This article is more than 5 years old. Information may no longer be current.
ADHD, stimulant therapy did not affect childhood growth, adult height
Childhood ADHD and stimulant treatment for ADHD during childhood did not affect growth or adult height, according to study findings published in Pediatrics.
Elizabeth B. Harstad, MD, MPH, of Boston Children’s Hospital and Harvard Medical School, and colleagues assessed medical and educational records for 5,718 children born from January 1976 through December 1982 to mothers living in Rochester, Minn., who continued to live in the area until children were aged 5 years. Researchers assessed children’s height from birth through August 2010. The final cohort included 340 children with ADHD and 680 age- and gender-matched controls without ADHD.
Approximately 70% of children with ADHD with at least one recorded height measurement during three follow-up intervals (n=243) were treated with stimulants for at least 3 months; methylphenidate and dextroamphetamine were most common. Nearly 40% of children with ADHD were prescribed more than one type of stimulant over time.
Mean age at peak height velocity did not significantly differ among children with or without ADHD. Differences in age at peak height velocity were not statistically significant among children with ADHD treated with stimulants and controls. Magnitude of peak height velocity also was not significantly different between these groups.
However, mean age at peak height velocity was greater among males with ADHD treated with stimulants for at least 3 months by the time they reached peak height velocity, compared with stimulant-naive males with ADHD (13.5 years vs. 12.9 years; P=.002). Further, among males with ADHD, duration of stimulant usage before peak height velocity was positively correlated with age at peak height velocity (P=.01). Magnitude of peak height velocity did not differ between males with ADHD who used stimulants for at least 3 months and stimulant-naive males and females with ADHD.
“There was no significant correlation between duration of treatment and change in height-for-age z scores at the beginning, the end, or 24 months after the end of stimulant treatment,” Harstad and colleagues wrote.
Children treated with stimulants for a cumulative duration of at least 3 months, however, had a significant mean decrease in z scores during treatment (P=.06). Magnitude of change in z scores was clinically insignificant among these children, according to researchers.
At least one adult height measurement was available for 285 children with ADHD and 457 controls. Based on these data, adult height did not differ among children with ADHD and those without. Adult height did not differ among children treated with stimulants vs. stimulant-naive children, and cumulative duration of stimulant treatment was not associated with adult height.
“Childhood ADHD is not associated with dysregulated growth,” according to the researchers. “Furthermore, in this population-based cohort, stimulant treatment of childhood ADHD is not associated with deficits in adult height nor with a significant adverse impact on growth throughout childhood and adolescence.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to Top
We are now more than a half-century since the introduction of amphetamines and methylphenidate for treatment of hyperactivity and inattention in children. Yet lingering questions remain regarding adverse effects related to their long-term use, including tics, cardiac effects and hypertension. The issue of possible growth suppression from the stimulants also continues. There are indisputable and readily observable effects on appetite and weight. However, while the evidence has leaned away from an effect on long-term height or growth, debate continues.
This study group tackles this question with a large longitudinal clinical sample, comparing those with medication-treated and untreated ADHD to a control sample into adulthood. There were no differences identified, including final adult height, independent of ADHD and treatment status. Parents, the public and practitioners should all be reassured regarding the absence of a long-term effect on height in those treated with stimulant medication for prolonged periods. However, given the medication effects on appetite and weight, growth should nevertheless be regularly monitored and considered in those treated chronically for ADHD.
