Concerta use with children with ADHD – growth inhibitor?

[Anonymous]

Hi Dr. J.

My husband and I have been helping our son cope with his ADHD since receiving a diagnosis about 3 years ago. He has been taking his medication since, but our family doctor is concerned about his growth ratios, and feels this can be attributed to the meds. My husband is beside himself with worry and feels that a discontinuation may be in order. I, however, am less convinced.

Can you tell me how much of an effect this medication can have on my son’s overall growth? Are there any numbers out there that would tell me how much of an impact this will have on his overall stature through adulthood? AND would discontinuing medication at this time reverse these effects?

Our son uses his meds for school. We have worked hard at helping him develop his social skills and his coping skills so that he can manage at home and in the community without medication successfully. But school is just not the flexible environment that permits this kind of adjustment. Without meds, we will see a return to his “bad kid” label and the rejection and alienation that comes along with it. For me, that would be the worst thing that could happen to a little boy who is finally starting to enjoy some social success.

Thoughts, suggestions, ideas, anyone? I’m all ears.

S.

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[Anonymous]

Hi, these are great questions!

My degree is in special education and my focus is ADHD and similar disorders. I’ve asked this question of several of my professors and the answer is pretty consistent: there will be some initial physical growth inhibition but the child will catch up by adulthood. The impact will be lessened by the same things it is for normal children: limit caffeine intake, make sure the child gets at least 8 hours of sleep per night, proper nutrition is key, make sure the child drinks enough water, etc.

From what I remember when I was younger, my brother was on this medication and there wasn’t really a noticeable difference. He was still within the normal spectrum. He might have ended up a couple of inches (that little of a difference!) taller if he hadn’t been on the medication.

My recommendation is don’t take him off the medication. The growth inhibition is not a noticeable amount, but the behavioural difference is definitely something that gets noticed! Also, when he is an adult, which is going to make a bigger difference: that he’s 5’7″ or 5’10” or that he is someone who believes in himself, has a good support network of friends, and experiences academic/career success?

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[Anonymous]

The current CADDRA Guidelines coming out in November will state that Drug Holiday’s are reasonable to allow a child to grow better as their appetite resurfaces on the weekends. Might be hell on the parents on the weekends unless they make the day very structured and low stress for the kid.

i also suggest a bone age just before the kid hits puberty to check out how much growth is left and if there is a problem, seeing an endocrinologist to see if growth hormone may be an option.

The evidence is really fuzzy about growth. Some studies show a mild risk, some show a significant risk and others suggest that it is negligable. I think the prudent thing to say is that if the parents are short (less than 5’7″), then monitoring of height should be more often and with greater vigilence. There is a huge difference JayBird in kids self esteem between 5’7″ and 5’10”. But, if it were between 6’1 and 5’11”, OK, I might agree with you and not worry about the issue. This is not a macho thing. This is one of the most common issues that cause depression in adolescent boys is being short. Let’s not forget there are some cultural issues as well to consider. Had a Portugese boy come to me and said, “I’m never going to be 6′ on these medications.” His parents were 5’2″ and 5’3″. I said, “Are you kidding me? Even without the meds, we might get you to 5’4″ but we are going to have to invent in a rack.”

Always speak to your doctor before making any changes to medications. Dr. Jain provides advice generically and not for any one person. Advice does not constitute a therapeutic relationship or promise of care. Please consult the privacy policy for more information.

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