Stimulant Treatment Over 5 Years: Effects on Growth

Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada.
Journal of the American Academy of Child & Adolescent Psychiatry (Impact Factor: 7.26). 04/2006; 45(4):415-21. DOI: 10.1097/01.chi.0000199026.91699.20
Source: PubMed


Long-term effects of psychostimulants on growth in height and in weight are investigated in children with attention-deficit/hyperactivity disorder.
Participants were 79 children, 6 to 12 years of age, with attention-deficit/hyperactivity disorder, who were followed annually for up to 5 years, between the years 1993 and 1994 and 1998 and 1999. Annual height and weight measurements were standardized by age and gender using the 2000 Centers for Disease Control and Prevention Growth Charts for the United States and reported as z scores. For children taking stimulants throughout the previous school year, dose potency was standardized to methylphenidate in milligrams per kilogram per day. We used hierarchical linear modeling to investigate the influence of dose and duration of stimulant treatment on the rate of growth in height and weight.
Controlling for time since initiation of treatment, daily dose of stimulant medication was negatively associated with z scores for height (beta = -.11, SE = 0.03, p <.01) and for weight (beta = -.29, SE = 0.04, p <.01). Estimates based on the statistical model suggest that children receiving > or = 1.5 mg/kg/day methylphenidate will show diminished weight gain after 1 year; those receiving > or = 2.5 mg/kg/day methylphenidate will show diminished gains in height after 4 years.
Long-term use of high doses of stimulants during a period of 1 to 5 years is likely to have measurable effects on the rate of growth in school-age children with attention-deficit/hyperactivity disorder.

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    • "Other less common but serious side effects include retardation of growth rate in young children, seizures , and blurred vision. Psychiatric changes including paranoia, depression, and hallucinations have also been reported in rare cases (Charach, Figueroa, Chen, Ickowicz, & Schachar, 2006; FDA, 2007; National Institutes of Health, 2007; Schertz & Steinberg, 2008; Spensley & Rockwell, 1972; Tavakoli & Gleason, 2003). "
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    ABSTRACT: Objective: Methylphenidate (MPH) is the most often prescribed medication for treatment of ADHD. However, many of its specific cellular and molecular mechanisms of action, as well as developmental consequences of treatment, are largely unknown. This review provides an overview of current understanding of MPH efficacy, safety, and dosage in adult and pediatric ADHD patients, as well as adult animal studies and pioneering studies in juvenile animals treated with MPH. Method: A thorough review of the current literature on MPH efficacy and safety in children, adults, and animal models was included. Results of studies were compared and contrasted. Results: While MPH is currently considered safe, there is a lack of knowledge of potential developmental consequences of early treatment, as well as differences in drug actions in the developing versus mature brain system. Conclusion: This review emphasizes the need for further research into the age-dependent activities and potency of MPH, and a need for tighter control and clinical relevance in future studies.
    Journal of Attention Disorders 08/2012; 19(7). DOI:10.1177/1087054712455504 · 3.78 Impact Factor
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    • "However, around 20% of all children with ADHD fail to respond to psychostimulants (Swanson et al. 1998) and in many responders there is still room for improvement. Moreover, minor and serious adverse side effects have been reported such as reduced growth, sleep disorders and decreased appetite (Charach et al. 2004, 2006). Long-term follow-up evaluation (22 months after the treatment period) has also indicated that a substantial part of the ADHD children that started medication at 7–9 years stopped within 2 years, after which clinical symptoms of ADHD reappeared (Jensen et al. 2007; Murray et al. 2008). "
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    ABSTRACT: Electroencephalography (EEG)-neurofeedback has been shown to offer therapeutic benefits to patients with attention-deficit/hyperactivity disorder (ADHD) in several, mostly uncontrolled studies. This pilot study is designed to test the feasibility and safety of using a double-blind placebo feedback-controlled design and to explore the initial efficacy of individualized EEG-neurofeedback training in children with ADHD. Fourteen children (8–15 years) with ADHD defined according to the DSM-IV-TR criteria were randomly allocated to 30 sessions of EEG-neurofeedback (n = 8) or placebo feedback (n = 6). Safety measures (adverse events and sleep problems), ADHD symptoms and global improvement were monitored. With respect to feasibility, all children completed the study and attended all study visits and training sessions. No significant adverse effects or sleep problems were reported. Regarding the expectancy, 75% of children and their parent(s) in the active neurofeedback group and 50% of children and their parent(s) in the placebo feedback group thought they received placebo feedback training. Analyses revealed significant improvements of ADHD symptoms over time, but changes were similar for both groups. This pilot study shows that it is feasible to conduct a rigorous placebo-controlled trial to investigate the efficacy of neurofeedback training in children with ADHD. However, a double-blind design may not be feasible since using automatic adjusted reward thresholds may not work as effective as manually adjusted reward thresholds. Additionally, implementation of active learning strategies may be an important factor for the efficacy of EEG-neurofeedback training. Based on the results of this pilot study, changes are made in the design of the ongoing study. Electronic supplementary material The online version of this article (doi:10.1007/s00702-010-0524-2) contains supplementary material, which is available to authorized users.
    Journal of Neural Transmission 12/2010; 118(2):275-84. DOI:10.1007/s00702-010-0524-2 · 2.40 Impact Factor
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    • "However, the deficits in height and weight do not appear to be a clinical concern for most children treated with stimulants [60]. The slight reduction in height and weight seems to be dose related [62]. If necessary, dose could be lowered [21]. "
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    ABSTRACT: New drugs and new formulations enter the growing market for ADHD medication. The growing awareness of possible persistence of ADHD impairment beyond childhood and adolescence resulting in increased pharmacotherapy of ADHD in adults, is also a good reason for making an inventory of the what is generally known about pharmacotherapy in ADHD. To discuss current issues in the possible pharmacotherapy treatment of ADHD in children, adolescents and adults with respect to the position of pharmacotherapy in ADHD treatment guidelines, the pharmacoepidemiological trends, and current concerns about the drugs used. A search of the literature with an emphasis on the position of pharmacotherapy in ADHD treatment guidelines, the pharmacoepidemiological trends, and current concerns about the drugs used in pharmacotherapy. According to the guidelines, the treatment of ADHD in children consists of psychosocial interventions in combination with pharmacotherapy when needed. Stimulants are the first-choice drugs in the pharmacological treatment of ADHD in children despite a number of well known and frequently reported side effects like sleep disorders and loss of appetite. With regard to the treatment of adults, stimulant treatment was recommended as the first-choice pharmacotherapy in the single guideline available. Both in children and adults, there appears to be an additional though limited role for the nonadrenergic drug atomoxetine. The increase of ADHD medication use, in children, adolescents and in adults, can not only be interpreted as a sign of overdiagnosis of ADHD. Despite the frequent use of stimulants, there is still a lack of clarity on the effects of long-term use on growth and nutritional status of children. Cardiovascular effects of both stimulants and atomoxetine are rare but can be severe. The literature suggests that atomoxetine may be associated with suicidal ideation in children. Although pharmacotherapy is increasing common in the treatment of ADHD in both children and adults, there are still a lot of questions about side effects and how best to counter them. This suggests an important role for close monitoring of children and adults treated with stimulants or atomoxetine.
    International Journal of Clinical Pharmacy 07/2009; 31(5):509-16. DOI:10.1007/s11096-009-9302-3 · 0.92 Impact Factor
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