Validity of Self-Assessment of Pubertal Maturation

BACKGROUND AND OBJECTIVES: Studies of adolescents often use self-assessment of pubertal maturation, the reliability of which has shown conflicting results. We aimed to examine the reliability of child and parent assessments of healthy boys and girls. METHODS: A total of 898 children (418 girls, 480 boys, age 7.4-14.9 years) and 1173 parents (550 daughters, 623 sons, age 5.6-14.7 years) assessed onset of puberty or development of breasts, genitals, and pubic hair according to Tanner stages by use of a questionnaire and drawings. Physicians' assessments were blinded and set as the gold standard. Percentage agreement, kappa, and Kendall's correlation were used to analyze the agreement rates. RESULTS: Breast stage was assessed correctly by 44.9% of the girls (kappa = 0.28, r = 0.74, P < .001) and genital stage by 54.7% of the boys (kappa = 0.33, r = 0.61, P < .001). For pubic hair stage 66.8% of girls (kappa = 0.55, r = 0.80, P < .001) and 66.1% of boys (kappa = 0.46, r = 0.70, P < .001) made correct assessments. Of the parents, 86.2% correctly assessed onset of puberty in girls (kappa = 0.70, r = 0.71, P < .001) and 68.4% in boys (kappa = 0.30, r = 0.37, P < .001). Children who underestimated were younger and children who overestimated older than their peers who made correct assessments. Girls and their parents tended to underestimate, whereas boys overestimated their pubertal stage. CONCLUSIONS: Pubertal assessment by the child or the parents is not a reliable measure of exact pubertal staging and should be augmented by a physical examination. However, for large epidemiologic studies self-assessment can be sufficiently accurate for a simple distinction between prepuberty and puberty.