Study: Consistent use of ADHD meds may stunt growth

[bernorange 8362]

Quote

The Mul­ti­modal Treat­ment Study of ADHD (MTA Study) is the largest ADHD treat­ment study ever con­duct­ed ...

...

Three broad con­clu­sions can be drawn from this study.

First, there was sub­stan­tial per­sis­tence of ADHD symp­toms into adult­hood. Although not mean youth with ADHD con­tin­ue to strug­gle with ADHD as adults, this is not a con­di­tion that most chil­dren sim­ply out­grow. Rather, it is like­ly to be a chron­ic con­di­tion that must be man­aged effec­tive­ly over time. Keep­ing effec­tive treat­ment in place over many years, while extreme­ly chal­leng­ing, may often be nec­es­sary.

Sec­ond, although the ben­e­fits of med­ica­tion treat­ment on ADHD symp­toms dis­si­pate, the impact on adult stature per­sists. Con­sis­tent med­ica­tion treat­ment through ado­les­cence was not linked to reduced symp­toms in young adult­hood; unfor­tu­nate­ly, how­ev­er, it was asso­ci­at­ed with reduced adult height . The impact on height was not triv­ial, with aver­age dif­fer­ences between Con­sis­tent and Neg­li­gi­ble med­ica­tion treat­ment groups of rough­ly 2 inch­es. One impli­ca­tion of this find­ing is that reduc­ing med­ica­tion dose, which can be done when med­ica­tion is com­bined with behav­ior ther­a­py, could be an effec­tive way to mit­i­gate adverse height out­comes.

...

 

More:  https://sharpbrains.com/blog/2018/03/16/consistent-use-of-adhd-medication-may-stun-growth-by-2-inches-large-study-finds/

Reference:  https://www.ncbi.nlm.nih.gov/pubmed/28295312

 

The study did not track or compare EEG Neurofeedback as a treatment modality.  I'd be really interested to see the persistence data on patients who went that route.

[Doc Holliday 199]

Fake news.  Even smoking cigs and every other thing I did poorly as a child did not stunt my growth

Edited March 28, 2018 by Doc Holliday

[bernorange 8362]

Could you expound on that a bit?

[Hate 20108]

As the father of a 9 year old on ADHD meds, this has my attention. We see the doctor every 6 months to make sure he is still growing and so far there have been no issues. He’s one of the tallest in his class even though he is one of the youngest. This does have me concerned though.

[bernorange 8362]

Doc, I understand that you are tall, but your personal experience (assuming that you were a consistent user of the drug mentioned in the study) appears to be an outlier.  The study mentioned in the OP included over 600 people.  I'm not a statistician, but it seems like the reported results had some statistical significance.

[Viper 12109]

was the study on a certain medication or group of medications or all adhd medications?

[bernorange 8362]

@Viper - it's not clear from the summary on the PubMed abstract and I don't have a subscription to read the details.  The PubMed abstract references J Child Psychol Psychiatry. 2017 Jun;58(6):663-678, but I don't have a copy of that either.

The blog post that I quoted says:

Quote

... Dur­ing the annu­al assess­ments, infor­ma­tion on treat­ments received in the pri­or year was obtained; par­tic­i­pants were con­sid­ered to have received med­ica­tion treat­ment if they had tak­en the equiv­a­lent of at least 10 mg of methylphenidate on at least half the days dur­ing the year. ...

methylphenidate = Ritalin

[Viper 12109]

for myself he was struggling with school and we took him to a psychiatrist that specialized in ADHD diagnosis. 

[hayden_horn 11362]

8 minutes ago, Viper said:

for myself he was struggling with school and we took him to a psychiatrist that specialized in ADHD diagnosis. 

this is exactly why we did it for our boys. the difference at school is night and day.

but i do know that the drug depresses their overall mid-day appetite, and it would not surprise me if that had a knock-on effect on growth curves. but our shit is all fucked because they were both premature births.

[F250 28777]

15 minutes ago, Viper said:

for myself he was struggling with school and we took him to a psychiatrist that specialized in ADHD diagnosis. 

My son was on Adderrall from 6th - 8th grade. We did the same thing and saw a remarkable improvement.

6 minutes ago, hayden_horn said:

this is exactly why we did it for our boys. the difference at school is night and day.

but i do know that the drug depresses their overall mid-day appetite, and it would not surprise me if that had a knock-on effect on growth curves. but our shit is all fucked because they were both premature births.

We saw a drop in appetite with my son. We had to constantly remind him to eat for a couple of years. While he did drop some weight he never became underweight.

Edited March 28, 2018 by F250

[Judge Roybeanbag 11819]

Giving kids drugs unabated 

[phdhorn 6224]

My son started taking it in 9th grade.  He's now 6'1" at 18.

You're telling me he could have been in the NBA?  Who do I fucking SUE??  I need to get Kevin Morgan's shitbag attorney.

[Chuychanga 133]

I wonder if dosage is a factor. I would assume so. My son recently was switched from a low dose of focalin to vayvanse but he has friends who I know take 3-4x his dosage. 

I second the positive effects. He failed the STAAR one year and then after beginning therapy and focalin he aced the STAAR and tested into every pre-AP class in middle school including math that’s 2 years ahead of his grade.  Consistent honor roll now. This is after we worried he might need to be held back after 4th grade. 

Hes short, but he was short long before taking any meds. 

Edited March 28, 2018 by Chuychanga

[Guest]

3 hours ago, Doc Holliday said:

Fake news.  Even smoking cigs and every other thing I did poorly as a child did not stunt my growth

mr. holliday, you were well on your way to 7'11" until that first marlboro.

[Doc Holliday 199]

4 hours ago, bernorange said:

Doc, I understand that you are tall, but your personal experience (assuming that you were a consistent user of the drug mentioned in the study) appears to be an outlier.  The study mentioned in the OP included over 600 people.  I'm not a statistician, but it seems like the reported results had some statistical significance.

Yes, and out of respect for the sincerity of the subject, I didn't have the H, I do/did have the rest and was never on Ritalin or meds for it.  I learned how to cope and eased through most of primary schooling despite getting sent to the principal's office, detention, and general ruckus instigation because I was bored.  😂

57 minutes ago, The University said:

mr. holliday, you were well on your way to 7'11" until that first marlboro.

Yes, was actually supposed to be 7'2" and I'm happily at my height which technically could be considered stunted. 😂

[Hate 20108]

Ours was struggling in school. We started on Vyvnase but had to switch to Focalin recently. His behavior at school is better, but he still struggles to focus long enough to get as good as grades as he should. He can also be a real asshole at home at times when the medication wears off. We take him to counseling every other week as we keep trying to work through it. It can be exhausting.

[Kilgorehorn 308]

My son took Ritalin for ten years and he is 6' 3". Wonder how tall he would have been otherwise. Oh, and he is the tallest person in my family.

[bernorange 8362]

On 3/28/2018 at 11:39 AM, bernorange said:

The study did not track or compare EEG Neurofeedback as a treatment modality.  I'd be really interested to see the persistence data on patients who went that route.

Different study appears to answer this question. 

Quote

 A study just published in the February issue of the medical journal European Child & Adolescent Psychiatry shows Neurofeedback to have long-term positive effects in children with ADHD.

Neurofeedback is a non-invasive therapy, which is used to train brain activity, visualizing EEG waves on a computer screen via electrodes. This has been shown to help reduce symptoms of ADHD in children, particularly inattention and hyperactivity. However, scientists have debated whether the reported effects are long-lasting and a viable alternative to prescribing children with medications.

In this latest study, researchers compiled data of more than 500 children with ADHD comparing the results of Neurofeedback, with medications and "non-active" (no treatment) conditions. To critically interpret the data, researchers with different views on Neurofeedback were selected to contribute to the study.

They found that Neurofeedback had sustainable effects in the longer term, with positive and significant effects observed after six months of treatment. Moreover, the findings show that the effects of Neurofeedback show a tendency to improve over time, with no ongoing therapy sessions needed after the initial program compared to the group, which was still taking medication at six-month follow-up.

...

https://www.prnewswire.com/news-releases/study-confirms-neurofeedback-has-long-term-benefit-for-children-with-adhd-300601435.html

[Larry T. Spider 1746]

As a school administrator, I work with parents a lot on these decisions and giving good info to their doctors. My only comment is that it amazes me how differently the same med and dosage can impact different kids. We have had to tell parents to get their kid off a certain drug because they became a zombie on a tiny dose. Same thing for a different kid is like a miracle drug with all the benefits and almost no negative side effects. All I can suggest is to play around with it until you find what works. Also, don’t forget the behavioral side of it in teaching specific organizational strategies. The meds may help, but they don’t replace those lessons.

As far as the article, the most common side effect we see is loss of appetite. It’s also the most common reason I see parents taking their kid off meds. Some meds are better than others in that area so a switch sometimes works.

[Rimbo 25936]

On 3/28/2018 at 12:53 PM, Hate said:

As the father of a 9 year old on ADHD meds, this has my attention. We see the doctor every 6 months to make sure he is still growing and so far there have been no issues. He’s one of the tallest in his class even though he is one of the youngest. This does have me concerned though.

Father of a 13 year old with ADHD here. We've had a lot of luck with:

1. Using the smallest effective dose. 5mg Adderall is enough, and more hasn't proven necessary.

2. Giving him breaks from the medication when possible. Like on weekends.

3. His school emphasizes intense exercise to moderate the condition as opposed to higher doses. In particular, the school sends their miscreants off to set world records in open sea marathon swim relays. Like 27 mile swim relays.

He's 5'8" at age thirteen, but he does have genetics in his favor somewhat.

[Rimbo 25936]

2 hours ago, Larry T. Spider said:

As a school administrator, I work with parents a lot on these decisions and giving good info to their doctors. My only comment is that it amazes me how differently the same med and dosage can impact different kids. We have had to tell parents to get their kid off a certain drug because they became a zombie on a tiny dose. Same thing for a different kid is like a miracle drug with all the benefits and almost no negative side effects. All I can suggest is to play around with it until you find what works. Also, don’t forget the behavioral side of it in teaching specific organizational strategies. The meds may help, but they don’t replace those lessons.

As far as the article, the most common side effect we see is loss of appetite. It’s also the most common reason I see parents taking their kid off meds. Some meds are better than others in that area so a switch sometimes works.

This is all great stuff. What we've done re: appetite is big breakfasts and dinners, before he's started the meds and after the meds have worn off. We just don't expect him to eat much at lunch, and increase his caloric intake at the other meals (plus snacks).

This is not possible with e.g. Strattera or other non stimulant meds that are effectively in you 24/7.

[Anastasis 23469]

More on the MTA study @ https://www.nimh.nih.gov/funding/clinical-research/practical/mta/the-multimodal-treatment-of-attention-deficit-hyperactivity-disorder-study-mta-questions-and-answers.shtml. 

The core study was completed in the 90s or early 2000s.  The drug treatment in the core study was individually optimized dosing of methylphenidate (Ritalin).  The study bern is citing in the OP is a followup observational study. After the 14m core study, treatment was usual care directed by individual provider, so they likely switched around various stimulants.  I'd be interested in seeing how they defined consistent and inconsistent use, and the results for each of those subgroups.  Not sure why that paper is not publicly available, the study was NIMH funded. 

[Newdoc 3440]

The data is conflicting and some research shows that growth is delayed commonly but not ultimately stunted under genetic potential.  There's a lot of stuff we don't know.  The medical pendulum keeps swinging.

These are medicines that can be extremely helpful if a person truly needs them. Proper diagnosis is the key. ADHD symptoms can cross over with many other mental health issues.  You don't necessarily want to put a kid with conduct disorder on ADHD medicine. Bad mojo.

[Rimbo 25936]

On 3/31/2018 at 12:59 PM, Newdoc said:

The data is conflicting and some research shows that growth is delayed commonly but not ultimately stunted under genetic potential.  There's a lot of stuff we don't know.  The medical pendulum keeps swinging.

These are medicines that can be extremely helpful if a person truly needs them. Proper diagnosis is the key. ADHD symptoms can cross over with many other mental health issues.  You don't necessarily want to put a kid with conduct disorder on ADHD medicine. Bad mojo.

True. Way I heard it, ADHD is both tremendously over-diagnosed and under-diagnosed. We were very skeptical of the initial diagnosis, and I swear it took me 2 years before I really understood just what ADHD was. And we waited a good year before we began any meds, and even then minimal.

Turns out, my son really does have ADHD, and really does need the meds... but not very much of it.