ADHD Drugs Can Stunt Growth

(HealthDay News) -- A new review of past studies on the effect that attention-deficit hyperactivity disorder (ADHD) drugs have on children's growth concludes that the drugs do, in fact, suppress growth to some degree.

While the effect found was statistically significant, one of the study's authors, Dr. Omar Khwaja, an instructor in neurology at Children's Hospital Boston, said the average growth suppression for a 10-year-old boy was probably about three-quarters of an inch in height and a little more than two pounds in weight.

"Parents need to know that when children are on stimulant treatment, although they're probably the best way of treating ADHD, there's a possibility of growth restriction," Khwaja said. "Their physicians need to pay attention and monitor growth in these children, and if it falls off of what is expected, think about lowering the dose or changing the dosing schedule."

Results of the study were presented Monday at the Pediatric Academic Societies annual meeting, in San Francisco.

It's estimated that as many as 5 percent of American children have ADHD, according to the National Institute of Mental Health. The main symptoms are an inability to pay attention, hyperactive behavior and impulsivity. The standard treatment is with stimulant medications, such as Ritalin and Adderall. It seems counterintuitive, but these medications have a calming effect on children with ADHD and help them focus.

However, as with any medication, there's a potential for side effects. One suspected side effect is the suppression of appetite, which is believed to have an effect on a child's weight and possibly height. Dr. David W. Goodman, an assistant professor in the department of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, said the issue of whether these medications contribute to growth suppression has been debated for 35 years.

To try to settle this debate, Khwaja and his colleagues reviewed the literature, looking for studies on ADHD medications and their side effects. They found 22 studies that they considered to have valid, quality methodology.

They pooled the data from these studies and found there was, indeed, an effect on height and weight while children were taking these drugs.

"There was a significant effect on growth for both height and weight during the duration of treatment," Khwaja said.

What can't be gauged from this study, he said, is if those changes are lasting or if the children catch up when they go off the medications, or if they catch up as they get older.

Goodman said other studies have shown a height suppression of about a half inch, and that, in the long-term, children do catch up.

He said one limitation of the new analysis was that it didn't break down the data for short-term and long-term growth suppression.

What parents need to consider, Goodman said, "Is the quality of life improvement great enough to assume the possible risk of slight growth suppression? For most, it's my impression that parents and kids would accept that risk."

"These medications are remarkably helpful," he continued. "Let's put this risk in context with the tremendous benefits that can be gained. For parents that are reluctant to put children and adolescents on medications, I suggest a trial of a couple of weeks or months. You don't have to make a commitment to medication. For most, once they go on the medications, the improvement is so dramatic, they rarely go off."

Both Goodman and Khwaja said changing the timing of administering the medication might make a difference in growth suppression. Goodman said giving the medication after a meal might help offset appetite suppression. And Khwaja said some people just give their children medication when they must be able to focus and sit still, such as during school.

"Limiting the time they're taking medications might cause less of an effect."

Khwaja added that he believes more study needs to be done on this topic, and a prospective trial should be performed to look at the long-term effects these drugs have on children's growth.

More information
The American Academy of Pediatrics offers advice on starting an ADHD treatment plan for your child.