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

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ABSTRACT

Objective

To reevaluate the hypothesis that stimulants cause growth deficits in children with attention-deficit hyperactivity disorder (ADHD).

Method

Growth deficits in height and weight were examined in 124 children and adolescents with ADHD and 109 controls, using appropriate correction by age and parental height measures and attending to issues of pubertal stage, treatment, and psychiatric comorbidity.

Results

Small but significant differences in height were identified between ADHD children and controls. However, height deficits were evident in early but not late adolescent ADHD children and were unrelated to use of psychotropic medications. There was no evidence of weight deficits in ADHD children relative to controls, and no relationship between measures of malnutrition and short stature was identified.

Conclusions

ADHD may be associated with temporary deficits in growth in height through mid-adolescence that may normalize by late adolescence. This effect appears to be mediated by ADHD and not its treatment.

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      Some data suggest that these effects attenuate over time so that final adult stature is not affected by prior stimulant exposure (Faraone et al., 2008; Biederman et al., 2010; Kramer et al., 2000; Peyre et al., 2013). Finally, other authors reported that the height or weight changes might be a natural symptom of ADHD rather than a consequence of medication (Spencer et al., 1996; Hanc and Cieslik, 2008; Swanson et al., 2007). While, on average, reported effects of stimulants on growth appear to be modest, a substantial variability has been observed, with some children seemingly completely unaffected (Biederman et al., 2010; Findling et al., 2009; Zachor et al., 2006), whilst others experience significant growth suppression (Pliszka et al., 2006b; Charach et al., 2006; Zhang et al., 2010; Poulton et al., 2012).

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      The trajectory analysis expands and provides new information concerning the previously published endpoint analyses of adult height in the MTA14 by identifying periods in development (mean age 11.7 years and mean age 14.9 years) that might be most associated with a medication-related growth suppression. Most important, the Negligible subgroup’s z height trajectory showed a peak at the 3- and 6-year assessments (at 11.7 and 14.9 years of age) followed by a decline and stability by the 8-year assessment (at 16.8 years of age), suggesting faster-than-average tempo in the stimulant-untreated cases, the opposite of the Spencer et al.6,7 prediction that untreated children with ADHD would experience slower-than-average tempo, smaller size in childhood, and disorder-related catch-up in adolescence. This report has several strengths.

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    Preparation of this article was supported by NIMH grant K20 MH01169-01 (Dr. Spencer).

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