Does ADHD treatment suppress growth? Recent findings

One of the oldest controversies about ADHD medication treatments is their effect on physical growth.

In fact, this still remains controversial, as I explain in a special science pull ADHD growthout in chapter 8 of Getting Ahead of ADHD. Stimulant medicines suppress appetite, and this is why kids may fall behind on growth. The most recent study, published just a few months ago in June of this year, followed a large group of boys from age 7-10 up to age 25. They were grouped as medication treatment having been: (a) negligible, (b) inconsistent, or (c) consistent.Ongoing treatment with stimulant medication yielded about a 2.4-centimeter (about 1-inch) reduction in final adult height. Other prospective studies using other methods do not see this effect. While some controversy remains, it seems likely that ongoing use of stimulant medication can suppress adult height by 2-3 centimeters, at least in boys. However, this and other findings could also be interpreted as suggesting important variation in how children respond—some may see a large height reduction, some may see no height reduction. The take home message is that your prescribing physician should carefully track your child’s growth trajectory and if the child is falling off the growth curve, discuss with you the options for a reduction, pause, or changing in the treatment.  

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Always Look For The Science

You can find it in Getting Ahead of ADHD and with every Dr. Nigg blog post:

Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression.Swanson JM, Arnold LE, Molina BSG, Sibley MH, Hechtman LT, Hinshaw SP, Abikoff HB, Stehli A, Owens EB, Mitchell JT, Nichols Q, Howard A, Greenhill LL, Hoza B, Newcorn JH, Jensen PS, Vitiello B, Wigal T, Epstein JN, Tamm L, Lakes KD, Waxmonsky J, Lerner M, Etcovitch J, Murray DW, Muenke M, Acosta MT, Arcos-Burgos M, Pelham WE, Kraemer HC; MTA Cooperative Group. J Child Psychol Psychiatry. 2017 Jun;58(6):663-678. doi: 10.1111/jcpp.12684. Epub 2017 Mar 10.

Q: Melatonin | Okay for my ADHD child with sleep problems?

Answer: Up to half of children with ADHD have some sort of sleep disruption, and melatonin can seem like a good idea. But, slow down on this one. Melatonin is a hormone that affects the sleep-wake (circadian) cycle. In a natural sleep-wake cycle, melatonin production increases in the afternoon (several hours before it’s time to sleep) in response to the changing daylight. It then drops off toward morning. When people have a sleep-wake phase disorder, their sleep-wake cycle is not correctly synchronized, and melatonin production fails to increase like it should. One treatment is to give supplements. However, caution is in order. 

4 Precautions to Consider When Contemplating Melatonin:

Do not give it to infants–it can interfere with the natural training of their sleep wake cycle to daylight. 

Be careful with teenagers–we still don’t have complete knowledge of how it interacts with all the necessary hormonal developments of adolescence.

Understand the potential side effects, such as night sweats, a morning “hangover,” headaches, daytime “laziness” (from the hangover), and bedwetting.

Check the dosing – over-the-counter formulations are usually too high.

Bottom line: only use melatonin in consultation with your child’s pediatrician. If your child is having sleep problems, try a behavioral solution first. Behavioral counseling can be effective in just a few sessions. See my book Getting Ahead of ADHD on page 113 and surrounding pages for more discussion.

ADHD: Not A One-Size Fits All Condition

ADHD is expressed in many different ways

In Chapter 2 of “Getting Ahead of ADHD”, I emphasize that ADHD is not a one-size fits all condition. This is because ADHD taps into a more general process called poor “self-regulation.” Self-regulation affects everything from how we deploy our attention, to whether we are impulsive, to how we manage our emotions. So, if your child has ADHD plus a tendency to depression or anger, their struggle with self-regulation will mean they struggle more than many children with depression or anger also. If your child has ADHD plus a tendency to be exuberant and outgoing, then they may be extremely this way—in contrast to another child with ADHD. Some types of self-regulation problems lead to a problem inhibiting behavior—so a child is very impulsive. Others lead to a problem activating behavior-so a child is quite sluggish and cannot initiate their activity when they should. (That’s related to the old concept of ADD or pure inattention or the newer concept of sluggish cognitive tempo).  As we all know, even if two people look the same, they can behave very differently.

 

Personalized plans are most helpful

Likewise, even though it’s usually impossible to trace the cause of ADHD in a specific child, we know that at a population level ADHD has many causes. It is influenced by perinatal problems, by maternal and paternal health, by genetic makeup, and by other factors. We see distinct profiles of brain organization in subgroups of children with ADHD in our studies, as one example. All of this suggests there are likely several ways to have ADHD and several forms of it, which science is still finding out how to describe. As a result, it is important to personalize the treatment plan for your child based on what works for your child and your family, in consultation with a professional. Ulimately, we hope to discover the right prediction models to know which personalized plan is right for each child. Until then, it is a matter of combining best professional advice with some individual trial and error.

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Always Look For The Science

You can find it in Getting Ahead of ADHD and with every Dr. Nigg blog post:

Karalunas, SL, Fair, D, Musser, ED, Aykes, K, Iyer, S., Nigg, JT. (2014). Subtyping ADHD using temperament dimensions: Toward a biologically based nosology. JAMA Psychiatry, 9, 763.

Costa Dias TG, Iyer SP, Carpenter SD, Cary RP, Wilson VB, Mitchel SH, Nigg, JT, Fair DA (2015). Characterizing heterogeneity in children with and without ADHD based on reward system connectivity. Journal of Developmental Cognitive Neuroscience. Feb 11, 2015, p 155-174

ADHD is Related to Social Disadvantage

What does it mean?

A new article from my team was released this week, showing that ADHD is related to social disadvantage. That means that if a family is in poverty or low income, or is experiencing what social scientists call “low social status” due to lack of parental education or low paying job, that the chances of a child having ADHD are higher. We showed clearly that the effect is not explainable by the fact that social disadvantage and ADHD also both overlap with children’s general behavior problems, and also not explained by the fact that adults with ADHD (who also have kids with ADHD) tend to obtain less education and less well paying jobs. There seems to be an actual effect of social disadvantage on ADHD itself.

Why would this be?

My hunch is that these socio-economic challenges are associated with chronic stress for parents and for kids. Less resources, more stress. If you are in this situation, you already knew this! Chronic stress builds up physical inflammation and other cell damage in the body of the individual. This physical wear and tear has a fancy scientific term: allostatic load. Scientists are learning how to measure it in the body. It fits with an emerging idea that inflammation contributes to the development of ADHD. What should you do? Recognize that chronic stress can add to ADHD risk, and do what you can do build up your social supports and physical health (for you and your children) and also give permission to yourself to engage in your own self-care. Recognize that as you manage stress levels in your own life, you are also helping your child.

Read more here!

Stigma: Social Challenges With ADHD

Stigma Amplifies Social Rejection and Isolation

Parents of kids with ADHD, and kids and adults with ADHD, face social challenges including social rejection, isolation, and stigma. Kids with ADHD are either neglected (ignored, left out) or rejected (disliked) more often than other kids. Parents of kids with ADHD find that other parents stop inviting them over. Or they are told that their child is no longer welcome at the other house. Sometimes this is a response to the ADHD child’s misguided social behavior (e.g., not being good at taking turns or being too bossy), sometimes it is a response to the child’s frankly inappropriate behavior (e.g., aggression). The neighbors do not understand or know how to work patiently with the child with ADHD, or aren’t sure how to coach their child to respond, and so they push them away.

It’s Crucial to Recognize the Isolation Danger and Seek Support

This brings up the second part of the challenge: the problem of rejection/isolation is amplified by stereotyped or stigmatizing ideas. These include blaming parents for their child’s behavior problems, or labeling a child, teen, or adult as lazy or dumb due to their ADHD symptoms–or even just due to their having the label of ADHD, without even knowing the child. Many developmental disabilities place as much or more burden on a parent than a child with ADHD; but few if any bring as much approbation from other parents. Social support comes quickly if a child is blind, or if a child has Down Syndrome. But support does not come so quickly if a child has ADHD. Scientific observations confirm the isolation families face, and scientific experiments disprove the assumptions that parents of kids with ADHD are abnormal parents. In our own study of parents of kids with ADHD, we found that although a subgroup had elevated depression (as well as ADHD of their own), overall these are parents who have normal personalities and behave as normal parents. They simply don’t have the specialized skills demanded by a special-needs child. By the way, the elevated depression may be due to recently discovered genetic linkage between ADHD and depression, but more often may be due to secondary reactions to the social isolation, and to the discouragement experienced in trying to parent a child with developmental challenges like ADHD. One under-emphasized point that I highlight in my book “Getting Ahead of ADHD” is that it is crucial to recognize the isolation danger and to try to proactively seek and find social support as part of a deliberate self-care strategy when taking on the challenge of raising a child with ADHD.