A Randomized Controlled Trial of Interventions for Growth Suppression in Children With Attention-Deficit/Hyperactivity Disorder Treated With Central Nervous System Stimulants.

Abstract

OBJECTIVE\nTo examine the impact of central nervous system (CNS) stimulants on the growth of children with attention-deficit/hyperactivity disorder (ADHD) and assess the efficacy and feasibility of weight recovery interventions on growth.\n\n\nMETHOD\n230 children ages 5-12 with ADHD with no history of chronic CNS stimulant usage were randomly assigned to receive daily CNS stimulants (78%, primarily OROS-Methylphenidate [OROS-MPH]) or behavioral treatment (22%) for 30 months. After 6 months, children evidencing a decline in body mass index (BMI) of >.5 z-units were randomized to one of three 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.\n\n\nRESULTS\nBefore WRT assignment, medication was associated with significant reductions in standardized weight and height (p s<.01). Adherence to CS and DH during WRT was high, with significant increases in daily caloric intake and decreases in weekly medication exposure (p s<.05). Across all WRT participants (n=71), weight velocity increased significantly after WRT randomization ((β_2) ̅=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 (-0.44z-units) and height (-0.20z-units).\n\n\nCONCLUSION\nDrug holidays, caloric supplementation and increased monitoring all led to increased weight velocity in children taking CNS stimulants, but none led to increased height velocity.