Growth on stimulant medication; clarifying the confusion: A review

Western Clinical School, Nepean Campus, The University of Sydney, Australia.
Archives of Disease in Childhood (Impact Factor: 2.91). 09/2005; 90(8):801-6. DOI: 10.1136/adc.2004.056952
Source: PubMed

ABSTRACT To get an overview of the studies of growth in height in children with attention deficit hyperactivity disorder (ADHD) treated with stimulant medication, to establish the consistencies and to try to resolve the discrepancies.
Twenty nine studies were reviewed following a Medline search: 22 related to children, six to late adolescents or adults, and one to children and adults.
Children: Eleven studies gave results consistent with height attenuation on stimulant medication: eight were longitudinal, one was cross-sectional, and two showed growth rebound on ceasing medication. Studies with negative findings were inadequately powered (n = 3), lacked controls or statistical analysis (n = 3), measured height velocity without reference to treatment duration (n = 2), or used inappropriate growth parameters (n = 1), controls (n = 1), or normative data (n = 1). Late adolescents/adults treated with stimulant medication in childhood: Two studies associated childhood gastrointestinal side effects with attenuated late adolescent or adult height; all six cross-sectional studies had negative findings. The methodologies varied widely but there was some consistency in the degree of attenuation shown in studies with positive findings. The most sensitive methods analysed the changes in z-scores (standard deviation scores) or calculated the height deficits from paired measurements taken before and after an initial period of treatment with stimulant medication. The height deficit amounted to approximately 1 cm/year during the first 1-3 years of treatment.
Further research is needed into the causal mechanisms, the rate of physical maturation, and the long term implications for final stature.

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    • "It has been reported that temporary discontinuation of treatment – the so called " drug holiday " – reverses therapy-related retardation in growth, and that children thus reach the age-specifi c expected growth curve (Ma et al. 1996; Poulton 2005). However, it is also known that the drug holiday might lead to problems for both the child and family by causing re-exacerbation of ADHD symptoms. "
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    ABSTRACT: Abstract Objectives: We aimed to explore whether use of methylphenidate relates leptin, ghrelin, adiponectin, and brain-derived neurotrophic factor (BDNF). In addition, the relationship between methylphenidate related weight loss in attention deficit hyperactivity disorder (ADHD) patients and these biomolecules were evaluated. Methods: Thirty ADHD patients receiving methylphenidate and 20 healthy controls were included. Leptin, ghrelin, adiponectin, and BDNF levels were measured at baseline and after 2-month treatment in both groups. Results: At baseline, leptin, ghrelin, adiponectin, and BDNF levels were similar in the ADHD and control groups. The most common adverse events occurring in the ADHD group after 2-month treatment included loss of appetite (70%) and weight loss (66.7%). A significant difference was found in body weight, BMI, and CGI scores of the ADHD patients after the treatment. While posttreatment ghrelin and adiponectin levels were significantly higher in the ADHD group, BDNF level was significantly lower. Posttreatment decrease in leptin levels was not significant. Conclusions: Leptin and BDNF were not associated with poor appetite and/or weight loss due to methylphenidate treatment. However, ghrelin and adiponectin might be biomolecules that played a role in underlying neurobiological mechanisms of methylphenidate-related appetite or weight loss.
    International Journal of Psychiatry in Clinical Practice 07/2014; 18(4):1-34. DOI:10.3109/13651501.2014.940054 · 1.31 Impact Factor
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    • "metilfenidato) ha generando gran controversia. Varios autores sugieren que esta medicación podría causar retraso del crecimiento (Swanson et al., 2007; Charach, Figueroa, Chen, Ickowicz, y Schachar, 2006; Poulton, 2005), otros dicen que no hay tal relación (Pliszka, Matthews, Braslow y Watson, 2006; Spencer et al., 2006; Biederman et al., 2003; Sund y Zeiner, 2002), e investigaciones recientes apuntan que este tratamiento puede producir retraso mental o problemas cardiovasculares (Fung y Lee, 2009; Montañes, Gangoso y Martinez, 2009; Adler, 2008). Esta polémica ha provocado que algunas familias se muestren recelosas al tratamiento farmacológico de un trastorno que está causando serios problemas en diferentes ámbitos de la vida de los niños (académico, familiar, social...). "
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    ABSTRACT: The purpose of this study was to review the scientific literature on the influence of physical exercise in subjects with Attention Deficit Hyperactivity Disorder (ADHD) to propose how physical education may contribute to the treatment of this disorder. ADHD is causing diverse personal, family and academic problems. It is thought to have a multicomponent etiology, probably organic in origen with neurological, genetic, hormonal and environmental factors. Its main symptoms are inattention, hyperactivity, impulsivity, and very often, conduct disorders. Motor skills and personal relationships are often also affected. According to several sources, treatment should be pharmacological and also based in behavioral and psychoeducational intervention. The recent studies suggest that physical activity improves the core symptoms of ADHD and also that beneficts the executive function, inhibitory control, neurocognitive performance, behavior, motor skills, social, cognitive performance and academic performance of children with ADHD.
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    • "All but two studies found no difference between AMP and MPH in growth suppression. Faraone et al. (2008) also confirmed a previous systematic review showing that height deficit in children treated with psychostimulants amounted to approximately 1 cm/year during the first 1–3 years of treatment (Poulton, 2005). Several neurobiological mechanisms may contribute to psychostimulant-related deficits in expected growth. "
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    ABSTRACT: BACKGROUND: Medication is an important element of therapeutic strategies for ADHD. While medications for ADHD are generally well-tolerated, there are common, although less severe, as well as rare but severe adverse events AEs during treatment with ADHD drugs. The aim of this review is to provide evidence- and expert-based guidance concerning the management of (AEs) with medications for ADHD. METHODS: For ease of use by practitioners and clinicians, the article is organized in a simple question and answer format regarding the prevalence and management of the most common AEs. Answers were based on empirical evidence from studies (preferably meta-analyses or systematic reviews) retrieved in PubMed, Ovid, EMBASE and Web of Knowledge through 30 June 2012. When no empirical evidence was available, expert consensus of the members of the European ADHD Guidelines Group is provided. The evidence-level of the management recommendations was based on the SIGN grading system. RESULTS: The review covers monitoring and management strategies of loss of appetite and growth delay, cardiovascular risks, sleep disturbance, tics, substance misuse/abuse, seizures, suicidal thoughts/behaviours and psychotic symptoms. CONCLUSION: Most AEs during treatment with drugs for ADHD are manageable and most of the times it is not necessary to stop medication, so that patients with ADHD may continue to benefit from the effectiveness of pharmacological treatment.
    Journal of Child Psychology and Psychiatry 01/2013; 54(3). DOI:10.1111/jcpp.12036 · 5.67 Impact Factor
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