To evaluate the sex-specific effects of stimulants in children with Attention-Deficit/Hyperactivity Disorder (ADHD) on body mass index (BMI)-Z and Height-Z trajectories.
A retrospective cohort study utilizing the database of Israel Clalit Health Services. Participants included 5-18-year-old insureds with documentation of at least two consecutive prescriptions of stimulant drugs for ADHD. Participants were further compared with sex and age matched non-ADHD insureds.
A total of 4561 (66% boys) participants with ADHD were included. Of these, 2151 (70% boys) had follow-up data for ≥2 years of treatment. A decline of ≥ 1 SD in Height and BMI-Z-score was observed in 10.1% and 13.2% of the cohort, respectively. During ≥2 years follow-up, boys had a greater decline in Height-Z-score (∼0.2 SD) than girls (∼0.06 SD). Boys’ Height-Z-score continued to decline after one and ≥2 years, and girls’ Height-Z-score declined after one year, and then stabilized. The trajectory of BMI-Z-score of boys and girls was similar, showing a greater decline after one year, followed by an incline after ≥2 years. Younger age at stimulants initiation, better adherence, longer treatment duration and lower socioeconomic status were correlated with a greater impact on growth attenuation. The non-ADHD group (n=4561, 66% boys) had baseline Height-Z-score and BMI-Z-score similar to those in children with ADHD before treatment initiation. Height-Z-score and BMI-Z-score were higher in non-ADHD compared with children with ADHD following one year of treatment (P < .001).
These findings highlight the importance of growth monitoring accompanied with dietary counseling in children with ADHD treated with stimulants.

Copyright © 2021. Published by Elsevier Inc.