Objective: To estimate long-term stimulant treatment associations on standardized height, weight, and body mass index trajectories from childhood to adulthood in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (MTA).
Method: Of 579 children with DSM-IV ADHD-combined type at baseline (aged 7.0-9.9 years) and 289 classmates (local normative comparison group [LNCG]), 568 and 258 respectively, were assessed 8 times over 16 years (final mean age = 24.7). Parent interview data established subgroups with self-selected Consistent (n = 53, 9%), Inconsistent (n = 374, 66%), and Negligible (n = 141, 25%) stimulant medication use, as well as patients starting stimulants prior to MTA entry (n = 211, 39%). Height and weight growth trajectories were calculated for each subgroup.
Results: Height z scores trajectories differed among subgroups (F = 2.22, p < .0001) and by stimulant use prior to study entry (F = 2.22, p < .001). The subgroup-by-assessment interaction was significant (F = 2.81, p < .0001). Paired comparisons revealed significant subgroup differences at endpoint: Consistent was shorter than Negligible (-0.66 z units /-4.06 cm /1.6 inches, t = -3.17, p < 0.0016), Consistent shorter than Inconsistent (-0.45 z units /-2.74 cm /-1.08 inches, t = -2.39, p < .0172), and the Consistent shorter than LNCG (-0.54 z units/+3.34 cm/ 1.31 inches, t = -3.30, p < 0.001). Weight z scores initially diverged among subgroups, converged in adolescence, and then diverged again in adulthood when the Consistent outweighed the LNCG (+ 3.561 z units /+7.47 kg /+16.46 lb, p < .0001).
Conclusion: Compared with those negligibly medicated and the LNCG, 16 years of consistent stimulant treatment of children with ADHD in the MTA was associated with changes in height trajectory, a reduction in adult height, and an increase in weight and body mass index.
Clinical trial registration information: Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA); https://clinicaltrials.gov/; NCT00000388.
Keywords: ADHD; adult height; growth trajectory; longitudinal study; stimulant medication.
Copyright © 2019 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
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Weight and Height in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: A Longitudinal Database Study Assessing the Impact of Guanfacine, Stimulants, and No Pharmacotherapy.J Child Adolesc Psychopharmacol. 2019 May;29(4):285-304. doi: 10.1089/cap.2018.0132. Epub 2019 Apr 3. J Child Adolesc Psychopharmacol. 2019. PMID: 30942617 Free PMC article.
Effects of stimulant medication on growth rates across 3 years in the MTA follow-up.J Am Acad Child Adolesc Psychiatry. 2007 Aug;46(8):1015-1027. doi: 10.1097/chi.0b013e3180686d7e. J Am Acad Child Adolesc Psychiatry. 2007. PMID: 17667480 Clinical Trial.
Growth on stimulant medication; clarifying the confusion: a review.Arch Dis Child. 2005 Aug;90(8):801-6. doi: 10.1136/adc.2004.056952. Arch Dis Child. 2005. PMID: 16040876 Free PMC article. Review.
Long-term outcomes of stimulant medication in attention-deficit hyperactivity disorder.Expert Rev Neurother. 2006 Apr;6(4):551-61. doi: 10.1586/14737184.108.40.2061. Expert Rev Neurother. 2006. PMID: 16623654 Review.
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