Stimulants and growth in children with attention-deficit/hyperactivity disorder

Abstract

a b s t r a c tInitial suggestions that suppression of growth may be an intrinsic characteristic of attention-deficit/ hyperactivity disorder (ADHD) have now largely been disproven. Although controversy persists regarding the possible negative effect of adrenergic stimulants on growth in children with ADHD, the consensus that appears to be reached in the scientific literature is that stimulant usage may cause a manageable attenuation of growth in these children. Since it is known that stimulants increase the amount of dopamine and noradrenaline in the synapse, this writing suggests that these increases in dopamine and noradrenaline are responsible for the growth attenuation in these children. It appears that increased amounts of dopamine and noradrenaline have the ability to inhibit the secretion of growth hormone and growth-related hormones such as prolactin, thyroid hormones, sex hormones and insulin. Therefore, it would be reasonable to suggest that the increases in dopamine and noradrenaline caused by stimulant usage can disrupt the homeostasis of both growth hormone and growth-related hormones, generating the potential for the suppression of growth.

Endocrine Dysfunction and Growth in Attention Deficit Hyperactivity Disorder

“…Other studies have found more mild and transient growth disruptions in ADHD children (Negrao & Viljoen 2011), and that even with stimulant treatment, associated growth deceleration and loss of expected height may amount to only a one to two centimeter deficit per year during treatment (Poulton, 2005, Drappatz et al, 2006. Comparison of paired height measurements, before and after ADHD treatment, suggest a height deficit of only about 1 cm/year during the first 1 to 3 years of ADHD treatment (Pliszka, 1998).…”

“…Reductions in height, weight and / or body mass index are commonly reported with stimulant therapy use for ADHD (Faraone et al, 2008, Negrao & Viljoen, 2011, and may be worse in larger children, those who are naive to therapy or who have a greater cumulative exposure to stimulants (Faraone et al, 2010). Ptacek et al found a lower percent body fat in medically treated ADHD males (age 4 -16 years) as compared to non-treated peers (Ptacek et al, 2009b).…”

“…Other possible mechanisms for poor growth include decreased bone mineralization, maturation and linear growth (Lahat et al, 2000), or a medication-induced disruption of the hypothalamic -pituitary -IGF-I axis (Negrao & Viljoen, 2011). Adrenergic stimulants are known to increase dopamine and noradrenaline in neural synapses.…”

“…Adrenergic stimulants are known to increase dopamine and noradrenaline in neural synapses. Increased dopamine and noradrenaline may in turn inhibit the secretion of growth hormone (GH) and other growth-related peptides including thyroid hormones, sex hormones, prolactin and insulin, ultimately resulting in growth suppression (Negrao & Viljoen, 2011). However, studies of growth hormone have not shown a consistent altered pattern of GH secretion in association with stimulant treatment (Spencer et al,1998).…”

“…Because of the difficulties sited above, the actual long-term growth effects, if any, of ADHD or its treatment have remained unclear and controversial ( Spencer et al,1998, Pliszka, 1998, Poulton, 2005, Negrao & Viljoen, 2011. Recently, however, long-term, case control data have begun to emerge on final adult heights in ADHD.…”