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Carucci S, Zuddas A, Lampis A, Man KKC, Balia C, Buitelaar J, Danckaerts M, Dittmann RW, Donno F, Falissard B, Gagliano A, Garas P, Häge A, Hollis C, Inglis SK, Konrad K, Kovshoff H, Liddle E, McCarthy S, Neubert A, Nagy P, Rosenthal E, Sonuga-Barke EJS, Wong ICK, Banaschewski T, Coghill D. The Impact of Methylphenidate on Pubertal Maturation and Bone Age in ADHD Children and Adolescents: Results from the ADHD Drugs Use Chronic Effects (ADDUCE) Project. J Atten Disord 2024; 28:722-739. [PMID: 38366816 DOI: 10.1177/10870547241226726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
OBJECTIVE The short-term safety of methylphenidate (MPH) has been widely demonstrated; however the long-term safety is less clear. The aim of this study was to investigate the safety of MPH in relation to pubertal maturation and to explore the monitoring of bone age. METHOD Participants from ADDUCE, a two-year observational longitudinal study with three parallel cohorts (MPH group, no-MPH group, and a non-ADHD control group), were compared with respect to Tanner staging. An Italian subsample of medicated-ADHD was further assessed by the monitoring of bone age. RESULTS The medicated and unmedicated ADHD groups did not differ in Tanner stages indicating no higher risk of sexual maturational delay in the MPH-treated patients. The medicated subsample monitored for bone age showed a slight acceleration of the bone maturation after 24 months, however their predicted adult height remained stable. CONCLUSION Our results do not suggest safety concerns on long-term treatment with MPH in relation to pubertal maturation and growth.
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Affiliation(s)
- Sara Carucci
- University of Cagliari, Italy
- ASL Cagliari, Italy
| | | | | | - Kenneth K C Man
- Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
- Hong Kong Science Park, China
- University College London Hospitals NHS Foundation Trust, UK
- The University of Hong Kong, China
| | - Carla Balia
- University of Cagliari, Italy
- ASL Cagliari, Italy
| | - Jan Buitelaar
- Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | | | | | | | | | | | | | | | | | | | - Kerstin Konrad
- University Hospital RWTH Aachen, Germany
- RWTH Aachen and Research Centre Jülich, Germany
| | | | | | | | | | - Peter Nagy
- Bethesda Children's Hospital, Budapest, Hungary
| | | | | | - Ian C K Wong
- University College London, UK
- Hong Kong Science Park, China
- University College London Hospitals NHS Foundation Trust, UK
- The University of Hong Kong, China
- Aston University, Birmingham, UK
| | | | - David Coghill
- University of Dundee, UK
- University of Melbourne, VIC, Australia
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2
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Duong KL, Yang BR, Yun HY, Chae JW. Effect of methylphenidate on height in pediatric attention-deficit hyperactivity disorder patients: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02273-x. [PMID: 37589730 DOI: 10.1007/s00787-023-02273-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/29/2023] [Indexed: 08/18/2023]
Abstract
Methylphenidate (MPH), a first-line treatment for attention-deficit hyperactivity disorder (ADHD) management, has been the focus of debate for decades regarding its effect on growth. The aim of this PRISMA meta-analysis was to determine the effect of MPH on height in children/adolescents with ADHD and its predictive factors based on literature reports. Available full-text articles were systematically reviewed to identify clinical studies of pediatric ADHD patients with height Z-score (HZS) data for monotherapy MPH-treated and non-treated groups. We estimated standardized mean differences (SMDs) of HZS or its changes from baseline (ΔHZS) between groups, then identified associated factors through subgroup analyses and meta-regression. For before-after treatment studies, the paired standard errors of ΔHZS were re-estimated to demonstrate in the forest plot. Risk of bias was analyzed using the Newcastle-Ottawa Scale. Among the 29 eligible studies, 26 reported ΔHZS with self-control groups, and ΔHZS or absolute HZS were compared to other external controls in 11 studies. A significant reduction was observed between post-MHP and pre-MPH use, with high heterogeneity (SMD = - 0.40; 95% confidence interval = [ - 0.54, - 0.27]; I2 = 91%). The study region, ADHD subtype, and stimulant-naïve status of patients at baseline may modify the effect on HZS. Because of the high clinical heterogeneity in observational studies, clinicians should consider the negative effect of MPH on height in ADHD patients by determining whether patients fulfill appropriate high-risk criteria. Further well-designed longitudinal studies are required to better quantify this effect, especially with prolonged treatment.
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Grants
- MSIT; No. 2020-0-01441, Artificial Intelligence Convergence Research Center [Chungnam National University], No. RS-2022- 00155857, Artificial Intelligence Convergence Innovation Human Resources Development [Chungnam National University] Institute of Information & Communications Technology Planning & valuation (IITP) , Korea
- MSIT; No. 2020-0-01441, Artificial Intelligence Convergence Research Center [Chungnam National University], No. RS-2022- 00155857, Artificial Intelligence Convergence Innovation Human Resources Development [Chungnam National University] Institute of Information & Communications Technology Planning & valuation (IITP) , Korea
- MSIT; No. NRF-2018R1C1B5085278, NRF-2022R1A2C1010929, NRF-2022R1A5A7085156 National Research Foundation of Korea
- MSIT; No. NRF-2018R1C1B5085278, NRF-2022R1A2C1010929, NRF-2022R1A5A7085156 National Research Foundation of Korea
- 2021003310001 Korea Environmental Industry and Technology Institute
- 2021003310001 Korea Environmental Industry and Technology Institute
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Affiliation(s)
- Khanh Linh Duong
- College of Pharmacy, Chungnam National University, Daejeon, 34134, Republic of Korea
| | - Bo Ram Yang
- College of Pharmacy, Chungnam National University, Daejeon, 34134, Republic of Korea
- Department of Bio-AI Convergence, Chungnam National University, Daejeon, 34134, Republic of Korea
| | - Hwi-Yeol Yun
- College of Pharmacy, Chungnam National University, Daejeon, 34134, Republic of Korea.
- Department of Bio-AI Convergence, Chungnam National University, Daejeon, 34134, Republic of Korea.
| | - Jung-Woo Chae
- College of Pharmacy, Chungnam National University, Daejeon, 34134, Republic of Korea.
- Department of Bio-AI Convergence, Chungnam National University, Daejeon, 34134, Republic of Korea.
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Wei W, Chen L, Zhou H, Liu J, Zhang Y, Feng S, Bai Y, Leng Y, Chang E, Huang L. Safety profiles of methylphenidate, amphetamine, and atomoxetine: analysis of spontaneous reports submitted to the food and drug administration adverse event reporting system. Front Pharmacol 2023; 14:1208456. [PMID: 37645441 PMCID: PMC10461182 DOI: 10.3389/fphar.2023.1208456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
Background: Methylphenidate, atomoxetine, and Amphetamine are the three most commonly used medications approved by the United States Food and Drug Administration (FDA) for the treatment of attention deficit/hyperactivity disorder (ADHD). However, a comprehensive analysis of their safety profiles across various age groups and genders in real-world contexts has yet to be conducted. In this study, a pharmacovigilance analysis was performed using the FDA Adverse Event Reporting System (FAERS) database to examine differences in adverse events between methylphenidate, atomoxetine, and Amphetamine. Methods: From January 2014 to September 2022, FAERS reports listing "Methylphenidate," "Dexmethylphenidate," "Atomoxetine," "Amphetamine," "Lisdexamfetamine," "Dextroamphetamine," and "Methamphetamine" as primary suspects were analyzed after removing duplicate reports. We used the standardized Medical Dictionary for Regulatory Activities (MedDRA) query generalized search for adverse events at the preferred term level based on case reports. After filtering duplicate reports, disproportionality analysis was used to detect safety signals according to the proportional reporting ratio (PRR). In order to delve into potential safety concerns, we undertook a two-step analysis of the data. Initially, the data was segmented based on age cohorts: 0-5 years, 6-12 years, 13-18 years, and individuals aged ≥19 years. Following this, after partitioning the data into males and females within the 0-18 years age group, and similarly for those aged ≥19 years, further analysis was conducted. Results: The pharmacovigilance analysis uncovered substantial safety signals in the standardized MedDRA queries. Methylphenidate was associated with dyskinesia (PRR = 21.15), myocardial infarction (PRR = 12.32), and hypertension (PRR = 8.95) in children aged 0-5, 6-12, and 13-18 years, respectively, as well as neonatal exposures via breast milk (PRR = 14.10) in adults aged ≥19 years. Atomoxetine was linked to hostility/aggression (PRR = 15.77), taste and smell disorders (PRR = 6.75), and hostility/aggression (PRR = 6.74) in children aged 0-5, 6-12, and 13-18 years, respectively, as well as hostility/aggression (PRR = 14.00) in adults aged ≥19 years. Amphetamine was associated with psychosis and psychotic disorders (PRR = 16.78), hostility/aggression (PRR = 4.39), and Other ischaemic heart disease (PRR = 10.77) in children aged 0-5 years, 6-12 years, and 13-18 years, respectively, and hostility/aggression in adults aged ≥19 years (PRR = 9.16). Significant and noteworthy adverse event signals were also identified at the preferred term level. Specifically, methylphenidate was associated with myocardial infarction, acute myocardial infarction, coronary artery dissection, electrocardiogram QT prolonged, growth retardation, self-destructive behavior, suicidal ideation, and completed suicide. Atomoxetine was linked to electrocardiogram QT prolonged, growth retardation, and tic. Amphetamine was recorded for coronary artery dissection, suicidal ideation, and completed suicide. It was observed that male patients, including both children and adults, showed a more significant and frequent occurrence of adverse events compared to females, particularly in terms of cardiac disorders. The intensity and quantity of adverse event signals were distinctly different between the two genders, with males having a higher number of signals. All detected safety signals were confirmed using signals obtained from the disproportionality analysis. Conclusion: This pharmacovigilance analysis demonstrated significant variations in the safety profiles of methylphenidate, atomoxetine, and Amphetamine across different age groups and between different genders. Following an in-depth analysis of the FAERS database, we discerned prominent safety signals. Notably, the strength of the signals associated with coronary artery dissection induced by methylphenidate and amphetamine, as well as those related to suicide, demand particular attention. Consequently, it remains imperative to persist in monitoring these medications, assessing the associated risks, and carrying out comparative studies particularly geared towards ADHD drugs.
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Affiliation(s)
- Wei Wei
- Department of Pharmacy, Evidence-Based Pharmacy Center, West China Second University Hospital, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
- Department of Pharmacy, People’s Hospital of Zhongjiang County, Deyang, China
| | - Li Chen
- Department of Pharmacy, Evidence-Based Pharmacy Center, West China Second University Hospital, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Hui Zhou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
- Department of Pediatrics, West China Second University Hospital, Chengdu, China
| | - Jinfeng Liu
- Department of Pharmacy, People’s Hospital of Zhongjiang County, Deyang, China
| | - Yue Zhang
- Department of Pharmacy, People’s Hospital of Zhongjiang County, Deyang, China
| | - Shiyu Feng
- Department of Pharmacy, Evidence-Based Pharmacy Center, West China Second University Hospital, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
- Department of Pharmacy, Mianyang Orthopaedic Hospital, Mianyang, China
| | - Yingtao Bai
- Department of Pharmacy, People’s Hospital of Zhongjiang County, Deyang, China
| | - Yanen Leng
- Department of Pharmacy, People’s Hospital of Zhongjiang County, Deyang, China
| | - En Chang
- Department of Pharmacy, People’s Hospital of Zhongjiang County, Deyang, China
| | - Liang Huang
- Department of Pharmacy, Evidence-Based Pharmacy Center, West China Second University Hospital, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
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Wojnowski NM, Zhou E, Jee YH. Effect of stimulants on final adult height. J Pediatr Endocrinol Metab 2022; 35:1337-1344. [PMID: 36193720 PMCID: PMC9627528 DOI: 10.1515/jpem-2022-0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/13/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The use of stimulant medications for treatment of ADHD has raised concern as to whether they adversely impact linear growth. Previous studies have indicated that stimulant medications may suppress growth for a short period after treatment initiation; however, more information is needed to evaluate the long-term effects on final adult stature. This mini review aims to evaluate the effect of stimulant medications on final adult height in children with ADHD. CONTENTS We performed a literature review across PubMed/MEDLINE database. Only articles that included data on final adult height or near final adult height (age≥16 or 17 years) were included. SUMMARY Early studies investigating the long-term impacts of stimulant medications observed growth suppression during the active treatment period, but when comparing final adult height, there was no difference between the control and ADHD groups. A recent larger comprehensive study (Multimodal Treatment of ADHD study) has suggested that the long-term use of significant doses of stimulants during childhood may compromise final adult height to a clinically significant degree when comparing adult height across three long-term patterns of stimulant treatment (Consistent, Intermittent, Negligible). The consistent use subgroup was significantly shorter than other subgroups. OUTLOOK For children with ADHD, a significant long-term dose of stimulant treatment should be used with caution to avoid diminishing adult height potential. Pediatric endocrinologists should consider chronic use of stimulants as a factor contributing to reduced adult height.
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Affiliation(s)
- Natalia M Wojnowski
- Eunice Kennedy Shriver, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Elaine Zhou
- Eunice Kennedy Shriver, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Youn Hee Jee
- Eunice Kennedy Shriver, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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5
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Gohlke BC, Bettendorf M, Binder G, Hauffa B, Reinehr T, Dörr HG, Wölfle J. [Effect of Psychosocial Factors on Growth]. KLINISCHE PADIATRIE 2021; 234:61-67. [PMID: 34902873 DOI: 10.1055/a-1672-4759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Genes, hormones and factors such as nutrition and psychosocial environment affect growth. OBJECTIVE What is the significance of various psychosocial factors on growth? METHODS Evaluation of results of a working meeting of paediatric endocrinologist with current literature research. RESULTS Psychosocial deprivation in children can be associated with growth hormone deficiency (GHD) and short stature. GHD can be reversed by a change of environment and psychosocial support. War and migration are often associated with underweight, growth disturbances and poor health care. These factors can improve after the end of conflicts, but children often remain too short. Consumption of alcohol or opiates during pregnancy are associated with lower birth weight and increased risk of early and small for gestational age (SGA) childbirth. Children with attention deficit hyperactivity disorder show a slight slowdown in growth after they started stimulant therapy. However, they reach normal adult height. CONCLUSIONS In children with idiopathic short stature, psychosocial causes should be taken into account in the differential diagnosis. Notably there is an increased risk of growth disturbances in children from conflict regions or after prenatal drug exposure.
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Affiliation(s)
- Bettina C Gohlke
- Pädiatrische Endokrinologie, Universitätskinderklinik, Endokrinologie Bonn, Germany, Bonn, Deutschland
| | - Markus Bettendorf
- Division of Paediatric Endocrinology and Diabetes, University Children's Hospital Heidelberg, University Hospital Heidelberg, Heidelberg, Deutschland
| | - Gerhard Binder
- Paediatric Endocrinology, University Hospital Tubingen Department of Pediatrics, Tubingen, Deutschland
| | - Berthold Hauffa
- Universitätsklinikum Essen, Klinik für Pädiatrische Hämatologie, Onkologie und Endokrinologie, Essen, Deutschland
| | - Thomas Reinehr
- Pädiatrische Ernährungsmedizin, Vestische Kinderklinik, Datteln, Deutschland
| | | | - Joachim Wölfle
- Department of Paediatrics, Erlangen University Hospital, Erlangen, Deutschland
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6
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Yackobovitch-Gavan M, Mimouni-Bloch A, Gabbay U, Carmi D, Goldstein B, Keinan-Boker L, Bloch S, Meyerovitch J. Sex-Specific Long-Term Height and Body Mass Index Trajectories of Children Diagnosed with Attention-Deficit/Hyperactivity Disorder and Treated with Stimulants. J Pediatr 2021; 238:296-304.e4. [PMID: 34293373 DOI: 10.1016/j.jpeds.2021.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the sex-specific effects of stimulants in children with attention-deficit/hyperactivity disorder (ADHD) on body mass index (BMI) z and height z trajectories. STUDY DESIGN A retrospective cohort study using the database of Israel Clalit Health Services was performed. Participants included 5- to 18-year-old insured patients with documentation of at least 2 consecutive prescriptions of stimulant drugs for ADHD. Participants were further compared with sex- and age-matched insured control patients without ADHD. RESULTS A total of 4561 (66% boys) participants with ADHD were included. Of these, 2151 (70% boys) had follow-up data for ≥2 years of treatment. A decline of ≥1 SD in height and BMI z score was observed in 10.1% and 13.2% of the cohort, respectively. During ≥2 years follow-up, boys had a greater decline in height z score (~0.2 SD) than girls (~0.06 SD). Boys' height z score continued to decline after 1 and ≥2 years, and girls' height z score declined after 1 year, and then stabilized. The trajectory of BMI z score of boys and girls was similar, showing a greater decline after 1 year, followed by an incline after ≥2 years. Younger age at stimulants initiation, better adherence, longer treatment duration, and lower socioeconomic status were correlated with a greater impact on growth attenuation. The non-ADHD group (n = 4561, 66% boys) had baseline height z score and BMI z score similar to those in children with ADHD before treatment initiation. Height z score and BMI z score were greater in children without ADHD compared with children with ADHD following 1 year of treatment (P < .001). CONCLUSIONS These findings highlight the importance of growth monitoring accompanied with dietary counseling in children with ADHD treated with stimulants.
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Affiliation(s)
- Michal Yackobovitch-Gavan
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviva Mimouni-Bloch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Neurology and Developmental Unit, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Uri Gabbay
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Quality Unit, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Doron Carmi
- Shoham Community Pediatric Center, Clalit Health Services, Shoham, Israel
| | - BatEl Goldstein
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Lital Keinan-Boker
- School of Public Health, University of Haifa, Haifa, Israel; Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
| | - Stav Bloch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Meyerovitch
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Baweja R, Hale DE, Waxmonsky JG. Impact of CNS Stimulants for Attention-Deficit/Hyperactivity Disorder on Growth: Epidemiology and Approaches to Management in Children and Adolescents. CNS Drugs 2021; 35:839-859. [PMID: 34297331 DOI: 10.1007/s40263-021-00841-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 12/30/2022]
Abstract
Central nervous system stimulants are established treatments for pediatric attention-deficit/hyperactivity disorder with robust efficacy data. Reductions in appetite, weight, and growth velocity are some of the most common concerns regarding the long-term use of central nervous system stimulants in developing children. They are associated with suppression of weight and body mass index in childhood. However, both weight and body mass index often progressively increase over adolescence at rates faster than those seen in non-attention-deficit/hyperactivity disorder youth to the degree that attention-deficit/hyperactivity disorder is associated with elevated body mass index by the end of adolescence regardless of medication use. The capacity of central nervous system stimulants to slow growth was identified 50 years ago. Recent work has established that the growth deficits accumulate during the first 2 years of use and may persist provided medication is used. Early initiation coupled with persistent use through adolescence is most likely to be associated with clinical impactful growth suppression. There has been limited formal investigation of treatments for stimulant-associated reductions in weight and height. The most robust evidence exists for drug holidays improving weight gain. Observational studies suggest that limiting lifetime exposure or discontinuing medication is associated with greater adult height. Additional research is needed to identify the causal mechanisms driving the observed slowing in growth as well as the identification of predictors of clinically impactful growth suppression.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA.
| | - Daniel E Hale
- Division of Pediatric Endocrinology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - James G Waxmonsky
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA
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8
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Carucci S, Balia C, Gagliano A, Lampis A, Buitelaar JK, Danckaerts M, Dittmann RW, Garas P, Hollis C, Inglis S, Konrad K, Kovshoff H, Liddle EB, McCarthy S, Nagy P, Panei P, Romaniello R, Usala T, Wong ICK, Banaschewski T, Sonuga-Barke E, Coghill D, Zuddas A. Long term methylphenidate exposure and growth in children and adolescents with ADHD. A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 120:509-525. [PMID: 33080250 DOI: 10.1016/j.neubiorev.2020.09.031] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/11/2020] [Accepted: 09/27/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Methylphenidate (MPH) is an efficacious treatment for ADHD but concerns have been raised about potential adverse effects of extended treatment on growth. OBJECTIVES To systematically review the literature, up to December 2018, conducting a meta-analysis of association of long-term (> six months) MPH exposure with height, weight and timing of puberty. RESULTS Eighteen studies (ADHD n = 4868) were included in the meta-analysis. MPH was associated with consistent statistically significant pre-post difference for both height (SMD = 0.27, 95% CI 0.16-0.38, p < 0.0001) and weight (SMD = 0.33, 95% CI 0.22-0.44, p < 0.0001) Z scores, with prominent impact on weight during the first 12 months and on height within the first 24-30 months. No significant effects of dose, formulation, age and drug-naïve condition as clinical moderators were found. Data on timing of puberty are currently limited. CONCLUSIONS Long-term treatment with MPH can result in reduction in height and weight. However, effect sizes are small with possible minimal clinical impact. Long-term prospective studies may help to clarify the underlying biological drivers and specific mediators and moderators.
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Affiliation(s)
- Sara Carucci
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy.
| | - Carla Balia
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy
| | - Antonella Gagliano
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy
| | - Angelico Lampis
- Paediatric Endocrinology Unit, A. Cao" Pediatric Hospital, Brotzu Hospital Trust, Cagliari, Italy
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, & Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
| | - Marina Danckaerts
- Department of Child and Adolescent Psychiatry, University Psychiatric Center, Leuven, KU, Belgium; Department of Neurosciences, University Psychiatric Center, Leuven, KU, Belgium
| | - Ralf W Dittmann
- Paediatric Psychopharmacology, Department of Child & Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Garas
- Semmelweis University Mental Health Sciences School of PhD Studies, Budapest, Hungary
| | - Chris Hollis
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK; NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Sarah Inglis
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, RWTH Aachen University, Aachen, Germany; JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Hanna Kovshoff
- School of Psychology, University of Southampton, Southampton, UK
| | - Elizabeth B Liddle
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | | | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Pietro Panei
- Grant Office and Technology Transfer, Istituto Superiore di Sanità, Rome, Italy
| | - Roberta Romaniello
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Tatiana Usala
- Child and Adolescent Neuropsychiatry Unit, Azienda per la Tutela della Salute, ATS Sardegna, ASSL Oristano, Italy
| | - Ian C K Wong
- Centre for Paediatric Pharmacy Research, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tobias Banaschewski
- Paediatric Psychopharmacology, Department of Child & Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK; Department of Child & Adolescent Psychiatry, Aarhus University, Denmark
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Alessandro Zuddas
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy
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Greenhill LL, Swanson JM, Hechtman L, Waxmonsky J, Arnold LE, Molina BSG, Hinshaw SP, Jensen PS, Abikoff HB, Wigal T, Stehli A, Howard A, Hermanussen M, Hanć T. Trajectories of Growth Associated With Long-Term Stimulant Medication in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2020; 59:978-989. [PMID: 31421233 PMCID: PMC7021562 DOI: 10.1016/j.jaac.2019.06.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/11/2019] [Accepted: 08/07/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To estimate long-term stimulant treatment associations on standardized height, weight, and body mass index trajectories from childhood to adulthood in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (MTA). METHOD Of 579 children with DSM-IV ADHD-combined type at baseline (aged 7.0-9.9 years) and 289 classmates (local normative comparison group [LNCG]), 568 and 258 respectively, were assessed 8 times over 16 years (final mean age = 24.7). Parent interview data established subgroups with self-selected Consistent (n = 53, 9%), Inconsistent (n = 374, 66%), and Negligible (n = 141, 25%) stimulant medication use, as well as patients starting stimulants prior to MTA entry (n = 211, 39%). Height and weight growth trajectories were calculated for each subgroup. RESULTS Height z scores trajectories differed among subgroups (F = 2.22, p < .0001) and by stimulant use prior to study entry (F = 2.22, p < .001). The subgroup-by-assessment interaction was significant (F = 2.81, p < .0001). Paired comparisons revealed significant subgroup differences at endpoint: Consistent was shorter than Negligible (-0.66 z units /-4.06 cm /1.6 inches, t = -3.17, p < 0.0016), Consistent shorter than Inconsistent (-0.45 z units /-2.74 cm /-1.08 inches, t = -2.39, p < .0172), and the Consistent shorter than LNCG (-0.54 z units/+3.34 cm/ 1.31 inches, t = -3.30, p < 0.001). Weight z scores initially diverged among subgroups, converged in adolescence, and then diverged again in adulthood when the Consistent outweighed the LNCG (+ 3.561 z units /+7.47 kg /+16.46 lb, p < .0001). CONCLUSION Compared with those negligibly medicated and the LNCG, 16 years of consistent stimulant treatment of children with ADHD in the MTA was associated with changes in height trajectory, a reduction in adult height, and an increase in weight and body mass index. CLINICAL TRIAL REGISTRATION INFORMATION Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA); https://clinicaltrials.gov/; NCT00000388.
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Affiliation(s)
- Laurence L Greenhill
- Division of Child Psychiatry, New York State Psychiatric Institute, and Columbia University, New York, NY.
| | | | - Lily Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - James Waxmonsky
- Pennsylvania State University Division of Child and Adolescent Psychiatry, Centre County
| | | | | | - Stephen P Hinshaw
- University of California, Berkeley, and the University of California, San Francisco
| | - Peter S Jensen
- University of Arkansas for Medical Sciences, Little Rock, and The REACH Institute, New York, NY
| | - Howard B Abikoff
- Division of Child Psychiatry, New York State Psychiatric Institute, and Columbia University, New York, NY
| | - Timothy Wigal
- Clinical Services for Avida Inc., Newport Beach, California
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Davallow Ghajar L, DeBoer MD. Children With Attention-Deficit/Hyperactivity Disorder Are at Increased Risk for Slowed Growth and Short Stature in Early Childhood. Clin Pediatr (Phila) 2020; 59:401-410. [PMID: 32009447 DOI: 10.1177/0009922820902437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Our objective was to evaluate the risk of short stature in children with attention-deficit/hyperactivity disorder (ADHD) and the effect of ADHD and its treatment on height-for-age z score (HAZ) and body mass index-for-age z score (BMIZ) in early childhood. We evaluated 7603 children from the Early Childhood Longitudinal Study-Kindergarten Cohort 2011 and found that children with ADHD had lower HAZ at second and fourth grades and lower BMIZ at K to fourth grade. Children with ADHD at fourth grade had almost 4 times higher odds of short stature. Children with ADHD at K grew at a slower rate from K to fourth grade (difference in ΔHAZ = 0.23, 95% confidence interval = 0.04-0.42) and had less gain in BMI (difference in ΔBMIZ = 0.16, 95% confidence interval = 0.03-0.29). Longer duration of ADHD medication use was associated with lower HAZ at fourth grade and slower growth from K to fourth grade. These data may assist pediatricians in considering risk of poor growth in children with ADHD.
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Koonrungsesomboon K, Koonrungsesomboon N. The Effects of Methylphenidate Treatment on Child Growth in Thai Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2020; 30:189-197. [PMID: 31841645 DOI: 10.1089/cap.2019.0115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: To determine the effects of methylphenidate treatment on child growth in Thai pediatric patients with attention-deficit/hyperactivity disorder (ADHD). Methods: The medical records of children and adolescents with ADHD, between 5 and 18 years of age, who received pharmacological treatment with methylphenidate as a sole psychiatric medication for ≥1 year between 2001 and 2018 at the Rajanagarindra Institute of Child Development, Thailand, were retrospectively reviewed. Data on anthropometric parameters and methylphenidate use were extracted. Height and weight were converted to age- and gender-corrected standard scores (z-scores) using norms from the Thai pediatric population. Changes in height and weight z-scores were assessed using a paired t-test or one-way repeated measures ANOVA with the Bonferroni correction. Results: In this retrospective observational study, 911 children and adolescents were eligible, with the mean age of 95.0 ± 19.5 months at baseline, the cumulative duration of methylphenidate treatment of 39.4 ± 23.5 months, and the average daily dosage of 14.1 ± 6.2 mg/day. Comparative analysis found no statistically significant change in height z-scores between baseline and last recorded measurement (mean difference = 0.0017, confidence interval [95% CI] = -0.0004 to 0.0038, p = 0.107), while a slight, but significant increase in weight z-scores was observed (mean difference = 0.0271, 95% CI = 0.0179-0.0362, p < 0.001). Longitudinal analysis observed that weight z-scores were significantly decreased during the first year of therapy, but regained in the second year and continued to increase in subsequent years of therapy. Conclusion: Treatment with methylphenidate in our cohort of Thai pediatric patients with ADHD was not associated with growth deficits, except for a slightly significant decrease in weight during the first year of therapy.
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Affiliation(s)
| | - Nut Koonrungsesomboon
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Musculoskeletal Science and Translational Research Center, Chiang Mai University, Chiang Mai, Thailand
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Díez-Suárez A, Vallejo-Valdivielso M, Marín-Méndez JJ, de Castro-Manglano P, Soutullo CA. Weight, Height, and Body Mass Index in Patients with Attention-Deficit/Hyperactivity Disorder Treated with Methylphenidate. J Child Adolesc Psychopharmacol 2017; 27:723-730. [PMID: 28817309 DOI: 10.1089/cap.2016.0150] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe the methylphenidate (MPH) effects on weight, height, and body mass index (BMI) in a Spanish sample diagnosed with attention-deficit/hyperactivity disorder (ADHD). METHODS Patients (6-18 years) diagnosed with ADHD treated at our Unit with MPH in the last 10 years were included in an observational longitudinal study. Weight, height, and BMI Z scores were measured at baseline and at last follow-up. RESULTS Three hundred forty-two patients (mean [standard deviation] age: 10.7 [3.8] years, 80% males) were included. Mean dose was 1.25 (0.40) mg/(kg·d). After 27 (14-41) months taking MPH, weight and BMI standard deviation score (SDS) were reduced by treatment (baseline weight-SDS: 0.34 [1.22], follow-up weight-SDS: -0.06 [1.38], t-test p < 0.001; baseline BMI-SDS: 0.35 [1.10], and follow-up BMI-SDS [SDS]: -0.23 [1.08], t-test p < 0.001). In the whole sample, no differences in height before and after treatment were observed. However, considering only the group of patients who were children 6-12 years (68.6%) when starting treatment, height was slightly affected (baseline height-SDS: 0.04 [1.14], follow-up: -0.10 [1.11], p < 0.001). This effect was not observed if treatment was started during adolescence. Linear regression analysis showed that age starting MPH (B = 0.07, p = 0.003), dose (B = -0.50, p = 0.001), and duration of treatment (B = 0.07, p = 0.031) affect follow-up height. CONCLUSION MPH slightly decreased weight and BMI in this group of ADHD patients followed naturalistically over 2.2 years, and slightly affected height only if treatment was started before the age of 12. Girls, children who started treatment being younger or children on higher MPH doses, showed greater impact in height.
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Affiliation(s)
- Azucena Díez-Suárez
- 1 Child and Adolescent Psychiatry Unit, Psychiatry and Clinical Psychology Department, University of Navarra Clinic , Pamplona, Spain .,2 IDISNA (Health Research Institute of Navarra-Instituto de Investigación Sanitaria de Navarra) , Pamplona, Spain
| | - María Vallejo-Valdivielso
- 1 Child and Adolescent Psychiatry Unit, Psychiatry and Clinical Psychology Department, University of Navarra Clinic , Pamplona, Spain
| | - Juan J Marín-Méndez
- 1 Child and Adolescent Psychiatry Unit, Psychiatry and Clinical Psychology Department, University of Navarra Clinic , Pamplona, Spain .,2 IDISNA (Health Research Institute of Navarra-Instituto de Investigación Sanitaria de Navarra) , Pamplona, Spain
| | - Pilar de Castro-Manglano
- 1 Child and Adolescent Psychiatry Unit, Psychiatry and Clinical Psychology Department, University of Navarra Clinic , Pamplona, Spain .,2 IDISNA (Health Research Institute of Navarra-Instituto de Investigación Sanitaria de Navarra) , Pamplona, Spain
| | - César A Soutullo
- 1 Child and Adolescent Psychiatry Unit, Psychiatry and Clinical Psychology Department, University of Navarra Clinic , Pamplona, Spain .,2 IDISNA (Health Research Institute of Navarra-Instituto de Investigación Sanitaria de Navarra) , Pamplona, Spain
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Swanson JM, Arnold LE, Molina BSG, Sibley MH, Hechtman LT, Hinshaw SP, Abikoff H, Stehli A, Owens EB, Mitchell JT, Nichols Q, Howard A, Greenhill LL, Hoza B, Newcorn J, Jensen P, Vitiello B, Wigal T, Epstein J, Tamm L, Lakes KD, Waxmonsky J, Lerner M, Etcovitch J, Murray D, Muenke M, Acosta M, Arcos-Burgos M, Pelham WE, Kraemer H. Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression. J Child Psychol Psychiatry 2017; 58:663-678. [PMID: 28295312 PMCID: PMC6168061 DOI: 10.1111/jcpp.12684] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Multimodal Treatment Study (MTA) began as a 14-month randomized clinical trial of behavioral and pharmacological treatments of 579 children (7-10 years of age) diagnosed with attention-deficit/hyperactivity disorder (ADHD)-combined type. It transitioned into an observational long-term follow-up of 515 cases consented for continuation and 289 classmates (258 without ADHD) added as a local normative comparison group (LNCG), with assessments 2-16 years after baseline. METHODS Primary (symptom severity) and secondary (adult height) outcomes in adulthood were specified. Treatment was monitored to age 18, and naturalistic subgroups were formed based on three patterns of long-term use of stimulant medication (Consistent, Inconsistent, and Negligible). For the follow-up, hypothesis-generating analyses were performed on outcomes in early adulthood (at 25 years of age). Planned comparisons were used to estimate ADHD-LNCG differences reflecting persistence of symptoms and naturalistic subgroup differences reflecting benefit (symptom reduction) and cost (height suppression) associated with extended use of medication. RESULTS For ratings of symptom severity, the ADHD-LNCG comparison was statistically significant for the parent/self-report average (0.51 ± 0.04, p < .0001, d = 1.11), documenting symptom persistence, and for the parent/self-report difference (0.21 ± 0.04, p < .0001, d = .60), documenting source discrepancy, but the comparisons of naturalistic subgroups reflecting medication effects were not significant. For adult height, the ADHD group was 1.29 ± 0.55 cm shorter than the LNCG (p < .01, d = .21), and the comparisons of the naturalistic subgroups were significant: the treated group with the Consistent or Inconsistent pattern was 2.55 ± 0.73 cm shorter than the subgroup with the Negligible pattern (p < .0005, d = .42), and within the treated group, the subgroup with the Consistent pattern was 2.36 ± 1.13 cm shorter than the subgroup with the Inconsistent pattern (p < .04, d = .38). CONCLUSIONS In the MTA follow-up into adulthood, the ADHD group showed symptom persistence compared to local norms from the LNCG. Within naturalistic subgroups of ADHD cases, extended use of medication was associated with suppression of adult height but not with reduction of symptom severity.
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Affiliation(s)
- James M. Swanson
- Department of Pediatrics, School of Medicine, University of California, Irvine, CA
| | - L. Eugene Arnold
- Department of Psychiatry, Ohio State University, Nisonger Center, Columbus, OH
| | - Brooke S. G. Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh School of Medicine, PA
| | | | - Lily T. Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | | | - Howard Abikoff
- Child Study Center at New York University Langone Medical Center, NY
| | - Annamarie Stehli
- Department of Pediatrics, School of Medicine, University of California, Irvine, CA
| | | | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Quyen Nichols
- Department of Psychological Science, University of Vermont, Burlington, VT
| | - Andrea Howard
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | | | - Betsy Hoza
- Department of Psychological Science, University of Vermont, Burlington, VT
| | - Jeffrey Newcorn
- Department of Psychiatry, Mount Sinai Medical School, New York, NY
| | - Peter Jensen
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | | | - Jeffery Epstein
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Leanne Tamm
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Kimberly D. Lakes
- Department of Pediatrics, School of Medicine, University of California, Irvine, CA
| | | | - Marc Lerner
- Orange County Department of Education, Costa Mesa, CA
| | - Joy Etcovitch
- Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Desiree Murray
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC
| | | | - Maria Acosta
- National Human Genome Research Institute, Bethesda, MD
| | | | - William E. Pelham
- Department of Psychology, Florida International University, Miami, FL
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Ptacek R, Kuzelova H, Paclt I. Effect of Stimulants on Growth of ADHD Children: A Critical Review. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/bf03379556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed childhood psychiatric disorders manifested in almost every part of children’s behavior. The most common treatment of ADHD is medication with stimulants, by specific amphetamine and methylphenidate. It is known that the treatment by stimulants may be accompanied by side effects from among decrease of appetite or changes in development as growth suppression and loss of weight which may present very serious phenomenon. Although many studies have monitored changes in growth and weight during medication, they did not provide definite results that the growth and weight suppression are caused by medication or not. According to many studies the height deficit is approximately amounted to 1 cm/year during the first 3 years of the treatment and can be clinically serious. Contrary to these findings some authors reported that the growth or weight changes can be a natural symptom of ADHD and not just a consequence of medication. The present article reviews key studies monitoring changes in parameters of growth in medicated children with ADHD, compares their results and suggest methodology improvements for further studies.
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Powell SG, Frydenberg M, Thomsen PH. The effects of long-term medication on growth in children and adolescents with ADHD: an observational study of a large cohort of real-life patients. Child Adolesc Psychiatry Ment Health 2015; 9:50. [PMID: 26516345 PMCID: PMC4624592 DOI: 10.1186/s13034-015-0082-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 09/16/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Children and adolescents with ADHD treated with central stimulants (CS) often have growth deficits, but the implications of such treatment for final height and stature remain unclear. METHODS Weight and height were assessed multiple times in 410 children and adolescents during long-term treatment with CS, which lasted between 0.9 and 16.1 years. Weight and height measures were converted to z-scores based on age- and sex-adjusted population tables. RESULTS CS treatment was associated with (1) a relative reduction in body weight and a temporary halt in growth, (2) a weight and height lag after 72 months compared with relative baseline values. No relation to early start of medication (<6 years), gender, comorbid ODD/CD or emotional disorders was observed. CONCLUSIONS Treatment with central stimulants for ADHD impacts growth in children and adolescents, and growth should be continuously monitored in patients on chronic treatment with these medications.
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Affiliation(s)
- Shelagh Gwendolyn Powell
- Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Skovagervej 2, entr. 81, 8240 Risskov, Denmark
| | - Morten Frydenberg
- Department of Public Health, Aarhus University, Bartholins Allé, build. 1260, 8000 Aarhus C, Denmark
| | - Per Hove Thomsen
- Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Skovagervej 2, entr. 81, 8240 Risskov, Denmark
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Abstract
PURPOSE OF REVIEW This article provides an overview of current controversies in attention-deficit/hyperactivity disorder (ADHD) research, with an emphasis on recent findings that are directly relevant to clinical practice. RECENT FINDINGS Over the past few years, a number of studies have added key evidence to ongoing debates about the epidemiology, nosology, and treatment of ADHD. Although the causes of the rising prevalence of ADHD in the USA are still not fully understood, recent research suggests that environmental factors and changes to the diagnostic criteria may have played a role. In addition, there continues to be controversy surrounding the clinical diagnosis of ADHD and newly recognized, related conditions such as sluggish cognitive tempo. Recent studies have also challenged previous assumptions about the long-term effects of stimulant treatment on growth, academic achievement, and substance use. Moreover, although most complementary and alternative therapies for ADHD appear to be ineffective, there is emerging evidence supporting the value of fatty acid supplementation. Although these findings are promising, more research is needed on all fronts. SUMMARY Although research has shed light on unanswered questions about the epidemiology, nosology, and treatment of ADHD, much is still not known. An understanding of the most important current controversies in ADHD research may aid pediatricians in clinical decision making and allow them to counsel patients more effectively.
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Calarge CA, Schlechte JA, Burns TL, Zemel BS. The effect of psychostimulants on skeletal health in boys co-treated with risperidone. J Pediatr 2015; 166:1449-54.e1. [PMID: 25863660 PMCID: PMC4446198 DOI: 10.1016/j.jpeds.2015.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/19/2015] [Accepted: 03/03/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To examine the skeletal effects of chronic psychostimulant treatment in children and adolescents. STUDY DESIGN Medically healthy 5- to 17-year-old males from 4 different clinic-based studies were combined for this analysis. They were divided by psychostimulant use into 3 groups: none to negligible, intermittent, and continuous use. Most (95%) had also received risperidone for 6 months or more. Treatment history was extracted from medical and pharmacy records. Anthropometric and bone measurements, using dual-energy x-ray absorptiometry and peripheral quantitative computed tomography, were obtained at each research visit. Multivariable linear regression analysis models examined whether age-sex-specific height Z-score and skeletal outcomes differed among the 3 psychostimulant-use groups. RESULTS The sample consisted of 194 males with a mean age of 11.7 ± 2.8 years at study entry. The majority had an externalizing disorder. There was no significant difference across the 3 treatment groups in height Z-score or in skeletal outcomes at the radius, lumbar spine, or whole body. One hundred forty-four boys had valid follow-up skeletal data 1.4 ± 0.7 years after study entry. Again, neither height Z-score nor the skeletal outcomes were different among those who remained on psychostimulants between the 2 visits, started psychostimulants anew, or had not taken psychostimulants. CONCLUSIONS Following chronic treatment, psychostimulants did not appear to significantly affect bone mass accrual in children and adolescents taking risperidone. There was a small, but statistically not significant, negative impact on longitudinal growth.
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Affiliation(s)
- Chadi A. Calarge
- Menninger Department of Psychiatry and Behavioral Science and Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 6701 Fannin Street, Suite 1740, Houston, TX 77030-2399, Tel: 832-824-4764, Fax: 832-825-8981
| | - Janet A. Schlechte
- Department of Internal Medicine, The University of Iowa Carver College of Medicine
| | - Trudy L. Burns
- Department of Epidemiology, The University of Iowa College of Public Health
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Kim HW, Kim SO, Shon S, Lee JS, Lee HJ, Choi JH. Effect of methylphenidate on height and weight in Korean children and adolescents with attention-deficit/hyperactivity disorder: a retrospective chart review. J Child Adolesc Psychopharmacol 2014; 24:448-53. [PMID: 25285915 DOI: 10.1089/cap.2014.0025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of methylphenidate (MPH) on growth in Korean children and adolescents with attention-deficit/hyperactivity disorder (ADHD). METHODS The medical records of 157 subjects (mean age 8.9±2.2 years; 134 boys) with ADHD who received treatment with MPH for at least 1 year at the Department of Psychiatry at Asan Medical Center were retrospectively reviewed. Height and weight were prospectively obtained and retrospectively gathered. Height and weight were converted to age- and gender-corrected standard scores (z scores) using norms from the Korean population. Growth changes were analyzed from the starting to the end of treatment using random coefficients models with change in weight or height z score as the dependent variable. RESULTS Weight (β = -0.109, p<0.001) and height (β = -0.072, p<0.001) z scores significantly decreased during treatment. Weight z score decreased more in girls (β = -0.247, p<0.001) than in boys (β = -0.090, p<0.001). Weight z score decreased during the 1st year of medication (β = -0.327, p<0.001 for boys; β = -0.646, p<0.001 for girls), and did not change or increase after the 1st year. Height z score significantly decreased during treatment (β = -0.072, p<0.001) after controlling for the effect of age at treatment, gender, mean daily mg/kg dose, and comorbid depressive disorder. Height z score also decreased during the 1st year of medication (β = -0.089, p<0.001) but did not change after the 1st year. CONCLUSIONS These results suggest that MPH could be related to weight and height deficit in Korean children and adolescents, although the effects were minor, and disappeared after the 1st year. Because of the limitations of this study such as retrospective design, selection bias, and high attrition rate, further prospective studies are needed.
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Affiliation(s)
- Hyo-Won Kim
- 1 Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
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Harstad EB, Weaver AL, Katusic SK, Colligan RC, Kumar S, Chan E, Voigt RG, Barbaresi WJ. ADHD, stimulant treatment, and growth: a longitudinal study. Pediatrics 2014; 134:e935-44. [PMID: 25180281 PMCID: PMC4179095 DOI: 10.1542/peds.2014-0428] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSIONS Our findings suggest that ADHD treatment with stimulant medication is not associated with differences in adult height or significant changes in growth.
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Affiliation(s)
- Elizabeth B Harstad
- Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Seema Kumar
- Pediatrics, Mayo Clinic, Rochester, Minnesota; and
| | - Eugenia Chan
- Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert G Voigt
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - William J Barbaresi
- Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts;
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Fredriksen M, Halmøy A, Faraone SV, Haavik J. Long-term efficacy and safety of treatment with stimulants and atomoxetine in adult ADHD: a review of controlled and naturalistic studies. Eur Neuropsychopharmacol 2013; 23:508-27. [PMID: 22917983 DOI: 10.1016/j.euroneuro.2012.07.016] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 06/28/2012] [Accepted: 07/24/2012] [Indexed: 10/28/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common disorder of childhood that often persists into adulthood. Although stimulant medications are recommended as the first-line treatment for ADHD because of their documented short-term effects in children and adults, less is known about their effects on long-term outcome in adults. Here we review the long-term efficacy and safety of the stimulant drugs methylphenidate and amphetamine, as well as the related compound atomoxetine. We performed a systematic review to identify direct and indirect effects of stimulant therapy on long-term outcome in adults. Five randomized controlled trials (RCTs), and 10 open-label extension studies of initial short-term RCTs, with total follow-up of at least 24weeks, were identified. All these RCTs found that medication was significantly more efficacious than placebo in treating ADHD in adults, and the extension studies showed that this favorable effect of medication was maintained during the open-label follow-up period. However, since the maximum duration of these pharmacological trials was 4years, we also reviewed 18 defined naturalistic longitudinal and cross-sectional studies, to provide more information about longer term functional outcomes, side effects and complications. These observational studies also showed positive correlations between early recognition of the disorder, stimulant treatment during childhood and favorable long-term outcome in adult ADHD patients. In conclusion, stimulant therapy of ADHD has long-term beneficial effects and is well tolerated. However, more longitudinal studies of long duration should be performed. In addition, the ethical issues involved in performing double blind RCTs of many years duration should be further explored.
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Affiliation(s)
- Mats Fredriksen
- Division of Mental Health & Addiction, Vestfold Hospital Trust, Norway
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Renes JS, de Ridder MAJ, Breukhoven PE, Lem AJ, Hokken-Koelega ACS. Methylphenidate and the response to growth hormone treatment in short children born small for gestational age. PLoS One 2012; 7:e53164. [PMID: 23300884 PMCID: PMC3531371 DOI: 10.1371/journal.pone.0053164] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Growth hormone (GH) treatment has become a frequently applied growth promoting therapy in short children born small for gestational age (SGA). Children born SGA have a higher risk of developing attention deficit hyperactivity disorder (ADHD). Treatment of ADHD with methylphenidate (MP) has greatly increased in recent years, therefore more children are being treated with GH and MP simultaneously. Some studies have found an association between MP treatment and growth deceleration, but data are contradictory. OBJECTIVE To explore the effects of MP treatment on growth in GH-treated short SGA children METHODS Anthropometric measurements were performed in 78 GH-treated short SGA children (mean age 10.6 yr), 39 of whom were also treated with MP (SGA-GH/MP). The SGA-GH/MP group was compared to 39 SGA-GH treated subjects. They were matched for sex, age and height at start of GH, height SDS at start of MP treatment and target height SDS. Serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) levels were yearly determined. Growth, serum IGF-I and IGFBP-3 levels during the first three years of treatment were analyzed using repeated measures regression analysis. RESULTS The SGA-GH/MP group had a lower height gain during the first 3 years than the SGA-GH subjects, only significant between 6 and 12 months of MP treatment. After 3 years of MP treatment, the height gain was 0.2 SDS (± 0.1 SD) lower in the SGA-GH/MP group (P = 0.17). Adult height was not significantly different between the SGA-GH/MP and SGA-GH group (-1.9 SDS and -1.9 SDS respectively, P = 0.46). Moreover, during the first 3 years of MP treatment IGF-I and IGFBP-3 measurements were similar in both groups. CONCLUSION MP has some negative effect on growth during the first years in short SGA children treated with GH, but adult height is not affected.
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Affiliation(s)
- Judith S Renes
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands.
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Hanć T, Cieślik J, Wolańczyk T, Gajdzik M. Assessment of growth in pharmacological treatment-naïve Polish boys with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2012; 22:300-6. [PMID: 22897665 DOI: 10.1089/cap.2010.0113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective of this study was to estimate the growth of pharmacological treatment-naïve polish boys with attention-deficit/hyperactivity disorder (ADHD). METHOD The sample included 135 boys (mean age: 11.67 years) with ADHD. The level of subjects' height, weight, and body mass index (BMI) was compared to the reference growth charts. Full estimation of measurement accuracy was provided. Regression analysis was used to estimate the biological and social factors contributing to the growth determination in the examined group. RESULTS There were no statistically significant differences between mean body height of boys with ADHD and standards of growth of Polish children. Separate analyses for body height of the examined boys aged 6-10, 11-15, and 16-18 years also gave no statistically significant results. Mean body weight (z=0.28) and BMI (z=0.25) in the total cohort were statistically higher than the norm. After categorization of the boys according to age, statistically significant differences were demonstrated only for weight in the age range of 6-10 years (z=0.31) and for BMI in the age range of 11-15y (z=0.42). The regression analysis showed the strongest relation between the subjects' growth and the parents' body size, newborn's condition (birth, body weight, and APGAR score), factors connected with lifestyle, and socio-economic status of the family. CONCLUSION The study revealed that the height of drug-naïve boys with ADHD was not significantly different from the norm. The investigation also showed a tendency for greater body weight and BMI in boys with ADHD in comparison with the growth charts, which may be manifested also in greater risk of overweight and obesity in this group. The results of research suggest the necessity to control for such variables as genetic, perinatal, socioeconomic, and psychosocial factors, which may affect children's development, in future research on the growth of children with ADHD.
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Affiliation(s)
- Tomasz Hanć
- Department of Human Biological Development, Institute of Anthropology, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland.
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Komatsu DE, Thanos PK, Mary MN, Janda HA, John CM, Robison L, Ananth M, Swanson JM, Volkow ND, Hadjiargyrou M. Chronic exposure to methylphenidate impairs appendicular bone quality in young rats. Bone 2012; 50:1214-22. [PMID: 22465849 PMCID: PMC3352964 DOI: 10.1016/j.bone.2012.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 02/13/2012] [Accepted: 03/09/2012] [Indexed: 11/18/2022]
Abstract
Methylphenidate (MP) is a psychostimulant widely prescribed to treat Attention Deficit Hyperactivity Disorder (ADHD). Although generally well tolerated, growth deficits have been reported in children and adolescents undergoing MP treatment. This study was designed to elucidate the skeletal effects of chronic MP administration in adolescent rats. Male, 4-week-old rats received one of two doses of MP (MP-Low or MP-High) delivered for 8 h a day via drinking water, or were untreated (water only). After 13 weeks, half were sacrificed (N=12/group) and the remaining rats were left to recover, untreated for 5 additional weeks. Femora, tibiae, and L5 vertebra were analyzed using calipers, DXA, and mechanical testing. Immediately following treatment, MP decreased femoral anterior-posterior diameter (5% and 9% for MP-Low and MP-High, respectively), femoral and tibial bone mineral density (BMD) (6% and 5% for MP-High femora and tibiae, respectively), and bone mineral content (BMC) (9% for MP-High femora and tibiae). In addition, femora from MP treated rats had reduced ultimate force (20% for MP-High) and energy to failure (20% and 33% for MP-Low and MP-High, respectively). However, after recovery, there were no statistically significant differences for any measured parameters. Despite these effects on the appendicular skeleton, no differences were identified between vertebral samples at either time-point. In summary, MP treatment resulted in smaller, less mineralized, and weaker bones at appendicular sites, but did not affect the axial site. Although these effects were ameliorated within 5 weeks, these data suggest that adolescents undergoing MP treatment may be at an increased risk for long bone fractures.
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Affiliation(s)
- David E Komatsu
- Corresponding Author: Department of Orthopaedics, Stony Brook University, HSC Level 18, Room 085, Stony Brook, NY 11794-8181, USA, Phone: 631-444-7222, Fax: 631-444-8894, DEK:
| | - Panayotis K Thanos
- Behavior Neuropharmacology and Neuroimaging Lab, Brookhaven National Laboratory, P.O. Box 5000, Upton, NY 11973-5000, USA, PTK:, LR:, MA:
- Laboratory of Neuroimaging, NIAAA, NIH, 6001 Executive Blvd, Room NSC/5274:MSC 9581, Bethesda MD 20892, USA, NDV:
| | - Michelle N Mary
- St. Jude Children’s Research Hospital, 262 Danny Thomas Pl, Memphis TN 38105, MNM:
| | - Haden A Janda
- InMotion Orthopaedic Research Center, 20 South Dudley, Memphis, TN 38103, USA, HAJ: CMJ:
| | - Christine M John
- InMotion Orthopaedic Research Center, 20 South Dudley, Memphis, TN 38103, USA, HAJ: CMJ:
| | - Lisa Robison
- Behavior Neuropharmacology and Neuroimaging Lab, Brookhaven National Laboratory, P.O. Box 5000, Upton, NY 11973-5000, USA, PTK:, LR:, MA:
| | - Mala Ananth
- Behavior Neuropharmacology and Neuroimaging Lab, Brookhaven National Laboratory, P.O. Box 5000, Upton, NY 11973-5000, USA, PTK:, LR:, MA:
| | - James M Swanson
- Child Development Center, University California Irvine, 19262 Jamboree Road, Irvine, CA 92612-2502, USA, JMS:
| | - Nora D Volkow
- Laboratory of Neuroimaging, NIAAA, NIH, 6001 Executive Blvd, Room NSC/5274:MSC 9581, Bethesda MD 20892, USA, NDV:
| | - Michael Hadjiargyrou
- Department of Biomedical Engineering, Stony Brook University, Bioengineering Building, Room 101, Stony Brook, NY 11794-5281, USA, MH:
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Durá-Travé T, Yoldi-Petri ME, Gallinas-Victoriano F, Zardoya-Santos P. Effects of osmotic-release methylphenidate on height and weight in children with attention-deficit hyperactivity disorder (ADHD) following up to four years of treatment. J Child Neurol 2012; 27:604-9. [PMID: 22190507 DOI: 10.1177/0883073811422752] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is some controversy concerning \the potential negative influence of methylphenidate on growth. The authors reviewed clinical records of 187 patients with attention-deficit hyperactivity disorder under treatment with methylphenidate. The patients' weight, height, and body mass index were measured at diagnosis and during 4 years of follow-up. The dose of methylphenidate was gradually increased up to 1.31 ± 0.2 mg/kg/d. At diagnosis, mean weight value was lower than mean weight expected for age by 0.697 kg. This difference increased to 4.274 kg (at 30 months of treatment), although it subsequently decreased to 1.588 kg (at 48 months of treatment). Mean value of height was lower than expected mean height for age by 0.42 cm at diagnosis. This difference increased to 2.69 cm (at 30 months of treatment), but it subsequently decreased to 0.83 cm (at 48 months of treatment). The relationship between nutritional status and the negative effects on the height curve in those patients would require nutritional optimization to return anthropometric variables to normal.
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Huang YS, Tsai MH. Long-term outcomes with medications for attention-deficit hyperactivity disorder: current status of knowledge. CNS Drugs 2011; 25:539-54. [PMID: 21699268 DOI: 10.2165/11589380-000000000-00000] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD), a common neurobehavioural disorder characterized by inattention, hyperactivity and impulsivity, is a chronic disorder and often persists into adulthood. CNS stimulants have been the most well known treatment for ADHD for several decades due to their high effectiveness, good safety profiles and relatively minor adverse effects. Non-stimulant agents, including atomoxetine, extended-release guanfacine and extended-release clonidine (US FDA approved), and several non-FDA-approved agents, such as bupropion and tricyclic antidepressants (TCAs), were recently proven to be effective alternatives to the stimulants in several open-label and placebo-controlled trials. However, most medication trials for ADHD have been short term and thus have not provided information on the long-term outcomes of ADHD treatment. Since the medical treatment of many children with ADHD, especially those with more severe symptoms or co-morbid disorders, has to be continued for several years, recent studies have shifted their focus from the acute effectiveness of stimulants or non-stimulant drugs to the long-term outcomes of medications for ADHD. Evidence has shown that stimulants, along with the non-stimulants atomoxetine and extended-release guanfacine, are continuously effective for 24-month treatment periods with few and tolerable adverse effects.
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Affiliation(s)
- Yu-Shu Huang
- Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C
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Damiani D, Damiani D, Casella E. Hiperatividade e déficit de atenção: o tratamento prejudica o crescimento estatural? ACTA ACUST UNITED AC 2010; 54:262-8. [DOI: 10.1590/s0004-27302010000300003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Accepted: 12/07/2009] [Indexed: 11/22/2022]
Abstract
O presente estudo avaliou a influência de drogas estimulantes usadas no déficit de atenção e hiperatividade no crescimento estatural. Os autores procederam a uma revisão de literatura coletando artigos publicados sobre déficit de atenção e hiperatividade e sua relação com a baixa estatura. A fonte consultada foi o PubMed e o tópico levantado foi "Crescimento e Metilfenidato"/"Déficit de atenção e hiperatividade versus baixa estatura"/"Metilfenidato e distúrbios de crescimento". Os transtornos de atenção e hiperatividade constituem-se em situações clínicas difíceis, por interferir no bem-estar da criança e no seu relacionamento social, com prejuízos de seu desenvolvimento escolar. Uma vez feito o diagnóstico, as medicações estimulantes como o metilfenidato têm papel primordial no tratamento, mas muito se teme com relação a certos efeitos colaterais, particularmente a perda de peso e a perda estatural. Revisou-se uma série de publicações a respeito e pôde-se verificar que não há consenso sobre tais efeitos colaterais, mas que, mesmo quando ocorrem, não são suficientemente intensos para impedir o tratamento. Um julgamento da relação custo-benefício da medicação é sempre apropriado, mas os benefícios obtidos com a medicação e com a melhora do rendimento escolar e das relações sociais da criança não devem ser esquecidos. Uma cuidadosa monitorização da curva pondoestatural permite que o médico vigie com segurança o tratamento prescrito e possa tomar decisões se julgar que o prejuízo estatural compromete o bem-estar do paciente.
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Leddy JJ, Waxmonsky JG, Salis RJ, Paluch RA, Gnagy EM, Mahaney P, Erbe R, Pelham WE, Epstein LH. Dopamine-related genotypes and the dose-response effect of methylphenidate on eating in attention-deficit/hyperactivity disorder youths. J Child Adolesc Psychopharmacol 2009; 19:127-36. [PMID: 19364291 DOI: 10.1089/cap.2008.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE There are individual differences in the effects of methylphenidate (MPH), a dopamine (DA) transport inhibitor, on appetite in children with attention-deficit/hyperactivity disorder (ADHD). One potential moderating factor is variation in brain DA activity, which is influenced by dopamine-related genes: the DA transporter (DAT) (SLC6A3), the DA D2 receptor (DRD2), and the DA D4 receptor (DRD4) genes. The purpose of this study was to explore the relationship between dopamine-related gene polymorphisms and food consumption in ADHD children receiving varying doses of MPH. METHODS In a randomized, within-subject, double-blind design, 58 ADHD children (ages 6-12 years) received placebo, 0.15, 0.3, or 0.6 mg/kg of MPH three times daily over 9 weeks. Observations of percent lunch consumed as a function of dopamine-related genotypes and MPH dose were analyzed using mixed effects regression models. RESULTS A significant dose-response reduction in eating was observed across all genotypes (p < 0.001). There was an interaction of DAT SLC6A3 and DRD2 genotypes and dose, because 9/9 DAT children showed a stronger effect of dose when compared with the 9/10 and 10/10 children (p < 0.001) and DRD2 A2/A2 children showed a stronger effect of dose when compared with A1/A1 and A1/A2 children combined (p = 0.007). There was no significant interaction of dose by DRD4 genotype. CONCLUSIONS Lunch consumption decreased as a function of MPH dose. DA-related genotypes associated with greater brain DA signaling moderated the influence of drug on consumption. These results provide information relevant to predicting which children are likely to experience the greatest appetite suppression when taking MPH.
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Affiliation(s)
- John J Leddy
- State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
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Abstract
OBJECTIVE Stimulant medications are effective treatments for attention-deficit/hyperactivity disorder, but concerns remain about their effects on growth. METHOD We provide a quantitative analysis of longitudinal studies about deficits in expected growth among children with attention-deficit/hyperactivity disorder treated with stimulant medication. Study selection criteria were use of DSM criteria or clear operational definitions for hyperactivity or minimal brain dysfunction; outcome measures including raw, standardized, or percentile measurement of change in height and/or weight; first assessment of effects on growth occurred during childhood; and follow-up for at least 1 year. For issues not suitable for quantitative analyses, we provide a systematic, qualitative review. RESULTS The quantitative analyses showed that treatment with stimulant medication led to statistically significant delays in height and weight. This review found statistically significant evidence of attenuation of these deficits over time. The qualitative review suggested that growth deficits may be dose dependent, deficits may not differ between methylphenidate and amphetamine, treatment cessation may lead to normalization of growth, and further research should assess the idea that attention-deficit/hyperactivity disorder itself may be associated with dysregulated growth. CONCLUSIONS Treatment with stimulants in childhood modestly reduced expected height and weight. Although these effects attenuate over time and some data suggest that ultimate adult growth parameters are not affected, more work is needed to clarify the effects of continuous treatment from childhood to adulthood. Although physicians should monitor height, deficits in height and weight do not appear to be a clinical concern for most children treated with stimulants.
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Hanć T, Cieślik J. Growth in stimulant-naive children with attention-deficit/hyperactivity disorder using cross-sectional and longitudinal approaches. Pediatrics 2008; 121:e967-74. [PMID: 18381524 DOI: 10.1542/peds.2007-1532] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study was to investigate the growth of stimulant-naive children with attention-deficit/hyperactivity disorder in 3 aspects of development: level, trend, and structure of the process. PATIENTS AND METHOD The study sample included 53 individuals between the ages of 6 and 17 years (mean: 11.90). The average level of growth (z scores) in prepubertal, pubertal, and postpubertal stage of development and trend of the process were estimated on the basis of a comparison with growth charts. The prediction of adolescent growth spurt was conducted using the mathematical structural growth model of Jolioceur, Pontier, and Abidi. RESULTS Difference between boys with attention-deficit/hyperactivity and the norm was statistically significant in the prepubertal stage and for the average level of growth between the ages of 2 and 17 years. Distinct suppression of growth was found between the ages of 9 and 14. Analysis of development structure revealed an earlier onset of the adolescent growth spurt among boys (difference: 5 months) and a higher velocity of growth at this moment (difference: 0.33 cm/year) than expected values. CONCLUSIONS The application of both cross-sectional and longitudinal analyses clearly illustrated the higher level of growth of boys with attention-deficit/hyperactivity in the prepubertal stage, the suppression of growth on the turn of prepubertal and pubertal periods, and earlier occurrence of the spurt onset. Observed differences in the level and trend of growth as well as in the parameters of adolescent growth spurt are linked with disorder-related factors.
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Affiliation(s)
- Tomasz Hanć
- Department of Human Biological Development, Adam Mickiewicz University, Umultowska 89, 61-614 Poznań, Poland.
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Vitiello B. Understanding the Risk of Using Medications for ADHD with Respect to Physical Growth and Cardiovascular Function. Child Adolesc Psychiatr Clin N Am 2008; 17:459-74, xi. [PMID: 18295156 PMCID: PMC2408826 DOI: 10.1016/j.chc.2007.11.010] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The effects of stimulant medications and atomoxetine on physical growth and on cardiovascular function are reviewed in light of the most recent data, with attention to clinical implications and research needs. Although these medications have a favorable benefit/risk profile and do not induce clinically significant changes in growth or cardiovascular function in the majority of cases, careful patient monitoring is needed to identify individuals at risk for negative outcomes. More research is needed to elucidate the mechanism of growth suppression to estimate better the risk for rare but life-threatening events and test the effectiveness of monitoring procedures.
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Affiliation(s)
- Benedetto Vitiello
- National Institute of Mental Health, Room 7147, 6001 Executive Boulevard, Bethesda, MD 20892-9633, telephone: 301-443-4283, fax 301-443-4045,
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Spencer TJ, Kratochvil CJ, Sangal RB, Saylor KE, Bailey CE, Dunn DW, Geller DA, Casat CD, Lipetz RS, Jain R, Newcorn JH, Ruff DD, Feldman PD, Furr AJ, Allen AJ. Effects of atomoxetine on growth in children with attention-deficit/hyperactivity disorder following up to five years of treatment. J Child Adolesc Psychopharmacol 2007; 17:689-700. [PMID: 17979588 DOI: 10.1089/cap.2006.0100] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the effects on growth of long-term pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD), we present findings from an ongoing 5-year study of the efficacy and safety of treatment with atomoxetine. METHODS North American patients, 6-17 years old at study entry (N = 1,312) and with Diagnostic and Statistical Manual of Mental Disorders,4th edition (DSM-IV) ADHD, were studied under open-label atomoxetine treatment. Sixty-one were studied up to 5 years. RESULTS After 1 month's treatment, patients weighed less than expected from their starting percentiles relative to population norms, with a maximum shortfall at 15 months and a return to expected weight by 36 months. Patients were slightly shorter than expected after 12 months, reaching a maximum shortfall at 18 months and returning to expected height by 24 months. Patients in the top quartile for body mass index (BMI) or weight at baseline, and those in the third quartile for height, showed 5-year decreases from expected values. Those below median height at baseline showed increases relative to expected values. CONCLUSIONS These interim results indicate that continuous atomoxetine treatment for up to 5 years has little or no long-term effect on juvenile growth and final stature for most patients, although persistent decreases from expected may occur in some patients who are larger than average before treatment.
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Affiliation(s)
- Thomas J Spencer
- Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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Swanson JM, Elliott GR, Greenhill LL, Wigal T, Arnold LE, Vitiello B, Hechtman L, Epstein JN, Pelham WE, Abikoff HB, Newcorn JH, Molina BSG, Hinshaw SP, Wells KC, Hoza B, Jensen PS, Gibbons RD, Hur K, Stehli A, Davies M, March JS, Conners CK, Caron M, Volkow ND. Effects of stimulant medication on growth rates across 3 years in the MTA follow-up. J Am Acad Child Adolesc Psychiatry 2007; 46:1015-1027. [PMID: 17667480 DOI: 10.1097/chi.0b013e3180686d7e] [Citation(s) in RCA: 218] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the hypothesis of stimulant medication effect on physical growth in the follow-up phase of the Multimodal Treatment Study of Children With ADHD. METHOD Naturalistic subgroups were established based on patterns of treatment with stimulant medication at baseline, 14-, 24-, and 36-month assessments: not medicated (n = 65), newly medicated (n = 88), consistently medicated (n = 70), and inconsistently medicated (n = 147). Analysis of variance was used to evaluate effects of subgroup and assessment time on measures of relative size (z scores) obtained from growth norms. RESULTS The subgroup x assessment time interaction was significant for z height (p <.005) and z weight (p <.0001), due primarily to divergence of the newly medicated and the not medicated subgroups. These initially stimulant-naïve subgroups had z scores significantly >0 at baseline. The newly medicated subgroup showed decreases in relative size that reached asymptotes by the 36-month assessment, when this group showed average growth of 2.0 cm and 2.7 kg less than the not medicated subgroup, which showed slight increases in relative size. CONCLUSIONS Stimulant-naïve school-age children with Combined type attention-deficit/hyperactivity disorder were, as a group, larger than expected from norms before treatment but show stimulant-related decreases in growth rates after initiation of treatment, which appeared to reach asymptotes within 3 years without evidence of growth rebound.
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Pliszka S. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2007; 46:894-921. [PMID: 17581453 DOI: 10.1097/chi.0b013e318054e724] [Citation(s) in RCA: 1031] [Impact Index Per Article: 60.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This practice parameter describes the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) based on the current scientific evidence and clinical consensus of experts in the field. This parameter discusses the clinical evaluation for ADHD, comorbid conditions associated with ADHD, research on the etiology of the disorder, and psychopharmacological and psychosocial interventions for ADHD.
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Abstract
Attention-deficit-hyperactivity disorder (ADHD) is a commonly occurring, heritable neurobehavioral disorder distributed worldwide that does not typically resolve after childhood. The significant impact of ADHD on an individual's family, relationships, educational performance, and performance at work is now well established. Medical treatment of ADHD is effective, not only alleviating symptoms but also improving overall functioning. It is imperative that primary care physicians be well versed in this disorder and its clinical features across the age groups. The primary care physician should be able to screen, diagnose, educate, and initiate medication management in patients with uncomplicated ADHD.
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Affiliation(s)
- Sreenivas Katragadda
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, USA
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Leitner Y, Doniger GM, Barak R, Simon ES, Hausdorff JM. A novel multidomain computerized cognitive assessment for attention-deficit hyperactivity disorder: evidence for widespread and circumscribed cognitive deficits. J Child Neurol 2007; 22:264-76. [PMID: 17621495 DOI: 10.1177/0883073807299859] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Multidomain assessment may enhance the diagnosis of cognitive impairment in children with attention-deficit hyperactivity disorder (ADHD). A set of novel Web-enabled computerized tests has recently been shown to be valid for identifying mild cognitive impairment and characterizing the cognitive profile associated with various disorders. It was anticipated that these tests would be well suited for use in children with ADHD. The authors tested this idea in a pilot study of 15 children (12 males, 3 females; mean age, 11 years 10 months; range, 9-15 years) with ADHD and 15 age-, education-, and gender-matched controls. The profile of cognitive impairment in ADHD children off methylphenidate across 6 cognitive domains (memory, executive function, visual-spatial skills, verbal function, attention, and motor skills) was described relative to controls. The effect of treatment with methylphenidate was examined by comparing the ADHD children on methylphenidate and on placebo (administered in a double-blind randomized fashion) relative to controls and by comparing the ADHD children on methylphenidate relative to placebo. Significant impairment in ADHD was evident in memory, visual-spatial, verbal, and attention domains, and near-significant impairment was observed in executive function and motor skills. On methylphenidate but not placebo, performance was comparable to controls in immediate verbal memory, psychomotor accuracy, visual-spatial, verbal rhyming, and overall battery performance. Significant improvement with administration of methylphenidate relative to placebo was evident for psychomotor accuracy, verbal rhyming, and overall battery performance. Hence, on the limited basis of this pilot study, the set of computerized tests studied appears to be useful for measuring cognitive function in ADHD; however, additional studies are needed to confirm this.
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Affiliation(s)
- Yael Leitner
- Paediatric Neurology Unit and Child Development Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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37
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Wolraich ML, McGuinn L, Doffing M. Treatment of Attention Deficit Hyperactivity Disorder in Children and Adolescents. Drug Saf 2007; 30:17-26. [PMID: 17194168 DOI: 10.2165/00002018-200730010-00003] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Despite a large body of evidence for both the validity of the diagnosis of attention deficit hyperactivity disorder (ADHD) and the efficacy of its treatment with medication, there is an equally long history of controversy. This article focuses on presenting safety information for medications approved by the US FDA for the treatment of individuals with ADHD. Stimulant medications are generally safe and effective. The common adverse effects of stimulant medications, including appetite suppression and insomnia, are usually of mild severity and manageable without stopping the medication. The more severe adverse effects such as tics or bizarre behaviours occur with low frequency and usually resolve when the medication is stopped. The possible impact on growth requires careful monitoring. Several rare but potentially severe adverse effects including sudden cardiac death and cancer following long-term treatment have been reported; however, these effects have not been adequately demonstrated to be of significant concern at this time. Atomoxetine also has a mild adverse effect profile in terms of severity and frequency although the numbers of studies and years of clinical experience is considerably less with this drug than for the stimulant medications. When the risks are juxtaposed to the clear efficacy in significantly reducing dysfunctional symptoms of ADHD, benefit-risk analyses support the continued use of these pharmacological treatments for patients with ADHD.
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Affiliation(s)
- Mark L Wolraich
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73117, USA
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Swanson J, Greenhill L, Wigal T, Kollins S, Stehli A, Davies M, Chuang S, Vitiello B, Skrobala A, Posner K, Abikoff H, Oatis M, McCRACKEN J, McGOUGH J, Riddle M, Ghuman J, Cunningham C, Wigal S. Stimulant-related reductions of growth rates in the PATS. J Am Acad Child Adolesc Psychiatry 2006; 45:1304-1313. [PMID: 17023868 DOI: 10.1097/01.chi.0000235075.25038.5a] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate growth of children with attention-deficit/hyperactivity disorder (ADHD) in the Preschool ADHD Treatment Study (PATS) before and after initiation of treatment with methylphenidate at titrated doses (average, 14.2 mg/day) administered three times daily, 7 days/week for asymptotically equal to1 year. METHOD The heights and weights of 140 children with ADHD were measured up to 29 times in the PATS protocol, starting at an average age of 4.4 years. The relationship between standard (z) scores and time on medication was examined using mixed-effect regression to estimate change in relative size (slope). RESULTS Average relative size at baseline was significantly (p<.0001) greater than zero for z height (+0.45) and z weight (+0.78), indicating greater than expected height (by 2.04 cm) and weight (by 1.78 kg). During treatment, slopes were significantly (p<.0001) less than zero for z height (-0.304/yr) and z weight (-0.530/yr), indicating reduction of growth rates. For 95 children who remained on medication, annual growth rates were 20.3% less than expected for height (5.41 cm/yr-6.79 cm/yr=-1.38 cm/yr) and 55.2% for weight (1.07 kg/yr-2.39 kg/yr=-1.32 kg/yr). CONCLUSIONS Risks of reduced growth rates should be balanced against expected benefits when preschool-age children are treated with stimulant medication.
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Affiliation(s)
- James Swanson
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada..
| | - Laurence Greenhill
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - Tim Wigal
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - Scott Kollins
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - Annamarie Stehli
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - Mark Davies
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - Shirley Chuang
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - Benedetto Vitiello
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - Anne Skrobala
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - Kelly Posner
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - Howard Abikoff
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - Melvin Oatis
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - James McCRACKEN
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - James McGOUGH
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - Mark Riddle
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - Jaswinder Ghuman
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - Charles Cunningham
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
| | - Sharon Wigal
- Drs. Swanson, S. Wigal, and T. Wigal, and Ms. Stehli are with the University of California, Irvine; Dr. Kollins is with Duke University Medical Center, Durham, NC; Drs. Greenhill and Posner, and Ms. Chuang, Ms. Skrobala, and Mr. Davies (retired) are with New York State Psychiatric Institute/Columbia University, New York; Drs. Abikoff and Oatis are with New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Ghuman is with the University of Arizona, Tucson; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Cunningham is with McMaster University, Hamilton, Ontario, Canada
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Abstract
PURPOSE OF REVIEW Growth and maturation in children and adolescents with attention deficit hyperactivity disorder has been the subject of controversy for many years. The purpose of this review is to describe the course of current opinion, summarize findings that have been supported by scientific evidence and show why one widely disseminated opinion is unfounded. RECENT FINDINGS Recent studies have shown reductions in expected growth in height and weight in children starting treatment with stimulant medication. With prolonged treatment of 2-3 years, growth velocities show a trend towards normalization. There is evidence from recently published data that the effect of stimulant medication on growth is closely linked to its therapeutic effect--an interpretation which has not previously been reported. Normal growth velocities have been demonstrated in untreated children with attention deficit hyperactivity disorder. SUMMARY Recent findings that children with attention deficit hyperactivity disorder treated with stimulant medication grow more slowly than untreated children confirm the results of the early studies of 1972-1973. This should now focus research towards the areas that require further investigation, such as establishing the mechanism of the stimulant-associated growth attenuation, and defining in more detail the effects of stimulant medication on growth and maturation in children of different ages.
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Affiliation(s)
- Alison Poulton
- Western Clinical School, Nepean Campus, University of Sydney, New South Wales, Australia.
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40
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Correll CU, Carlson HE. Endocrine and metabolic adverse effects of psychotropic medications in children and adolescents. J Am Acad Child Adolesc Psychiatry 2006; 45:771-91. [PMID: 16832314 DOI: 10.1097/01.chi.0000220851.94392.30] [Citation(s) in RCA: 274] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Despite increasing use of psychotropic medications in children and adolescents, data regarding their efficacy and safety are limited. Endocrine and metabolic adverse effects are among the most concerning adverse effects of commonly used psychotropic medications. METHOD Selective review of endocrine and metabolic effects of psychotropic medications in pediatric populations, with a focus on monitoring and management strategies. RESULTS Because youth are still developing at the time of psychotropic drug exposure, most reference values need to be adjusted for gender and age. As in adults, youngsters receiving lithium require monitoring for thyroid dysfunction. Psychostimulants appear to cause mild reversible growth retardation in some patients, most likely because of decreased weight or slowing of expected weight gain; some patients may experience clinically significant reductions in adult height. Although still controversial, valproate use has been associated with an increased risk for polycystic ovary syndrome, in addition to causing weight gain. Although more data are required, children and adolescents appear to be at higher risk than adults for antipsychotic-induced hyperprolactinemia, weight gain, and possibly, associated metabolic abnormalities, which is of particular concern. CONCLUSIONS Clinicians and caregivers need to be aware of potential endocrine and metabolic adverse effects of psychiatric medications. A careful selection of patients, choice of agents with potentially lesser risk for these adverse events, healthy lifestyle counseling, as well as close health monitoring are warranted to maximize effectiveness and safety.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, 75-59 263rd Street, Glen Oaks, NY 11004, USA.
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41
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Pliszka SR, Matthews TL, Braslow KJ, Watson MA. Comparative effects of methylphenidate and mixed salts amphetamine on height and weight in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2006; 45:520-526. [PMID: 16670648 DOI: 10.1097/01.chi.0000205702.48324.fd] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether methylphenidate (MPH) and mixed salts amphetamine (MSA) have different effects on growth in children with attention-deficit/hyperactivity disorder. METHOD Patients treated for at least 1 year with MPH or MSA were identified. A linear regression was performed to determine the effect of stimulant type, patient gender, cumulative stimulant dose, and length of time in treatment on change in Z scores for height. A subset of patients was identified who had 3 years of consistent stimulant treatment on either MSA or MPH. Repeated-measures analyses of variance were performed to examine the effects of time and medication type on Z scores for weight, height, and body mass index. RESULTS The linear regression showed no effect of stimulant type, drug holidays, or length of time of treatment on change in height Z score. Cumulative dose of stimulant had a small (-0.26) relationship to change in height Z scores. For patients treated for 3 years, there were no effects of stimulant or time on height Z scores. MSA produced more decrease in weight and body mass index Z scores than MPH; all of the subjects were heavier than average at baseline. CONCLUSION MSA and MPH did not differ in their effects on height. MSA had more of an effect on weight than MPH, although the effect was modest in magnitude and may be of limited clinical significance.
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Affiliation(s)
- Steven R Pliszka
- Drs. Pliszka, Matthews, and Watson are with the Department of Psychiatry, University of Texas of Health Science Center at San Antonio; and Dr. Braslow is with the Department of Psychiatry, University of California at San Francisco.
| | - Thomas L Matthews
- Drs. Pliszka, Matthews, and Watson are with the Department of Psychiatry, University of Texas of Health Science Center at San Antonio; and Dr. Braslow is with the Department of Psychiatry, University of California at San Francisco
| | - Kenneth J Braslow
- Drs. Pliszka, Matthews, and Watson are with the Department of Psychiatry, University of Texas of Health Science Center at San Antonio; and Dr. Braslow is with the Department of Psychiatry, University of California at San Francisco
| | - Melissa A Watson
- Drs. Pliszka, Matthews, and Watson are with the Department of Psychiatry, University of Texas of Health Science Center at San Antonio; and Dr. Braslow is with the Department of Psychiatry, University of California at San Francisco
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Spencer TJ, Faraone SV, Biederman J, Lerner M, Cooper KM, Zimmerman B. Does prolonged therapy with a long-acting stimulant suppress growth in children with ADHD? J Am Acad Child Adolesc Psychiatry 2006; 45:527-537. [PMID: 16670649 DOI: 10.1097/01.chi.0000205710.01690.d4] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate whether prolonged therapy with a long-acting stimulant affects growth in children with attention-deficit/hyperactivity disorder (ADHD). METHOD One hundred seventy-eight children ages 6 to 13 years received OROS methylphenidate (OROS MPH, CONCERTA) for at least 21 months. Height and weight were measured monthly during the first year and every 3 months thereafter. RESULTS At baseline, subjects were approximately the expected height for their age and somewhat heavier than expected. Subjects gained height steadily throughout the study and were on average 0.23 cm less than expected at month 21. Weight did not increase and BMI decreased slightly in the first 4 months. Thereafter, weight Z score and BMI Z score remained relatively constant and children were on average 1.23 kg less than expected at month 21. Previous stimulant therapy tended to be associated with a smaller decrease in Z score during the study compared with no previous stimulant therapy. Drug holidays did not significantly affect growth. CONCLUSIONS The effects of prolonged OROS MPH therapy on growth were clinically insignificant and limited to slight decreases in weight during the first months of therapy. Drug holidays did not reduce any impact on growth and are thus of questionable utility for limiting potential effects of treatment on growth.
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Affiliation(s)
- Thomas J Spencer
- Drs. Spencer and Biederman are with Massachusetts General Hospital, Boston; Dr. Faraone is with the Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse; Dr. Lerner is with the University of California, Irvine; and Ms. Cooper and Ms. Zimmerman are with McNeil Consumer and Specialty Pharmaceuticals, Fort Washington, PA.
| | - Stephen V Faraone
- Drs. Spencer and Biederman are with Massachusetts General Hospital, Boston; Dr. Faraone is with the Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse; Dr. Lerner is with the University of California, Irvine; and Ms. Cooper and Ms. Zimmerman are with McNeil Consumer and Specialty Pharmaceuticals, Fort Washington, PA
| | - Joseph Biederman
- Drs. Spencer and Biederman are with Massachusetts General Hospital, Boston; Dr. Faraone is with the Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse; Dr. Lerner is with the University of California, Irvine; and Ms. Cooper and Ms. Zimmerman are with McNeil Consumer and Specialty Pharmaceuticals, Fort Washington, PA
| | - Marc Lerner
- Drs. Spencer and Biederman are with Massachusetts General Hospital, Boston; Dr. Faraone is with the Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse; Dr. Lerner is with the University of California, Irvine; and Ms. Cooper and Ms. Zimmerman are with McNeil Consumer and Specialty Pharmaceuticals, Fort Washington, PA
| | - Kimberly M Cooper
- Drs. Spencer and Biederman are with Massachusetts General Hospital, Boston; Dr. Faraone is with the Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse; Dr. Lerner is with the University of California, Irvine; and Ms. Cooper and Ms. Zimmerman are with McNeil Consumer and Specialty Pharmaceuticals, Fort Washington, PA
| | - Brenda Zimmerman
- Drs. Spencer and Biederman are with Massachusetts General Hospital, Boston; Dr. Faraone is with the Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse; Dr. Lerner is with the University of California, Irvine; and Ms. Cooper and Ms. Zimmerman are with McNeil Consumer and Specialty Pharmaceuticals, Fort Washington, PA
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43
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Charach A, Figueroa M, Chen S, Ickowicz A, Schachar R. Stimulant treatment over 5 years: effects on growth. J Am Acad Child Adolesc Psychiatry 2006; 45:415-21. [PMID: 16601646 DOI: 10.1097/01.chi.0000199026.91699.20] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Long-term effects of psychostimulants on growth in height and in weight are investigated in children with attention-deficit/hyperactivity disorder. METHOD 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. RESULTS 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. CONCLUSION 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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Affiliation(s)
- Alice Charach
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Abstract
AIMS 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. METHODS 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. RESULTS 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. CONCLUSIONS 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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Affiliation(s)
- A Poulton
- Western Clinical School, Nepean Campus, The University of Sydney, Australia.
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Pelham WE, Manos MJ, Ezzell CE, Tresco KE, Gnagy EM, Hoffman MT, Onyango AN, Fabiano GA, Lopez-Williams A, Wymbs BT, Caserta D, Chronis AM, Burrows-Maclean L, Morse G. A dose-ranging study of a methylphenidate transdermal system in children with ADHD. J Am Acad Child Adolesc Psychiatry 2005; 44:522-9. [PMID: 15908834 DOI: 10.1097/01.chi.0000157548.48960.95] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This was a multicenter, double-blind, randomized, dose-ranging study of a methylphenidate (MPH) transdermal system (MTS). Medication (placebo, 0.45, 0.9, and 1.8 mg/h) was crossed with application time (6 a.m., 7 a.m.) to evaluate MTS efficacy and influence of exposure time on morning effects. METHOD The study took place in a summer treatment program (STP) at three sites, with 36 children aged 7-12 years with attention-deficit/hyperactivity disorder. Each treatment was administered for 1 day in random order, for a total of 8 days. Behavioral and academic measures were taken as well as patch wear characteristics and side effects. RESULTS Evaluable participant data were analyzed in a series of dose x application time multivariate analyses of variance. All MTS conditions were significantly different from placebo across measures. Time of application had no significant effect on daily behavior, and effects of application time on morning behavior were inconclusive. Consistent with previous results in this setting, the highest dose produced limited incremental benefit compared with the mid-range dose. The wear characteristics of the MTS were acceptable, and the formulation was well tolerated. CONCLUSIONS The MTS produced significant effects that were similar to those previously reported with comparable MPH doses. There does not appear to be a substantial effect of application time on total daily functioning in this setting; further controlled time-course studies will be necessary to evaluate the question of morning onset fully.
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Wolraich ML, Doffing MA. Pharmacokinetic considerations in the treatment of attention-deficit hyperactivity disorder with methylphenidate. CNS Drugs 2004; 18:243-50. [PMID: 15015904 DOI: 10.2165/00023210-200418040-00004] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Methylphenidate is commonly used for the treatment of attention-deficit hyperactivity disorder (ADHD). Its efficacy in improving the core symptoms of ADHD, as well as some of the aggressive and oppositional behaviours, is well documented, based on a large volume of research. Methylphenidate has a wide margin of safety and relatively mild adverse effects, most commonly appetite suppression and insomnia. Methylphenidate is a rapidly absorbed medication that, in its d-isomer form, readily penetrates the CNS, particularly the striatum. It appears to function by blocking the reuptake of dopamine. Both the plasma concentrations and behavioural effects of methylphenidate demonstrate a time to maximum of between 1 and 3 hours, with the maximum behavioural effects occurring when the plasma concentrations are increasing. Because of the rapid onset of action, the effects of methylphenidate can be dramatic but usually last only about 4 hours with the immediate-release formulation. The behavioural responses of individuals are also highly variable, so that it is necessary to start treatment at a low dosage and increase up to a maximally effective dosage (usually starting at 10-15 mg/day with increases of 10-15mg at weekly intervals to a maximum dosage of 60 mg/day, irrespective of formulation). Because of the variability in behavioural responses, assessment of plasma concentrations is not clinically useful nor does weight help in deciding an appropriate dosage. The difficulties in administering methylphenidate multiple times a day, particularly during the school day, have been alleviated in the past few years by the development of extended-release preparations with varying behavioural effects lasting 8-12 hours. The 8-hour preparations (Metadate) CD and Ritalin) LA) utilise a microbead technology, while the 12-hour preparation (Concerta) utilises an osmotic pump system. All extended-release formulations effectively control the symptoms of ADHD. While pharmacokinetic differences appear to exist between some of these new formulations, there are currently no clinical data available to demonstrate clinical efficacy differences between them.
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Affiliation(s)
- Mark L Wolraich
- University of Oklahoma Health Sciences Center, Child Study Center, Oklahoma City, Oklahoma 73117, USA.
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Affiliation(s)
- T Lobstein
- IASO International Obesity TaskForce, 231 North Gower Street, London NW1 2NS, UK.
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National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: changes in effectiveness and growth after the end of treatment. Pediatrics 2004; 113:762-9. [PMID: 15060225 DOI: 10.1542/peds.113.4.762] [Citation(s) in RCA: 315] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Intent-to-treat analyses of the Multimodal Treatment Study of ADHD (MTA) revealed group differences on attention-deficit/hyperactivity disorder symptoms ratings, with better outcome in groups of participants who were assigned the medication algorithm-medication alone (MedMgt) and combined (Comb)--than in those who were not-behavior modification (Beh) alone and community comparison (CC). However, the effect size was reduced by 50% from the end of treatment to the first follow-up. The convergence of outcomes suggests differential changes by treatment group beween 14 and 24 months, which this report explores, both for benefits of treatment and for side effects on growth. METHODS We documented reported medication use at 14- and 24-month assessments and formed 4 naturalistic subgroups (Med/Med, Med/NoMed, NoMed/Med, and NoMed/NoMed). Then we performed exploratory mediator analyses to evaluate effects of changes in medication use on 14- to 24-month change scores of effectiveness (symptom ratings) and growth (height and weight measures). RESULTS The randomly assigned groups with the greatest improvement at the end of the treatment phase (Comb and MedMgt) deteriorated during the follow-up phase, but the other 2 groups (Beh and CC) did not. There were no significant differences in the 14- to 24-month growth rates among the randomly assigned groups, in contrast to significant growth suppression in the Comb and MedMgt at the end of the treatment phase. Changes in medication use mediated the 14- to 24-month change in attention-deficit/hyperactivity disorder symptom ratings: the subgroup that reported stopping medication (Med/NoMed) showed the largest deterioration, the subgroup that consistently reported (Med/Med) or never reported (NoMed/NoMed) medication use showed modest deterioration, and the subgroup that reported starting medication (NoMed/Med) showed improvement. Changes in medication use also mediated growth effects: the subgroup that consistently reported medication use (Med/Med) showed reduced height gain compared with the subgroup that never reported medication use (NoMed/NoMed), which actually grew faster than predicted by population norms. CONCLUSION In the MTA follow-up, exploratory naturalistic analyses suggest that consistent use of stimulant medication was associated with maintenance of effectiveness but continued mild growth suppression.
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Abstract
Treatment of hyperactive child is multimodal, a combination of behaviour therapy and medication. Stimulant drugs are the most often prescribed medications. In France, we use methylphenidate (Ritaline); its efficacy was demonstrated with mild side effects. New formulations of methylphenidate with prolonged action, and non-psychostimulant treatment (atomoxetine) are available in some countries, but not yet in France.
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Affiliation(s)
- M-F Le Heuzey
- Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Sérurier, 75935 Paris 19, France.
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Abstract
An extended-release formulation of methylphenidate (Ritalin LA), a CNS stimulant that inhibits dopamine and noradrenaline (norepinephrine) reuptake into presynaptic neurons, has been developed for use in patients with attention deficit/hyperactivity disorder (ADHD). In children with ADHD and healthy male adults, extended-release methylphenidate 20mg was rapidly absorbed and demonstrated two distinct peak plasma concentrations approximately 4 hours apart. The absorption pharmacokinetics of extended-release methylphenidate 20mg, which closely mimics those of immediate-release methylphenidate 10mg given in two doses 4 hours apart, permits once-daily administration. In a 2-week randomised, double-blind, placebo-controlled trial in 134 evaluable children aged 6 to 12 years with ADHD, symptoms improved to a significantly greater extent with extended-release methylphenidate 10 to 40mg once daily than with placebo. Extended-release methylphenidate improved both inattention and hyperactivity symptoms and was effective in children with combined- (inattentive and hyperactive/impulsive) type or predominantly inattentive-type ADHD. In clinical trials, the safety and tolerability profiles of extended-release methylphenidate were consistent with that of the immediate-release formulation.
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