Exceedingly Rare

The authors point out that differences in ethnicity, socioeconomic status, and possibly due to accelerated development or developmental disorders, have to be discussed in the assessor’s report (1). Since a completed 18^th year of life is crucial in terms of legal decisions, an unequivocal proof on the basis of biological characteristics would certainly be helpful in proving or excluding minority. All methods named by the authors relate to characteristics of biological maturity and therefore to identical physiological mechanisms that are regulated genetically, hormonally, and by the named external factors. In healthy persons, puberty starts at age X and ends after a time period Y when adulthood is reached. Both parameters are extremely variable, and, contrary to what the authors say, no evidence based studies exist for the group under discussion in the article—that is, a statistically large enough cohort with documented age and maturity characteristics. The studies cited in the reference list do not meet this standard. In Germany, data published in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) (2) showed that the confidence interval for the 3rd to 97^th percentile of the different maturity characteristics in healthy adolescents was at 5–6 years. For African youths, the relevant data exist only as samples, which imply that onset of maturation in this group differs by 1 to 2 years (3, 4). Without the relevant data, defining a “minimum age” seems arbitrary, even though it might be convenient for the assessor. “Differences in age estimations by the different diagnostic tools can be due to a possible endocrine disorder.” In principle this is possible, but in my personal experience, the disorders that this might apply to are exceedingly rare, whereas the substantial physiological variability in sexual maturation in healthy adolescents is something that pediatric endocrinologists are confronted with on a daily basis.