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Impact of CNS Stimulants for Attention-Deficit/Hyperactivity Disorder on Growth: Epidemiology and Approaches to Management in Children and Adolescents

Abstract

Central nervous system stimulants are established treatments for pediatric attention-deficit/hyperactivity disorder with robust efficacy data. Reductions in appetite, weight, and growth velocity are some of the most common concerns regarding the long-term use of central nervous system stimulants in developing children. They are associated with suppression of weight and body mass index in childhood. However, both weight and body mass index often progressively increase over adolescence at rates faster than those seen in non-attention-deficit/hyperactivity disorder youth to the degree that attention-deficit/hyperactivity disorder is associated with elevated body mass index by the end of adolescence regardless of medication use. The capacity of central nervous system stimulants to slow growth was identified 50 years ago. Recent work has established that the growth deficits accumulate during the first 2 years of use and may persist provided medication is used. Early initiation coupled with persistent use through adolescence is most likely to be associated with clinical impactful growth suppression. There has been limited formal investigation of treatments for stimulant-associated reductions in weight and height. The most robust evidence exists for drug holidays improving weight gain. Observational studies suggest that limiting lifetime exposure or discontinuing medication is associated with greater adult height. Additional research is needed to identify the causal mechanisms driving the observed slowing in growth as well as the identification of predictors of clinically impactful growth suppression.

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Correspondence to Raman Baweja.

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James G. Waxmonsky has received research funding from the National Institutes of Health, Supernus, and Pfizer in the past 3 years. Raman Baweja and Daniel E. Hale report no biomedical financial interests or potential conflicts of interest that are directly relevant to the content of this article.

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RB provided the concept, performed the literature search, and drafted the initial version of the manuscript. DH and JW provided the concept and critically revised the work. All authors contributed to the final manuscript, approved the final version of the manuscript for publication, and agree to be accountable for the review.

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Baweja, R., Hale, D.E. & Waxmonsky, J.G. Impact of CNS Stimulants for Attention-Deficit/Hyperactivity Disorder on Growth: Epidemiology and Approaches to Management in Children and Adolescents. CNS Drugs 35, 839–859 (2021). https://doi.org/10.1007/s40263-021-00841-w

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