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.
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.
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).
Our findings suggest that ADHD treatment with stimulant medication is not associated with differences in adult height or significant changes in growth.
Comments
Stimulant Treatments Effect on Bone Mass
Dear Editor:
The prevalence of childhood ADHD and the treatment implications are an important area of research. According to the research done in the article, "ADHD, Stimulant Treatment, and Growth: A Longitudinal Study", it's concerning that there are questions regarding whether stimulant medications can cause bone growth deficits in children. I agree with the statement "more research is needed to assess associations between ADHD and dysregulated growth" 1 (p. 2). I found that this particular study was very informative and the results that stimulant treatment of childhood ADHD weren't linked to any deficit in adult height or growth throughout childhood were very interesting. I feel that there are other areas of focus on this particular topic that can help extend and develop a better understanding of this medications affect on childrens' bone development.
One particular part of this study caught my attention. There was a portion of the article which stated that "the potential adverse effect of the stimulants on growth may be due to their anorexic affect"1(p.2). I feel that the anorexic effect of these stimulant medications are an important focal point when studying the impact of stimulant medication on children's bone integrity.
When children experience anorexic effects due to medications such as these, it can specifically affect the bone density in a developing child. If a child's bone density is weakened due to stimulants, it can affect not only their height, but also their susceptibility to bone fractures and bone diseases such as osteoporosis later in life.
Concerns are being raised about children and adolecents developing osteoporosis due to anorexia nervosa. 2 People dealing with anorexia have a decreased amount of nutrients going to the bone such as calcium and other vital minerals. When this happens, bones can weaken significantly and can result in osteoporosis.2
Even though the use of stimulant medications does not necessarily make a child susceptible to a clinical diagnosis of anorexia nervosa, this should still be considered an area of concern. The stimulants used to treat ADHD will typically be used over a long period of time. Therefore the continuous anorexic effect experienced by a developing child may have short term and long term consequences that research has not quite substantiated yet.
In addition, short term consequences of a child having lower bone density include a higher risk of bone fractures; such is quite concerning in that children have such active lifestyles. Having bones that do not develop to the strength that they should is quite concerning.
Also, in regards to the long term effects, studies in children have shown that the development of osteoporosis later in life has a strong correlation between ones' nutritional status during childhood.3 If children on stimulant medications for ADHD have a prolonged anorexic effect throughout their periods of bone development, I feel their bone mass as a child and their higher risk of developing osteoporosis as they age is of vital concern.
Michelle Doherty Health Studies Student, Utica College Utica, NY
References
1. Harstad EB, Weaver AL, Katusic SK, et al. ADHD, stimulant treatment, and growth: A longitudinal study. Pediatrics 2014;134(4):e935- e944. doi:10.1542/peds.2014-0428
2. Gordon CM. Normal bone accretion and effects of nutritional disorders in childhood. J Women's Health. 2003: 12(2): 137-143.
3. Gonzlez-Jimnez E, lvarez-Ferre J. Osteoporosis in childhood: related factors and prevention. Colom Med. 2011: 42(1): 111-116.
Conflict of Interest:
None declared