Predictors of Changes in Height, Weight, and Body Mass Index after Initiation of Central Nervous System Stimulants in Children with Attention-Deficit/Hyperactivity Disorder.

Abstract

OBJECTIVE\nTo identify predictors of changes in height, weight, and BMI in children with ADHD starting Central Nervous System (CNS) stimulants.\n\n\nSTUDY DESIGN\n230 medication-naïve children ages 5-12 with ADHD participated in a randomized trial evaluating the impact of CNS stimulants on growth over 30 months. This observational analysis focused on the 141 participants using study medication for ≥50% of weekdays over any 6-month period. Biometric variables, ADHD and oppositional defiant disorder symptom scores at medication initiation and medication usage over the study were examined as predictors of changes in standardized height, weight, and BMI.\n\n\nRESULTS\nMean changes in z-BMI, z-weight and z-height were negative throughout the study. The most consistent predictors of change in z-BMI, z-weight and z-height were percent days medicated and total medication exposure. Children with lower z-height and z-weight at medication initiation experienced greater z-BMI and z-weight reductions over the first 6 months on medication. Greater appetite suppression during dose optimization predicted greater reductions in z-weight over the entire study and greater reduction in z-height over the first 6 months on medication. Weight change correlated with height change. Behavioral symptoms did not predict changes in z-BMI, z-weight or z-height.\n\n\nCONCLUSIONS\nHow much and how often CNS stimulants are used predicts changes in z-BMI, z-weight, and z-height in children. Even smaller and lighter children may be at risk for z-weight and z-BMI decline. Parent ratings of appetite during dose titration may serve as feasible indicators of future weight and height change in children using CNS stimulants.