Posted on 07/21/2007 5:49:14 AM PDT by cinives
After three years on the ADHD drug Ritalin, kids are about an inch shorter and 4.4 pounds lighter than their peers, a major U.S. study shows.
The symptoms of childhood ADHD (attention deficit hyperactivity disorder) usually get dramatically better soon after kids start taking stimulant drugs. But this benefit may come with a cost, says James Swanson, Ph.D., director of the Child Development Center at the University of California, Irvine.
"Yes, there is a growth-suppression effect with stimulant ADHD medications," Swanson tells WebMD. "It is going to occur at the age of treatment, and over three years it will accumulate."
Whether these kids eventually grow to normal size remains a question. Kids entered the study in 1999 at ages 7 to 9. The current report is a snapshot taken three years later. The 10-year results — when the kids are at their adult height — won't be in for two more years.
"The big question now is whether there is any effect on these kids' ultimate height," Swanson says. "We don't know if by the time they are 18 they will regain the height."
The finding appears to end decades of debate over whether stimulant medications affect children's growth. Less than 10 years ago, a National Institutes of Health panel concluded that the drugs carried no long-term growth risk.
That opinion was so widely accepted that the study authors — who include most of the leading ADHD researchers in the U.S. — did not warn parents that the study medication might carry this risk.
At the time, researchers thought that any short-term stunting of growth would be made up by a hypothesized "growth spurt" that would occur with continued treatment. But Swanson and colleagues saw no evidence of such a growth spurt.
Another widely accepted theory was that ADHD itself stunted kids' growth. But in a surprise finding, the study found that ADHD kids who do not take stimulant drugs are much larger than kids without ADHD, and these untreated kids continued to grow much faster than kids taking stimulant drugs.
Swanson says that children who had been taking ADHD drugs before the study began were smaller than kids who had not yet started treatment. Those who first began treatment at the start of the study were normal in size, but grew more slowly than normal kids as the study went on.
After three years, the growth suppression seemed to reach its maximum effect. That's also when the effect of the ADHD drug used in the study — immediate-release Ritalin, three times a day, every day of the year — seemed to wear off.
"We compared the effect of medication relative to just pure behavioral treatment," Swanson says. "That effect was substantial at 14 months and reduced a bit at 24 months. But at 36 months the relative advantage of ADHD drugs over behavioral treatment is gone."
Swanson and colleagues note that the study did not test the sustained-release stimulant medications that are now the standard treatment for ADHD.
Omar Khwaja, M.D., Ph.D., a neurologist at Children's Hospital in Boston, last year analyzed studies of different ADHD drugs and found strong evidence that ADHD drugs do, indeed, stunt children's growth. In fact, Khwaja and colleagues calculated a growth effect that almost exactly matches the effect seen in the Swanson study.
But Khwaja agrees with Swanson that nobody yet knows what the long-term results of this side effect will be.
"Whether there will be rebound growth at end of puberty, the jury is still out," Khwaja tells WebMD.
"Parents have to be aware that stimulants are an enormous benefit to a lot of children with ADHD, but there is reason to be cautious with all medicines that affect the brain," he says. "Growth monitoring should be standard practice for kids taking these medications."
Swanson and colleagues report their findings in the August issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
Other findings from this large study show that both ADHD drugs and behavioral therapy work in children.
IOW, after 36 months, all benefits of the drugs wear off, so stunting your kid's growth, including brain growth, possibly for life, may be too much of a tradeoff.
We'll know more in 3 years at the conclusion of a ten year study period.
Bears repeating!
This result seems to fit with common sense expections. Drugs are going to have an immediate effect on actions. "Behavioral treatment" - or what we'd call "discipline," in the broadest sense - is going to take longer to affect actions, and should also become more effective as the child grows older.
Exactly. Behavioral treatments are more difficult, so people choose to take the “easy” way and just use drugs.
In my experience, behavioral therapy/discipline then takes a backseat because all concerned assume the drug is the magic fix.
Unfortunately, many families who push for getting their kids on these drugs are the least able to provide effective discipline. Mrs. Slim, until she retired last year, worked in Special Ed, and saw many people who saw this as just another way to get more services from the state. If your existance is tied to WIC, SSI, etc, etc... your self discipline is worthless, much less your ability to effect any change in your child (not that they want too).
I find the wholesale drugging of kids extremely sad.
Excuse me? My son is on ADHD meds on and off throughout the past school year. It was a struggle for us to decide to go this route. There is no lack of discipline in my household. If you had to deal with a child who truly has ADHD and at the end of seeking every kind of treatment possible you medicated them you’d understand.
I was merely stating that there is a large number of parents who are availing themselves of these drugs because of the percieved and actual welfare state benefits attached.
And unfortunately, the schools and special education industry is complicit to a certain degree.
I am sure that there are cases, like yours, where the medication is needed, and the family structure is intact and healthy. I am also sure that your situation is also in the minority of cases. I wish you and your son well, and did not intend any slight or insult.
Thanks for the link. We have friends whose son is on some kind of ADHD meds, and he has stopped growing. They have taken him to a number of specialists, but can’t seem to get his dosage right. They’re very concerned, as I can only imagine.
What you have is “normal childhood behavior” Kids are not miniaturized adults and do not act like replicas of adults. Good grief all past generations of kids figited, didn’t study, flunked in school, were restless and can’t stay still. Ask yourself ‘Why hasn’t this diagnosis been around for generations when kids and human nature hasen’t changed an iota for thousands of years?”
Your can drug kids so that they act more like a zombie, that has a ring of respectability these days; but you as a parent are nothing more than a pusher.
Every 'special needs' kid translates to additional funding.
Yes it does.
It would also seem that drug treatment would have to continue, whereas behavior modification becomes self-reinforcing, more so each year.
Assuming that a child does have a higher-than-average energy level, is more than usually distractable, and so forth, he can often be taught to manage these characteristics with exercise, practice in concentrating, removal of distracting circumstances, etc. In this way, he can get the most out of his potential without the health risks of drug treatment
We found that our son’s hyperactivity dissipated to some extent when he started cross-country running at 8 or 9, and has continued to decrease as he’s grown older. A few years ago, he would get up in the middle of the night and jump on the trampoline, but he doesn’t need to now that he’s running half-marathons.
I am not intending this as an insult to anyone’s efforts, but here go my observations on the subject based on much reading, personal experience and personal observations of others’ kids as well as mine -
The ADHD diagnosis is a catch-all description for kids who are usually very gifted, need structure different than most schools, even special ed classes, can or will provide, and who are often misunderstood and coerced into change because they are “different” from the average child.
They talk too much (or too little) because they have very intense thoughts, they daydream because their own thoughts are more interesting to them than the topics taught in the typical classroom, they have lots of ideas and interests that they are bursting to try/accomplish, and unlike the norm, they are capable of an intensity and hyperfocus that allows them to really excel at certain interests. In small children this also manifests itself in a lot of wiggles, foot tapping, bouncing and the like, because they are bursting with energy. Unfortunately, the child labeled ADHD is viewed as needing to be changed to fit his environment, not so much the other way around.
The only way to “solve” the ADHD problem is to find an environment that suits the child’s temperament and interests, keeps discipline, and allows the child to grow into more “normal” or self-controlled behavior over time. It may take lots of time, but often these kids have major contributions to make if they are not shamed or drugged into losing their intensity and drive.
It’s very uncomfortable for parents and schools to try to fit these round pegs into square holes, but the effort is worthwhile in the long run and it makes for a much happier and more productive child.
There is no way to get the dosage “right” - ADHD is a diagnosis based on the mindset of the beholder, and what works in one environment will not be effective in another.
It’s the reason these kids shine in a one-on-one situation but cannot cope or behave appropriately in a group situation.
I work with a guy who at age 44 still taps his feet, fidgets, abruptly leaves a conference if something else catches his eye that he thinks needs attention, yet this person is a very successful and talented entrepreneur.
Where would this world be without the fidgeters and hyperfocusers ?
I'm more skeptical about ADHD.
In 1st grade my gifted kid would often bring home notes from the teacher complaining about her daydreaming. They wanted her tested for adhd.
I took her to a holistic doctor who talked with her for 2 hours, and the things she told him were astounding. The richness of her inner world far outweighed the dreary classroom drill on material she had mastered weeks before.
It’s all in the eyes of the beholder.
One of my nephews was nicknamed “the whirling dervish” by age 2 because he was nonstop energy. This was also the same kid who was reading before age 3, could tell you all about his grandfather’s rock collection as well as any geologist, and knew the latin name of every single dinosaur at every time period that ever walked or flew over the earth.
Can you imagine a child like this in your typical school ? Yep, disaster happened. By age 9 the kid was on 5 different drugs for ADHD, depression, and high blood pressure brought on by Ritalin, and was in a school for LD kids.
Today this boy is 22 yo, is suicidal, bipolar, has Tourette’s, and his parents still don’t know what to do with him.
My contention is that if they’d stayed away from the drugs, hired a tutor/s and played to the kid’s strengths, you’d already be hearing about this kid having some exciting contributions to science. Instead, he’s a wreck.
What a wasted of talent.
My mother is worried that my 5-year-old son is autistic, so we’re getting him checked out. The Special-Ed coordinator at the elementary school he would attend talked to me on the phone for about half an hour, and then said, “It sounds like he’s really smart and pretty bratty! You need to do some behavior intervention!” (We have let him get a little out of hand; with our crowd, a kid who’s having a tantrum or levitating just gets ignored, unless he’s in front of the refrigerator.)
Our GP gave me a developmental questionnaire, and said she’d look at his behavior if I made an appointment. I will, just to reassure my mother, but I’m sure he is just smart and weird. He was reading our teenagers’ schoolbooks before he turned 5.
A link you might find very interesting:
http://www.kidsource.com/kidsource/content/ADHD_and_Gifted.html
And this is one of my all time favorites:
http://www.hoagiesgifted.org/d_major_chord.htm
That’s so sad. The little boy I know is also a very intelligent little kid. I think that’s pretty typical of so-called ADHD kids.
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