The most uncommon is surgical removal of breast buds, which Diekema says is done on occasion but is rare in the absence of pathology. "Somewhere in the middle is growth attenuation," a procedure that is both common and historically controversial. Attenuation of growth
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What is growth attenuation treatment and what is it for?
More recently, growth attenuation treatment has been in the news as part of the controversial Ashley Treatment administered to a developmentally disabled girl. This has been criticised as denying the human rights of disabled people.
Who are the authors of growth attenuation therapy?
Growth attenuation therapy: practice and perspectives of paediatric endocrinologists Allison J Pollock, Norman Fost, and David B Allen Author informationCopyright and License informationDisclaimer Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, USA
How is growth attenuation therapy (Gat) used in the treatment of SPCD?
Reduction in length and overall size for select children with SPCD can be accomplished by growth attenuation therapy (GAT), which reduces linear growth by administering hormones (eg, oestrogen) that accelerate epiphyseal closure.
Is growth attenuation ethical?
After a lengthy discussion, the committee reached consensus that both the requests for growth attenuation and hysterectomy were ethically appropriate in this case.
What is growth attenuation therapy?
Growth attenuation is an elective medical treatment which involves administering estrogen to cause closure of the epiphyses of the bones (Epiphyseal plates), resulting in a reduced adult height.
How does growth attenuation work?
Growth attenuation therapy involves the administration of estrogen to close the epiphyseal plates of bones, leading to a halt in their growth. The therapy grew in popularity in the 1940s and 1950s, when girls and young women would receive it to stop their growth before becoming 'too tall.
Is growth attenuation legal?
'This article explores the legal and ethical implications of Ashley's "treatment." Although there is no explicit legal prohibition on growth attenuation, the fact that doctors are capable of performing a particular intersvention does not neccssarily mean thcy should.
Is the Ashley treatment legal?
The Hysterectomy Washington law clearly states that a court order is required when parents seek to sterilize their minor or adult children with developmental disabilities for whom they are legal guardian whether the sterilization is being sought as part of the “Ashley Treatment” or alone.
What is growth attenuation therapy?
In 2006, Gunther and Diekema [i] published a description of an intervention they termed “growth attenuation therapy” in which a six year old girl with profound and multiple disabilities received hormone therapy, a hysterectomy, and bilateral mastectomy with the goal of keeping her stature and physical features undeveloped by halting growth prior to reaching her full adult size. They stated that they found it “hard to imagine how being smaller would be disadvantageous to a person whose mental capacity will always remain that of a young child” (p. 1016). In stating that there will be no significant future improvement from her baseline, Gunther and Diekema revealed that they and their colleagues recognized little potential for growth and development of this young child. The abundant evidence that all children are able to learn and that the cognitive capabilities of children with severe motor impairments can be grossly underestimated were not mentioned, nor were issues of bias and discrimination considered.
Can lack of available support be used to justify interventions?
A lack of available support (real or perceived) cannot be used to justify interventions for which there is no objective evidence for an improved quality of life for the person with IDD in the short- or long-term.
Comments
Caring for a child with severe motor and cognitive disabilities in the home is a challenge which may become more difficult as a child grows to adult size.
Conflict of Interest
I offer another perspective on attenuating the growth of children with severe disabilities. As a neurodevelopmental disabilities pediatrician my experience is different.
Conflict of Interest
Growth attenuation with high dose estrogen is a new and radical therapy for children with profound neurologic impairments as described in a recent Pediatrics article . Proponents of this therapy cite the benefit of a smaller body habitus for children requiring significant care as justification for limiting their growth potential.
What was the initial report of Ashley treatment?
The initial report of the “Ashley treatment”#N#Footnote#N#1 provoked much public comment and academic debate.#N#Footnote#N#2,#N#Footnote#N#3 In response to these comments and criticisms, Diekema and Fost usefully catalogued and analyzed 25 discrete objections to the interventions offered to Ashley and her parents, providing a comprehensive map of the discussions that had occurred. Ultimately, these authors concluded that although many of the critiques fail when subject to close scrutiny, others provide strong reasons for proceeding with caution in future cases.#N#Footnote#N#4 Gillett has revisited some of these objections in his article in this symposium, and in addition has provided two useful principles to assist in reasoning about such cases.
Why do parents oppose GAT?
Those parents who oppose GAT therefore believe that the treatment reflects a lack of respect for and understanding of children with PCI. Much of their concern relates to the specific individuals involved, but it is also tied to the history of abusive treatment (such as involuntary sterilization) to which people with disabilities have been subjected, purportedly for both societal and individual benefits.#N#Footnote#N#71 Such concerns mean that these parents believe that the impact of individual decisions concerning GAT on the broader group of people with disabilities should be taken very seriously, as “targeting an already stigmatized group runs the risk of their further stigmatization and maltreatment.”#N#Footnote#N#72 In this regard they are also concerned about slippery slopes: