recruited. Two instruments were used in this study; the self-reported PDS and the line-drawing Tanner pubertal questionnaire. Children completed both the self-reported PDS and self-reported Tanner pubertal questionnaire prior to physical examination through visual depiction by a same gender rater. Puberty Category Score (PCS) which were derived from the PDS, was used to categorize children into one of five pubertal development stages. Tanner derived composite stage (TDCS) which was derived from the Tanner pubertal questionnaires, was used to compare with PCS to obtain the inter-rater agreement. Results Moderately high agreements were found between raters’ TDCS and PCS in girls [weighted kappa (WK) 0.57 (0.44, 0.71); Kendallτ-b 0.60 (0.51, 0.69)] and in boys [WK 0.58 (0.47, 0.69), Kendall τ-b 0.50 (0.38, 0.62)]. The correlation between self-reported PDS and rater’s assessment was substantial in girls [Kendallτ-b 0.61 (0.54, 0.69)] and moderate in boys [Kendall τ-b 0.49 (0.38, 0.61)]. Discussion/Conclusion The Hong Kong Chinese children and adolescents were able to reliably estimate their own SMS using a Chinese version PDS. This instrument may be useful in epidemiological studies when cost, privacy and other concerns preclude the use of other SMS assessment tools.