From the Guidelines
For children with hyperactivity, impulsivity, growth deficiency, and poor weight gain, a comprehensive treatment approach prioritizing non-stimulant ADHD medications and nutritional support is recommended to balance ADHD symptom management with nutritional needs. This approach is based on the most recent and highest quality study available, which emphasizes the importance of considering the patient's age and specific needs in the treatment of ADHD 1.
Key Considerations
- Non-stimulant ADHD medications like atomoxetine (Strattera) or guanfacine (Intuniv) are preferred over stimulants, which can suppress appetite and growth.
- Nutritional support, including high-calorie, nutrient-dense meals and snacks, is crucial for addressing growth deficiency and poor weight gain.
- Behavioral therapy techniques can be used to address both ADHD symptoms and eating behaviors.
- Regular growth monitoring (every 3-6 months) is necessary to track progress and adjust the treatment plan as needed.
Treatment Approach
- For preschool-aged children (4–5 years of age), evidence-based parent- and/or teacher-administered behavior therapy is recommended as the first line of treatment, with methylphenidate considered if significant improvement is not seen and there is moderate-to-severe continuing disturbance in the child’s function 1.
- For elementary school–aged children (6–11 years of age), US Food and Drug Administration–approved medications for ADHD, such as atomoxetine or guanfacine, and/or evidence-based parent- and/or teacher-administered behavior therapy are recommended, preferably both 1.
- For adolescents (12–18 years of age), FDA-approved medications for ADHD, with the assent of the adolescent, and possibly behavior therapy, are recommended 1.
Additional Recommendations
- A pediatric endocrinologist should evaluate for underlying growth hormone deficiency or other endocrine disorders that might require additional treatment.
- The treatment plan should be individualized, taking into account the child's specific needs, preferences, and circumstances, as well as the family's preferences and ability to adhere to the treatment plan 1.
From the Research
Treatment Options for Children with Hyperactivity and Impulsivity
- Methylphenidate and atomoxetine are two commonly used medications for treating attention-deficit/hyperactivity disorder (ADHD) in children, as shown in a 24-week, open-label, head-to-head clinical trial 2.
- Both medications have been found to be effective in reducing core symptoms of ADHD, as well as improving emotional and behavioral problems in children with the disorder 2, 3.
Growth Deficiency and Poor Weight Gain
- Research has shown that children with ADHD may experience temporary deficits in height gain, but this effect appears to be mediated by the disorder itself, rather than its treatment 4.
- There is no evidence to suggest that ADHD is associated with weight deficits in children, and no relationship has been found between measures of malnutrition and short stature in children with the disorder 4.
Treatment Considerations
- When treating children with ADHD, it is essential to consider the potential effects of medication on growth and weight gain, as well as the child's overall health and well-being 4, 5.
- A comprehensive treatment plan may include a combination of medication, behavioral therapy, and lifestyle changes to help manage symptoms of ADHD and promote healthy growth and development 5, 3.
Medication Efficacy
- Methylphenidate has been shown to be effective in improving core symptoms of ADHD, as well as addressing conduct problems and cognitive function in children with the disorder 2, 3.
- Atomoxetine, on the other hand, may be a better choice for children with ADHD who also experience anxiety, as it has been found to be effective in reducing symptoms of anxiety in these patients 3.