Study: ADHD Medications will not stunt children's growth

A study shows that taking ADHD medications will not stunt a child's growth.

Stimulant medications -- such as Adderall, Ritalin and Concerta -- used to treat attention-deficit/hyperactivity disorder (ADHD) in children, won't stunt their growth, a new study suggests.

"Stimulant medication did not affect children's final height as adults," said study researcher Dr. Slavica Katusic, an associate professor of pediatrics at the Mayo Clinic in Rochester, Minn.

Katusic noted that results of earlier studies have been mixed, with some showing these drugs retard growth and others showing they don't. But, most of the previous studies had limitations, such as having too few children or spotty information about adult height, she said.

Katusic said this study is unique because it followed a group of people with ADHD who were taking stimulant medications and compared them with a group with ADHD who were not taking medication and also a group that didn't have ADHD. These individuals were followed from childhood to adulthood, she said.

ADHD is one of the most common disorders of childhood, according to the U.S. National Institute of Mental Health (NIMH). Symptoms include difficulty paying attention or staying focused on one task, overactivity and impulsive behavior, the NIMH explains.

Stimulant medications are a mainstay of ADHD treatment, and while it may seem odd to use stimulant medication on an overactive child, stimulant drugs have a calming, focusing effect on youngsters with ADHD, according to the NIMH. Katusic said these drugs are important for improving school and social functioning.

Katusic's team studied 340 children with ADHD and 680 without the condition. "We compared the height when they were children and when they were grown up," she said.

The average follow-up time was 26 years for those with ADHD and 23 years for people without ADHD. Approximately 70 percent of those with ADHD who completed the study had taken stimulant medication for more than three months, the researchers noted.

There was no difference in adult height between those who took ADHD drugs and those who didn't, the investigators found.

"Neither childhood ADHD itself nor stimulant medication was associated with shorter stature as adults," Katusic said.

Boys with ADHD who were treated with stimulants for three or more months had a later growth spurt than boys who didn't take these drugs, but there was no difference in the size of the growth spurt, the researchers noted.

In addition, no connection was seen between the amount of time a child took stimulant drugs and adult height, the study authors found.

"But despite our findings, doctors should monitor growth when making medication decisions," she said. "Our study says don't worry at all, but human beings are all different and you always have to be careful."

The report was published online Sept. 1 in the journal Pediatrics.

Dr. Marcel Deray, a pediatric neurologist at Miami Children's Hospital, said, "This is good news, because we discuss this issue with parents of kids with ADHD."

Deray hopes the study will be replicated to prove the point that these stimulants don't affect height. "It would good to have a couple of studies showing the same thing," he said.

He also said this finding should be reassuring to parents who may be reluctant to allow their children to use these drugs because of the potential risk of stunting their child's growth.

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Link between sleep apnea and ADHD

This article discusses the potential link between sleep apnea and ADHD in children.

Parents with toddlers displaying symptoms like decreased attention span, hyperactivity, irritability, sleep walking, snoring or breathing through the mouth must check with doctors if the child is suffering from sleep apnea.

Experts emphasize that even if two of these symptoms are seen, the child should be taken to a specialist and tested. If any form of sleep apnea is detected during the sleep study, then appropriate treatment should be sought, they said.

Even two-year-olds can be affected by sleep apnea, and if left untreated, it may hamper the child's growth.

"I have seen children affected almost in the same numbers as adults, and if left undetected and untreated for a long period, may affect the growth of the facial structure of a child," said Seemab Shaikh, ENT surgeon and sleep specialist. He is also the founder and national president of the Indian Association of Surgeons for Sleep Apnea. He sees at least three children with sleep apnea symptoms every day.

Sleep apnea is a condition in which the breathing pauses for a few seconds to minutes during sleep. Typically, normal breathing starts again, with a loud snort or a choking sound. If left untreated, sleep apnea may result in poor performance in academics and physical activities, and behavioral problems such as attention deficit which is sometimes diagnosed as attention deficit hyperactivity disorder (ADHD).

"Various parts of the body do not get proper supply of oxygen and over a longer period of time, this affects the cardiovascular system and the nervous system," said Shaikh.

Shripal Shrishrimal, who specializes in pulmonary medicine and is an American Board certified sleep specialist, said the common symptoms of sleep apnea in children would be - snoring, frequent nightmares, lethargy, hyperactivity, mouth breathing, drooling in sleep, irritability, lack of focus, constant headache, frequent awakening, gasping, sleep walking, bed wetting, daytime sleepiness, drop in academic performance and improper growth.

Just like adults, children too may suffer from any form of sleep apnea - obstructive, central and mixed. Obstructive sleep apnea (OSA), is the most common form and is caused by partial or complete blockage of the upper airway. Central sleep apnea occurs when the brain does not send proper signals to the muscles to control the breathing.

Shrishrimal said the most common causes of sleep apnea in children are swelling or enlargement of tonsils and adenoids, also kn as adenotonsillar hypertrophy. Children who are obese or overweight may also suffer from sleep apnea, and are in this case, asked to first lose weight and then treated through medicines.

"Though surgery is prescribed to remove polyps or correct adenotonsillar hypertrophy, in case symptoms persist, then the continuous positive airway pressure (CPAP) method is used, in which masks are to be worn over the face or nose," said KT Mohan, pulmonologist and sleep disorder breathing specialist.

Doctors say minimally invasive technologies are available to remove extra tissue and enable better breathing, such as radiofrequency ablation and coblation. Although, with early diagnosis, sometimes surgical intervention can be avoided, said Shaikh.

Shrishrimal added that if untreated, sleep apnea over a long term in children may cause cardiac complications, growth failure, learning problems and behavioral problems.

"Often, OSA is the underlying cause of various serious health problems and due to lack of awareness, goes undetected. People with no history of heart or high blood pressure suffer from life-threatening strokes," said Shaikh. "Cases of depression, poor memory, mood disorders and even marital problems happen because of sleep apnea," he added.

Don't ignore the snore

As many as four percent children are affected by sleep apnea

Symptoms

Decreased attention span, drop in academic performance, snoring, frequent nightmares, lethargy, hyperactivity, mouth breathing, drooling in sleep, irritability, lack of focus, constant headache, frequent awakening, gasping, sleep walking, bed wetting, daytime sleepiness

Treatment options

Surgery in case of enlarged tonsils, adenoids or polyps

Weight loss combined with medicine for overweight children

Positional therapy

CPAP therapy, where positive air pressure is forced through the throat by a mask worn over the nose or face

Tests for sleep apnea are a must for children who are obese, have family history of sleep apnea, have cerebral palsy, Down syndrome, or craniofacial anomalies

The effect of anti-epileptic drugs on children's growth

A recent study looked into how the use of anti-epilepsy drugs effects children's growth and health, and results showed that the use of certain drugs to impair the growth of children with epilepsy.

This study investigated whether long–term treatment with antiepileptic drugs (AEDs) had negative effects on statural growth and serum calcium levels in children with epilepsy in Taiwan. These results raise serious concerns about the growth of pediatric epilepsy patients who use AEDs, and potentially the need to closely monitor growth in children with epilepsy and adolescents under AED treatment, especially VPA.

Methods

• Children with epilepsy treated with one prescription of AEDs (monotherapy) for at least 1year were selected.
• The AEDs included valproic acid (VPA; Deparkin) in 27 children (11 boys and 16 girls) aged 4-18years, oxcarbazepine (Trileptal) in 30 children (15 boys and 15 girls) aged 5-18years, topiramate (Topamax) in 19 children (10 boys and 9 girls) aged 6-18years, and lamotrigine (Lamicta) in eight children (5 boys and 3 girls) aged 5-13years.
• Patients with a history of febrile convulsions were selected as the controls.

Results

• One year of VPA treatment significantly impaired the statural growth of pediatric patients with epilepsy (p<0.005) compared with the control group.
• The underlying mechanism may have been due to the direct effect of VPA on the proliferation of growth plate chondrocytes rather than alterations of serum calcium.

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