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A Randomized Controlled Trial of Interventions for Growth Suppression in Children With
James G Waxmonsky1, William E Pelham2, Adriana Campa3
1Penn State College of Medicine, Hershey, Pennsylvania.
Insights
Central nervous system (CNS) stimulants for attention-deficit/hyperactivity disorder (ADHD) can reduce growth. Interventions like drug holidays and caloric supplementation improved weight velocity but not height velocity in children with ADHD.
Area of Science:
- Pediatric Endocrinology
- Neurodevelopmental Disorders
- Child Psychology
Background:
- Attention-deficit/hyperactivity disorder (ADHD) affects numerous children globally.
- Central nervous system (CNS) stimulants are a primary treatment for ADHD, but can impact growth.
- Understanding and mitigating stimulant-induced growth suppression is crucial for long-term child health.
Purpose of the Study:
- To investigate the effects of CNS stimulants on growth in children with ADHD.
- To evaluate the effectiveness and feasibility of weight recovery interventions (WRIs) in addressing growth deficits.
Main Methods:
- A 30-month study involving 230 children (5-12 years) with ADHD, treated with CNS stimulants or behavioral therapy.
- Children with a BMI decline (>0.5 z-units) after 6 months were randomized to monthly monitoring, drug holidays, or caloric supplementation.
- Weight and height velocity were measured before and after WRI randomization.
Main Results:
- CNS stimulant treatment was associated with significant reductions in standardized weight and height.
- Weight recovery interventions (caloric supplementation, drug holidays) increased weight velocity.
- No WRI demonstrated an increase in height velocity; overall study participants showed declines in standardized weight and height.
Conclusions:
- Weight recovery interventions can enhance weight velocity in children with ADHD on CNS stimulants.
- Current interventions do not appear to improve height velocity and overall growth may still be impacted.
- Further research is needed to optimize interventions for comprehensive growth support in children with ADHD.
Objective:
To examine the impact of central nervous system (CNS) stimulants on the growth of children with attention-deficit/hyperactivity disorder (ADHD), and to assess the efficacy and feasibility of weight recovery interventions on growth.
Method:
A total of 230 children aged 5 to 12 years with ADHD with no history of chronic CNS stimulant use were randomly assigned to receive daily CNS stimulants (78%, primarily osmotic release oral system-methylphenidate [OROS-MPH]) or behavioral treatment (22%) for 30 months. After 6 months, children evidencing a decline in body mass index (BMI) of >0.5 z-units were randomized to 1 of 3 weight recovery treatments (WRTs): monthly monitoring of height/weight (MON) plus continued daily medication; drug holidays (DH) with medication limited to school days; or daily caloric supplementation (CS) with a 150-kcal supplement plus daily medication.
Results:
Before WRT assignment, medication was associated with significant reductions in standardized weight and height (p values <.01). Adherence to CS and DH during WRT was high, with significant increases in daily caloric intake and decreases in weekly medication exposure (p values <.05). Across all WRT participants (n = 71), weight velocity increased significantly after WRT randomization (β2 = 0.271, SE = 0.027, p < .001).When analyzed by what parents did (versus what they were assigned to), CS (p < .01) and DH (p < .05) increased weight velocity more than MON. No increase in height velocity was seen after randomization to any WRT. Over the entire study, WRT participants declined in standardized weight (-0.44 z-units) and height (-0.20 z-units).
Conclusion:
Drug holidays, caloric supplementation, and increased monitoring all led to increased weight velocity in children taking CNS stimulants, but none led to increased height velocity.
Clinical Trial Registration Information:
Novel Approach to Stimulant Induced Weight Suppression and Its Impact on Growth; https://clinicaltrials.gov/; NCT01109849.
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