Growth deficits in children with attention deficit hyperactivity disorder

Stimulant-associated growth deficits in children with attention deficit hyperactivity disorder (ADHD) have long been a concern. Height deficits in preadolescence have been reported, but adult heights have been reported to be uncompromised. It is possible that the catch-up growth that occurs is related to ADHD-associated delayed maturation and not to the cessation of stimulant treatment. To date, no consistent neurohormonal pathophysiology to explain stimulant-associated height deficits has been identified nor have the initial associations of height and weight deficits been replicated. Attention deficit hyperactivity disorder is associated with dysregulation of several neurotransmitter systems, especially the catecholamines, that may alter neuroendocrine function and lead to growth delays. The literature on neuroendocrine aspects of growth and treatment in ADHD and on growth in boys with ADHD who are treated with psychotropics is reviewed, and the results of a controlled study in 124 boys with ADHD are presented. Small but significant differences in height were found between children with and without ADHD. However, the height deficits were evident in early, but not late, adolescence and were not related to the use of psychotropic medications. There was no evidence of weight deficits in children with ADHD relative to control subjects and no relationship between measures of malnutrition and short stature was found. These findings suggest that ADHD may be associated with temporary deficits in height gain through midadolescence that may normalize by late adolescence. This effect appears to be mediated by ADHD and not by its treatment.