Joachim Cieślik

Growth in Stimulant-naive Children With Attention-Deficit/Hyperactivity Disorder Using Cross-sectional and Longitudinal Approaches

OBJECTIVE. The objective of this study was to investigate the growth of stimulant-naive children with attention-deficit/hyperactivity disorder in 3 aspects of development: level, trend, and structure of the process. PATIENTS AND METHOD. The study sample included 53 individuals between the ages of 6 and 17 years (mean: 11.90). The average level of growth (z scores) in prepubertal, pubertal, and postpubertal stage of development and trend of the process were estimated on the basis of a comparison with growth charts. The prediction of adolescent growth spurt was conducted using the mathematical structural growth model of Jolioceur, Pontier, and Abidi. RESULTS. Difference between boys with attention-deficit/hyperactivity and the norm was statistically significant in the prepubertal stage and for the average level of growth between the ages of 2 and 17 years. Distinct suppression of growth was found between the ages of 9 and 14. Analysis of development structure revealed an earlier onset of the adolescent growth spurt among boys (difference: 5 months) and a higher velocity of growth at this moment (difference: 0.33 cm/year) than expected values. CONCLUSIONS. The application of both cross-sectional and longitudinal analyses clearly illustrated the higher level of growth of boys with attention-deficit/hyperactivity in the prepubertal stage, the suppression of growth on the turn of prepubertal and pubertal periods, and earlier occurrence of the spurt onset. Observed differences in the level and trend of growth as well as in the parameters of adolescent growth spurt are linked with disorder-related factors.

Growth patterns in children with mucopolysaccharidosis I and II

BackgroundMucopolysaccharidosis (MPS) diseases lead to a profound disruption in normal mechanisms of growth and development. This study was undertaken to determine the general growth of children with MPS I and II.MethodsThe anthropometric data of patients with MPS I and II (n=76) were retrospectively analyzed. The growth patterns of these patients were analyzed and then plotted onto Polish reference charts. Longitudinal analyses were performed to estimate age-related changes.ResultsAt the time of birth, the body length was greater than reference charts for all MPS groups (Hurler syndrome, P=0.006; attenuated MPS II, P=0.011; severe MPS II, P<0.001). The mean z-score values for every MPS group showed that until the 30th month of life, the growth patterns for all patients were similar. Afterwards, these growth patterns start to differ for individual groups. The body height below the 3rd percentile was achieved around the 30th month for boys with Hurler syndrome, between the 4th and 5th year for patients with severe MPS II and between the 7th and 8th year for patients with attenuated MPS II.ConclusionsThe growth pattern differs between patients with MPS I and II. It reflects the clinical severity of MPS and may assist in the evaluation of clinical efficacy of available therapies.

An association between adverse events, anxiety and body size of adolescents.

The aim of the study was to assess the relationship between adverse life events, a tendency to respond with a high level of anxiety, and height and adiposity of adolescents. The sample included 575 persons (309 girls and 266 boys) aged 10-15 (mean 12.73) from the Wielkopolska region of Poland. The influence of adverse events during the 6 months before the examination and anxiety trait, as assessed with a STAIC questionnaire, on body height and BMI was analysed. Also sex, age, chronic diseases and socioeconomic status indicators were assessed. One-way and two-way ANOVA was used for assessment of relationships. Adverse events had no influence on body height and BMI. Subjects with a high level of anxiety trait (>34 score) were shorter (difference z=0.21) than subjects with a normal level of anxiety trait (≤34 score). The association of anxiety trait and body height was significant after adjustment for sex, age, chronic diseases and history of adverse life events. The analysis showed no statistically significant influence of adverse life events on height and BMI and a significant relationship between the general tendency to respond with anxiety and body height of adolescents. This suggests that psychological characteristics associated with the cognitive tendency to interpret events as threatening, and consequently, to respond with stress, may be involved in the variability of biological traits regardless of the objective harmfulness of the situation.

Measurement of Growth in Stimulant-Naive Children With Attention-Deficit/Hyperactivity Disorder by Using Cross-sectional and Longitudinal Approaches: In Reply

Hanć and Cieślik1 investigated growth in untreated children with attention-deficit/hyperactivity disorder (ADHD) and showed that stimulant-naive children with ADHD aged 2 to 17 years were significantly taller than normal controls (P .002). This observation raises major concerns with regards to the impact of stimulant medication on growth. Stimulant medication has been shown to have a significant negative impact on growth. The biggest study on this issue has been the Multimodal Treatment Study of ADHD (MTA study).2 The MTA study showed that children consistently treated with stimulant medication had heights of 0.165 SDs below the population mean (height z score: 0.165) at the age of 9. A comparable normal control group had an average height z score of 0.23, implying a stimulant-associated total reduction in height z score of 0.395. In their study, Hanć and Cieœlik found that at the age of 9 years children with ADHD were actually 1.0 z scores taller than normal children. This would imply that the average 9-year-old child with ADHD would have a baseline height z score of 1.23 and that treatment with stimulant medication could be associated with a reduction in height z score of 1.625. Assuming an SD for height of 5.8 cm for boys at the age of 9 years,3 this would translate to a clinically significant height deficit of 9.4 cm for children with ADHD on stimulant medication. The authors’ findings are important, because they imply a far greater impact of stimulant medication on growth than has been shown in any other study. However, the methodology of comparing observed growth in controls with predicted growth by using mathematical modeling in subjects may require additional scrutiny.