Growth Deficits in ADHD Children Revisited: Evidence for Disorder-Associated Growth Delays?

Spencer, Thomas; Biederman, Joseph; Harding, Margaret; O’Donnell, Deborah A.; Faraone, Stephen V.; Wilens, Timothy E.

doi:10.1097/00004583-199611000-00014

Cited by 199 publications

(109 citation statements)

References 35 publications

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“…[11][12][13] Early adolescents with ADHD may have small but significant height deficits compared with controls. 14 In contrast, among stimulantnaive patients with ADHD, baseline height may be slightly greater than population norms, 9 and children referred for ADHD treatment are reportedly taller at baseline than those not referred. 9,15,16 The Multimodal Treatment Study of Children With ADHD Cooperative Group reported that untreated prepubertal children with ADHD had average height Z scores that increased over time, suggesting faster growth than population norms.…”

Section: Discussionmentioning

confidence: 96%

ADHD, Stimulant Treatment, and Growth: A Longitudinal Study

Harstad

Weaver²,

Katusic³

et al. 2014

Pediatrics

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BACKGROUND AND OBJECTIVE: There is ongoing concern that stimulant medications may adversely affect growth. In a sample of attention-deficit/hyperactivity disorder (ADHD) cases and controls from a population-based birth cohort, we assessed growth and the association between stimulant treatment and growth. METHODS: Subjects included childhood ADHD cases (N = 340) and controls (N = 680) from a 1976 to 1982 birth cohort (N = 5718). Height and stimulant treatment information were abstracted from medical records and obtained during a prospective, adult follow-up study. For each subject, a parametric penalized spline smoothing method modeled height over time, and the corresponding height velocity was calculated as the first derivative. Peak height velocity (PHV) age and magnitude were estimated from the velocity curves. Among stimulant-treated ADHD cases, we analyzed height Z scores at the beginning, at the end, and 24 months after the end of treatment. RESULTS: Neither ADHD itself nor treatment with stimulants was associated with differences in magnitude of PHV or final adult height. Among boys treated with stimulants, there was a positive correlation between duration of stimulant usage before PHV and age at PHV (r = 0.21, P = .01). There was no significant correlation between duration of treatment and change in height Z scores (r = −0.08 for beginning vs end change, r = 0.01 for end vs 24 months later change). Among the 59 ADHD cases treated for ≥3 years, there was a clinically insignificant decrease in mean Z score from beginning (0.48) to end (0.33) of treatment (P = .06). CONCLUSIONS: Our findings suggest that ADHD treatment with stimulant medication is not associated with differences in adult height or significant changes in growth.

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Section: Discussionmentioning

confidence: 96%

ADHD, Stimulant Treatment, and Growth: A Longitudinal Study

Harstad

Weaver²,

Katusic³

et al. 2014

Pediatrics

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“…If there are indications of growth retardation, drug holidays (e. g. during the summer vacation) are recommended [119,158].…”

Section: ■ Adverse Effects Of Stimulant Medicationmentioning

confidence: 99%

European clinical guidelines for hyperkinetic disorder ? first upgrade

Taylor

Döpfner

Sergeant

et al. 2004

European Child & Adolescent Psychiatry

502

452

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■ Abstract Background The validity of clinical guidelines changes over time, because new evidencebased knowledge and experience develop. Objective Hence, the European clinical guidelines on hyperkinetic disorder from 1998 had to be evaluated and modified. Method Discussions at the European Network for Hyperkinetic Disorders (EUNETHYDIS) and iterative critique of each clinical analysis. Guided by evidence-based information and based on evaluation (rather than metaanalysis) of the scientific evidence a group of child psychiatrists and psychologists from several European countries updated the guidelines of 1998. When reliable information is lacking the group gives a clinical consensus when it could be found among themselves. Results The group presents here a set of recommendations for the conceptualisation and management of hyperkinetic disorder and attention deficit/hyperactivity disorder (ADHD). Conclusion A general scheme for practice in Europe could be provided, on behalf of the European Society for Child and Adolescent Psychiatry (ESCAP).

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“…2,4,[24][25][26][27][28] Temporary growth retardation related to stimulant therapy may partly explain altered growth trajectories among children with ADHD, but alternate hypotheses may also implicate the pathophysiology of ADHD. 25 Although direct evidence is generally lacking, 4 several hypotheses have been considered. A dysmaturity hypothesis suggested that among some children with ADHD, development and rate of growth may be delayed in early life, but this may lessen with age.…”

Section: Discussionmentioning

confidence: 99%

“…A dysmaturity hypothesis suggested that among some children with ADHD, development and rate of growth may be delayed in early life, but this may lessen with age. 25 This hypothesis was explained by the fact that height, but not weight, retardation was observed in young children with ADHD but not among older children at 4-year followup, and no association was found between height deficits and stimulant use. 25 Our findings do not support this hypothesis; children with an ADHD diagnosis and without any stimulant orders had higher BMIs.…”

Section: Discussionmentioning

confidence: 99%

“…25 This hypothesis was explained by the fact that height, but not weight, retardation was observed in young children with ADHD but not among older children at 4-year followup, and no association was found between height deficits and stimulant use. 25 Our findings do not support this hypothesis; children with an ADHD diagnosis and without any stimulant orders had higher BMIs. Psychological hypotheses have been offered, including deficient inhibitory control, poor executive functions, and inability to monitor eating behaviors.…”

Section: Discussionmentioning

confidence: 99%

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Attention Deficit Disorder, Stimulant Use, and Childhood Body Mass Index Trajectory

2014

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Childhood attention-deficit/ hyperactivity disorder has been associated with both childhood and adult obesity, whereas treatment with stimulants has been associated with delayed child growth. No longitudinal studies with details about dates of diagnosis, treatment, and duration of stimulant use have been published. WHAT THIS STUDY ADDS:Using electronic health record data, this was the first study to evaluate the independent associations of attention-deficit/hyperactivity disorder diagnosis, stimulant treatment, age at first stimulant use, and duration of stimulant use on longitudinal BMI trajectories throughout childhood and adolescence.abstract BACKGROUND: Childhood attention-deficit/hyperactivity disorder (ADHD) has been associated with childhood and adult obesity, and stimulant use with delayed childhood growth, but the independent influences are unclear. No longitudinal studies have examined associations of ADHD diagnosis and stimulant use on BMI trajectories throughout childhood and adolescence. METHODS:We used longitudinal electronic health record data from the Geisinger Health System on 163 820 children ages 3 to 18 years in Pennsylvania. Random effects linear regression models were used to model BMI trajectories with increasing age in relation to ADHD diagnosis, age at first stimulant use, and stimulant use duration, while controlling for confounding variables.RESULTS: Mean (SD) age at first BMI was 8.9 (5.0) years, and children provided a mean (SD) of 3.2 (2.4) annual BMI measurements. On average, BMI trajectories showed a curvilinear relation with age. There were consistent associations of unmedicated ADHD with higher BMIs during childhood compared with those without ADHD or stimulants. Younger age at first stimulant use and longer duration of stimulant use were each associated with slower BMI growth earlier in childhood but a more rapid rebound to higher BMIs in late adolescence. CONCLUSIONS:The study provides the first longitudinal evidence that ADHD during childhood not treated with stimulants was associated with higher childhood BMIs. In contrast, ADHD treated with stimulants was associated with slower early BMI growth but a rebound later in adolescence to levels above children without a history of ADHD or stimulant use. The findings have important clinical and neurobiological implications. Pediatrics 2014;133:668-676

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Growth Deficits in ADHD Children Revisited: Evidence for Disorder-Associated Growth Delays?

Cited by 199 publications

References 35 publications

ADHD, Stimulant Treatment, and Growth: A Longitudinal Study

ADHD, Stimulant Treatment, and Growth: A Longitudinal Study

European clinical guidelines for hyperkinetic disorder ? first upgrade

Attention Deficit Disorder, Stimulant Use, and Childhood Body Mass Index Trajectory

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