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Trajectories of Growth Associated With Long-Term Stimulant Medication in the Multimodal Treatment Study of
Laurence L Greenhill1, James M Swanson2, Lily Hechtman3
1Division of Child Psychiatry, New York State Psychiatric Institute, and Columbia University, New York, NY.
Insights
Consistent stimulant treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) over 16 years was linked to reduced adult height and increased weight in the Multimodal Treatment Study of ADHD (MTA).
Area of Science:
- Child and Adolescent Psychiatry
- Neurodevelopmental Disorders
- Pharmacological Treatments
Background:
- Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder.
- Stimulant medications are frequently prescribed for ADHD management.
- Long-term effects of stimulant treatment on physical growth require further investigation.
Purpose of the Study:
- To examine the long-term associations between stimulant treatment and height, weight, and body mass index (BMI) trajectories.
- To compare growth patterns in children with ADHD receiving consistent stimulant treatment versus those with negligible or inconsistent use.
- To assess these associations from childhood into adulthood using data from the Multimodal Treatment Study of ADHD (MTA).
Main Methods:
- The study followed 579 children with ADHD and 289 classmates over 16 years, with 8 assessments.
- Participants were categorized into subgroups based on stimulant medication use: Consistent, Inconsistent, and Negligible.
- Height and weight trajectories were analyzed using standardized z scores for each subgroup.
Main Results:
- Height z-score trajectories significantly differed among subgroups and by prior stimulant use.
- Consistent stimulant users were shorter in adulthood compared to negligible users and the local normative comparison group (LNCG).
- Weight z scores diverged, converged in adolescence, and diverged again in adulthood, with consistent users outweighing the LNCG.
Conclusions:
- Sixteen years of consistent stimulant treatment for ADHD was associated with reduced adult height.
- Consistent stimulant use also correlated with increased adult weight and BMI compared to negligible use and LNCG.
- These findings highlight the long-term physical growth implications of sustained stimulant treatment in ADHD.
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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