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Growth and pubertal development of adolescent boys on stimulant medication for attention deficit hyperactivity disorder

Med J Aust 2013; 198 (1): 29-32. || doi: 10.5694/mja12.10931

Summary

Objective: To investigate the growth and pubertal attainment of boys with attention deficit hyperactivity disorder (ADHD) on stimulant medication.

Design, setting and participants: Longitudinal study of boys aged 12.00–15.99 years at recruitment in 2005–2011, with stimulant-treated ADHD for at least 3 years, attending three paediatric practices (subjects), compared with longitudinal data from 174 boys from the Nepean longitudinal study (controls).

Main outcome measures: Subjects’ growth parameters before treatment were compared with controls aged 7 or 8 years; growth parameters and longitudinal changes on treatment to ages 12.00–13.99 and 14.00–15.99 years were compared with controls reviewed at 13 and 15 years of age, respectively. The subjects’ pubertal staging and height velocity were related to their treatment history.

Results: Sixty-five subjects were recruited; mean duration of treatment was 6.3 ± 1.9 years. At baseline, their growth parameters were not significantly different from those of the controls after adjusting for age. Compared with the controls, after adjusting for current age and baseline growth parameter z score, subjects aged 12.00–13.99 years had significantly lower weight and body mass index (P < 0.01), and those aged 14.00–15.99 years had significantly lower height and weight (P < 0.05). At 12.00–13.99 years of age, the subjects were comparable to the controls in their pubertal development adjusted for age, but those aged 14.00–15.99 years reported significant delay (mean Tanner stage, 3.6 for subjects v 4.0 for controls; P < 0.05). The dose of medication was inversely correlated with the height velocity from baseline to 14.00–15.99 years of age (P < 0.05).

Conclusions: Prolonged treatment (more than 3 years) with stimulant medication was associated with a slower rate of physical development during puberty. To maintain adequate height velocity during puberty, we recommend keeping the dose as low as possible.

  • Alison S Poulton1
  • Elaine Melzer1
  • Paul R Tait2
  • Sarah P Garnett2
  • Chris T Cowell2
  • Louise A Baur2
  • Simon Clarke2

  • 1 Sydney Medical School Nepean, University of Sydney, Sydney, NSW.
  • 2 The Children’s Hospital at Westmead, University of Sydney, Sydney, NSW.


Acknowledgements: 

We thank the children and their families for agreeing to participate in this study. The stimulant growth study was supported by the Australian Women and Childrens Research Foundation. The Nepean longitudinal study was supported by National Health and Medical Research Council (NHMRC) grant 206501 and a Meat and Livestock Australia grant. Sarah Garnett was supported by an NHMRC Australian Clinical Research Fellowship from 2007 to 2010 (457225) and is currently supported by a Cancer Institute NSW Fellowship from 2011 to 2013 (10/ECF/2-11). The funding organisations had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.

Competing interests:

No relevant disclosures.

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