Experts say it's important to give kids break from ADHD drugs
July 20, 2007 - A first of its kind, long-term study on the effects
of ADHD medication on children was released today. It takes a look at
what ADHD is like as kids get older.

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The study on Attention Deficit Hyperactivity Disorder found that a
combination of medication and behavioral therapy worked best for
treatment. Results showed only about half of children improved right
after starting drug treatment, while a third improved more gradually.
More than 1 in 10 children responded well at first but the
medication's benefits decreased over time.

The study in the Journal of the American Academy of Child and
Adolescent Psychiatry found after three years children taking ADHD
drugs were no better off than those in behavioral therapy. The study
confirmed ADHD medications slow children's growth by about 3/4 of an
inch.

Experts say it is important to get children treated early and then to
take periodic breaks from the drugs


ADHD Drug Does Stunt Growth
After 3 Years on Ritalin, Kids Are Shorter, Lighter Than Peers
By Daniel J. DeNoon
WebMD Medical NewsReviewed by Louise Chang, MDJuly 20, 2007 – 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, PhD, 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, MD, PhD, 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.