JOURNAL OF ADOLESCENT HEALTH CARE 1988;9:480-482

Adolescent Self-Assessment of Sexual Maturation

Effects of Fatness Classification and Actual Sexual Maturation Stage

RICKEY L. WILLIAMS, M.D., KEN L. CHEYNE, M.D.,

LINDA K. HOUTKOOPER Ph.D., AND TIMOTHY G. LOHMAN, Ph.D.

Accuracy of self-assessed staging of sexual maturationwas studied on 96 adolescents (49 boys and 47 girls) tovalidate previous studies and evaluate the effects of anadolescent's fatness level and actual sexual maturationstage on their ability to assess their level of sexual ma­turation. Correlation between the adolescents' self­assessments and physician assessments was moderatelyhigh (Kendall's -r-b = 0.65-0.82). Boys tended to over­estimate, while girls underestimated their level of sexualmaturation. Differences between physician and subjectratings by fatness classification or by actual sexual ma­turation stage was not significant. This study supportsprevious studies showing that adolescents can accuratelyassess their own stage of sexual maturation regardless oftheir fatness classification or actual sexual maturationstage.

KEY WORDS:

Sexual maturationPubertySelf-assessmentObesity

Studies of normal adolescents have shown that thesel f-assessed staging of sexual maturation can be ac­curately performed (1-3), but no previous study hasmentioned whether the subjects involved are thin,average, or obese, or whether the actual sexual rna-

From tile Departments of Pediatrics (K L.W., K.L.C,) and ExerciseIlnd Sport Sciences (L.K.H" T.G.L.), University of Arizona, Tucson,Arizona .

Address reprint requests to: Rickey L. Williallls, M,D., Departmentof Pediatrics, University of Arizona Health Sciences Center, Tucson ,AZ 85724,

Manuscript accepted [une 17, 1987.

turation stage has an effect on their ability to self­assess their sexual maturation .

The present study was designed to validate pre­vious studies and evaluate the effects of an adoles­cent's fatness level and actual sexual maturationstage on his or her ability to assess personal level ofsexual maturation . Adolescents of average fatnessmight be expected to assess their level of sexual ma­turation more accurately than thin or obese adoles­cents because patients with eating disorders such asanorexia nervosa and obesity inaccurately assesstheir overall body image (4). Or, more mature ad­olescents might assess their level of sexual matura­tion more accurately than the less mature subjects .

MethodsSubjects recruited for a study on body compositiondevelopment of children and youth were asked toparticipate in this study. The recruited subjects werestudents in physical education classes at two ele­mentary schools and one junior high school or on acompetitive swimming team in Tucson, Arizona.Consent to participate in the study was obtainedaccording to guidelines of the University of ArizonaHuman Subjects Committee .

Subj ects were asked to choose from photographsand line drawings of the five Tanner stages of sexualmaturation the stage that most closely correspondedto their present stage of sexual maturation. Malesubjects were asked to choose the most appropriategenital and pubic hair stage, and female subjects themost appropriate breast and pubic hair stage. Thephotographs, drawings, and written descriptions ofeach stage of development were derived from mod-

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November 1988 SELF-ASSESSMENT OF SEXUAL MATURATION 481

ifications of previous work by Morris and Udry (2),Tanner (5), and Comerci (6). A complete physicalexamination, including assessment of sexual matur­ation, was then performed by one of two physiciansexperienced in determining sexual maturation stage.The physicians were unaware of the self-assessmentstages chosen by the adolescents. Differences be­tween adolescents' self-assessment scores and phy­sicians' examination scores of sexual maturationstages were calculated by subtracting the adoles­cent's score from the physician's score.

Fatness classification was determined by skinfoldthickness using the sum of triceps and subscapularskinfold measurements. A subject was consideredaverage if the skinfold thickness was between the30th and 70th percentile for age and sex accordingto National Children and Youth Fitness Study data(7), and obese or thin if the skinfold thickness wasoutside this range.

Agreement between adolescents' self-assessmentscores and physicians' physical examination scoresof sexual maturation stages was determined usingKendall's rank-order correlation coefficient (r). Dif­ferences between adolescents' self-assessmentscores and physicians' examination scores of sexualmaturation stages were compared using the t testand analysis of variance (ANOVA). Pearson corre­lation coefficients were used to compare subject agewith physician-assessed sexual maturation stageand with differences between physician and subjectratings.

ResultsOne hundred sixteen subjects (55 boys and 61 girls)were asked to participate; 20 refused, leaving a sam­ple size of 96 (49 boys and 47 girls). Boys ranged inage from 10.3 to 14.8 years and girls from 10.2 to14.4 years. Thirty-seven subjects were classified asobese, 25 average, and 34 thin. Differences in agebetween the three fatness groups or between thesexes were not statistically significant (p= 0.66 and0.36, respectively).

Physician assessment of sexual maturation wascompared to subjects' assessment of sexual matur­ation. The correlation (Kendall's -r-b) betweenadolescents' self-assessments and physician assess­ments ranged from 0.65 for boys' genital develop­ment to 0.82 for boys' pubic hair development.

Differences between adolescents' self-assessmentscores and physicians' examination scores of sexualmaturation stages show that boys overestimatedtheir level of sexual maturation by a mean of 0.22

stages for pubic hair and 0.31 stages for genital de­velopment, while girls underestimated their level ofsexual maturation by a mean of 0.26 stages for pubichair and 0.21 stages for breast development. Thesedifferences between the sexes were statistically sig­nificant (t = 3.46, df = 94, P = 0.001) for estimatingpubic hair stage.

Differences between physician and subject rat­ings by fatness classification were not statisticallysignificant [p = 0.55 for pubic hair (both sexes), 0.17for genital stage (boys), and 0.16 for breast stage(girls)]. Differences between physician and subjectratings by physician-assessed sexual maturationstage were not statistically significant. As expected,subject age correlated with physician-assessed sex­ual maturation stage (r = 0.67 for pubic hair; p <0.001). However, differences between physician andsubject ratings by age were not statistically signifi­cant (r = 0.05 for pubic hair; p = 0.64).

DiscussionThis study supports previous studies showing thatadolescents can accurately assess their own stage ofsexual maturation using pictures (I), line drawings(2), or self-report (3). Our finding that boys tendedto overestimate and girls to underestimate their levelof sexual maturation is consistent with previousstudies of adolescent development that have sug­gested that in our society early maturation is sociallydesirable for boys and undesirable for girls duringearly adolescence (3,8).

The differences between physician and subjectratings by fatness classification or by physician­assessed sexual maturation stage were not statisti­cally significant. This could be due in part to thesmall sample size. None of our subjects were mor­bidly obese or anorexic. There have been no studiesto measure whether morbidly obese or anorexic pa­tients assess their level of sexual maturation less ac­curately than normal subjects.

These findings suggest that the technique de­scribed can be used for adolescents of various fatnessclassifications and sexual maturation stages. Whileself-assessed measurement of sexual maturation willnever be accurate enough for some studies of phys­iologic development, it may find a place in educa­tional or psychologic research in whichmeasurement of pubertal development is desirablebut physician assessment is impractical. The datasuggest that researchers can conduct studies relatedto maturation without requiring the adolescents toundergo a physical examination to assess sexual ma-

482 WILLIAMS ET AL. JOURNAL OF ADOLESCENT HEALTH CARE Vol. 9, No.6

turation. This could lead to increased subject re­cruitment because knowing that a physical exami­nation is a requirement for participation could be adisincentive for some adolescents to enroll in astudy. Similarly, coaches who wish to assign playersto teams based upon developmental status will beable to do so without requiring an intrusive exami­nation for sexual maturity.

References1. Duke PM, Litt IF, Gross RT. Adolescents' self-assessment of

sexual maturation. Pediatrics 1980;66:918-20.2. Morris NM, Udry JR. Validation of a self-administered instru-

ment to assess stage of adolescent development. J YouthAdoles 1980;9:271-80.

3. Petersen AC, Tobin-Richards M, Boxer A. Puberty: Its mea­surement and its meaning. J Early Adoles 1983;3:47-62.

4. Garner OM, Garfinkel PE, Moldofsky H. Perceptual experi­ences in anorexia nervosa and obesity. Can Psych Assn J1978;23:249-63.

5. Tanner JM. Growth at adolescence, 2nd ed. Oxford: BlackwellScientific Publications, 1962.

6. Comerci GO. Adolescent medicine case studies. Garden City,NY, Medical Examination Publishing Company, 1979.

7. Ross JG, Dotson CO, Gilbert GG, et aI. The National Childrenand Youth Fitness Study: New standards for fitness measure­ment. JPhys Ed Rec Dance 1985;56:62-5.

8. Weatherly O. Self-perceived rate of physical maturation andpersonality in late adolescence. Child Dev 1964;35:1197-210.