Background/Aims: Determine (1) frequency of attention-deficit hyperactivity disorder (ADHD) treatment and (2) growth responses in growth hormone (GH)-treated children who are receiving ADHD medication versus GH alone. Methods: Prepubertal children with idiopathic short stature (ISS) or GH deficiency (IGHD) enrolled in Genentech’s National Cooperative Growth Study. ADHD treatment was determined by documentation of psycho-stimulant medication use at enrollment. Results: ADHD medication use increased from 0.8% (7/850) in 1985 to 5.8% (752/12,113) in 2005. First-year GH treatment response for ADHD + IGHD versus IGHD: 8.5 ± 2.0 vs. 9.4 ± 2.6 cm/year, but when adjusted for age, sex, and enrollment body mass index, the difference is clinically insignificant (–0.4 cm/year). First-year growth was similar in all ISS: 8.1 ± 1.9 versus 8.6 ± 2.1 cm/year (ADHD + ISS vs. ISS, an adjusted –0.2-cm/year difference). Conclusion: Increasing numbers of GH-treated children are taking ADHD medications and their growth responses during the first year of GH therapy are similar to those not taking ADHD medications.

1.
August GP, Lippe BM, Blethen SL, Rosenfeld RG, Seelig SA, Johanson AJ, Compton PG, Frane JW, McClellan BH, Sherman BM: Growth hormone treatment in the United States: demographic and diagnostic features of 2331 children. J Pediatr 1990;116:899–903.
2.
Blethen SL, Allen DB, Graves D, August G, Moshang T, Rosenfeld R: Safety of recombinant deoxyribonucleic acid-derived growth hormone: the National Cooperative Growth Study experience. J Clin Endocrinol Metab 1996;81:1704–1710.
3.
Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL: CDC growth charts: United States. Adv Data 2000;8:1–27.
4.
Daley KC: Update on attention-deficit/hyperactivity disorder. Curr Opin Pediatr 2004;16:217–226.
5.
Centers for Disease Control and Prevention (CDC): Mental health in the United States. Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder – United States, 2003. MMWR Morb Mortal Wkly Rep 2005;54:842–847.
6.
Froehlich TE, Lanphear BP, Epstein JN, Barbaresi WJ, Katusic SK, Kahn RS: Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Arch Pediatr Adolesc Med 2007;161:857–864.
7.
Greenhill LL, Pliszka S, Dulcan MK, Bernet W, Arnold V, Beitchman J, Benson RS, Bukstein O, Kinlan J, McClellan J, Rue D, Shaw JA, Stock S; American Academy of Child and Adolescent Psychiatry: Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. J Am Acad Child Adolesc Psychiatry 2002;41:26S–49S.
8.
Swanson JM, Lerner M, Williams L: More frequent diagnosis of attention deficit-hyperactivity disorder. N Engl J Med 1995;333:944.
9.
Vitiello B, Jensen P: Medication development and testing in children and adolescents: current problems, future directions. Arch Gen Psychiatry 1997;54:871–876.
10.
Finkelstein BS, Silvers JB, Marrero U, Neuhauser D, Cuttler L: Insurance coverage, physician recommendations, and access to emerging treatments: growth hormone therapy for childhood short stature. JAMA 1998;279:663–668.
11.
Kemp S: Growth hormone deficiency; in Rosenbloom AL (ed): eMedicine: Pediatrics General Medicine Web site. Updated April 19, 2006. Available at: http://www.emedicine.com/ped/topic1810.htm.
12.
Visser SN, Lesesne CA, Perou R: National estimates and factors associated with medication treatment for childhood attention-deficit/hyperactivity disorder. Pediatrics 2007;119(suppl 1):S99–S106.
13.
Rao JK, Julius JR, Breen TJ, Blethen SL: Response to growth hormone in attention deficit hyperactivity disorder: effects of methylphenidate and pemoline therapy. Pediatrics 1998;102:497–500.
14.
Jensen JB, Garfinkel BD: Neuroendocrine aspects of attention deficit hyperactivity disorder. Endocrinol Metab Clin North Am 1988;17:111–129.
15.
Spencer T, Biederman J, Wilens T: Growth deficits in children with attention deficit hyperactivity disorder. Pediatrics 1998;102:501–506.
16.
Pliszka SR: The use of psychostimulants in the pediatric patient. Pediatr Clin North Am 1998;45:1085–1098.
17.
Poulton A: Growth on stimulant medication; clarifying the confusion: a review. Arch Dis Child 2005;90:801–806.
18.
Drappatz J, Khwaja O, Neovius M, Sarco D: Growth in children with ADHD treated with stimulant medications: a meta-analysis. Presented at Pediatric Academic Societies’ 2006 Ann Meet, San Francisco, 2006, abstr 4885.458.
19.
Martha PM Jr, Reiter EO, Davila N, Shaw MA, Holcombe JH, Baumann G: The role of body mass in the response to growth hormone therapy. J Clin Endocrinol Metab 1992;75:1470–1473.
20.
Data on file, Genentech safety database.
21.
Perrin JM, Friedman RA, Knilans TK; Black Box Working Group and Section on Cardiology and Cardiac Surgery: Cardiovascular Monitoring and Stimulant Drugs for Attention-Deficit/Hyperactivity Disorder. Elk Grove Village, American Academy of Pediatrics, 2008.
22.
Vetter VL, Elia J, Erickson C, Berger S, Blum N, Uzark K, Webb CL; American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee; American Heart Association Council on Cardiovascular Nursing: Cardiovascular monitoring of children and adolescents with heart disease receiving medication for attention deficit/hyperactivity disorder: a scientific statement from the American Heart Association Council on Cardiovascular Disease in Young Congenital Defects Committee and the Council on Cardiovascular Nursing. Circulation 2008;117:2407–2423.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.