Do drug holidays from stimulants (Central Nervous System stimulants) help children achieve their full height potential since stimulants normally suppress growth?

From the Guidelines

Drug holidays from stimulants are not recommended as a routine practice to minimize potential growth suppression effects, as the evidence for this approach is mixed and the benefits of consistent treatment for ADHD symptoms may outweigh potential height concerns for many children. Stimulant medications like methylphenidate (Ritalin, Concerta) and amphetamine-based medications (Adderall, Vyvanse) can potentially slow growth by 1-2 cm in height, though most children eventually reach their expected adult height 1. The Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) study results identified stimulants as having a more persistent effect on decreasing growth velocity compared to most previous studies, with diminished growth in the range of 1 to 2 cm from predicted adult height 1.

However, the growth effects of stimulants are generally modest, and the benefits of consistent treatment for ADHD symptoms may outweigh potential height concerns for many children. Regular monitoring of height, weight, and overall development by your child's healthcare provider is essential to make individualized decisions about medication management. If considering drug holidays, these are typically implemented during school breaks like summer vacation or weekends when academic demands are lower, but this practice should always be discussed with your child's doctor first, as abruptly stopping medication can cause behavioral challenges and may not be appropriate for all children 1.

Some key points to consider when making decisions about medication management for ADHD include:

• The child's response to stimulants is variable and unpredictable, and titration from a low dose to one that achieves a maximum, optimal effect in controlling symptoms without adverse effects is recommended 1.
• Parent and child education is an important component in the chronic illness model to ensure cooperation in efforts to achieve appropriate titration and monitoring of medication efficacy 1.
• Treating ADHD as a chronic illness and providing continuity of care and, where possible, a medical home is essential for optimal management 1.

From the FDA Drug Label

1. 11 Effects on Growth Data on the long-term effects of atomoxetine hydrochloride on growth come from open-label studies, and weight and height changes are compared to normative population data. In general, the weight and height gain of pediatric patients treated with atomoxetine hydrochloride lags behind that predicted by normative population data for about the first 9 to 12 months of treatment Subsequently, weight gain rebounds and at about 3 years of treatment, patients treated with atomoxetine hydrochloride have gained 17.9 kg on average, 0.5 kg more than predicted by their baseline data. After about 12 months, gain in height stabilizes, and at 3 years, patients treated with atomoxetine hydrochloride have gained 19.4 cm on average, 0. 4 cm less than predicted by their baseline data

The FDA drug label does not provide information on the effects of drug holidays from stimulants on achieving full height potential. However, it does mention that atomoxetine hydrochloride (a non-stimulant) may affect growth in pediatric patients, with height gain stabilizing after about 12 months of treatment and being 0.4 cm less than predicted after 3 years of treatment 2.

• Key points:
  • Atomoxetine hydrochloride may affect growth in pediatric patients.
  • Height gain stabilizes after about 12 months of treatment.
  • No information is available on the effects of drug holidays from stimulants on achieving full height potential.

From the Research

Effects of Stimulants on Height

• Studies have shown that stimulant medications can lead to statistically significant delays in height and weight in children with attention-deficit/hyperactivity disorder (ADHD) 3, 4, 5.
• However, the evidence suggests that these effects may attenuate over time, and some data indicate that ultimate adult growth parameters are not affected 3, 6.
• A review of the literature found that treatment with stimulant medication led to a temporary halt in growth, but no significant differences in final adult height were observed 3, 6.

Impact of Drug Holidays on Growth

• There is limited evidence to suggest that drug holidays from stimulants can help children achieve their full height potential 3, 4.
• One study found that treatment cessation may lead to normalization of growth, but further research is needed to confirm this finding 3.
• Another study found that growth deficits may be dose-dependent, and that deficits may not differ between methylphenidate and amphetamine 3.

Monitoring Growth in Children with ADHD

• The evidence suggests that growth should be continuously monitored in patients on chronic treatment with central stimulants 4, 5.
• Physicians should be aware of the potential effects of stimulants on growth and adjust treatment accordingly 3, 5.
• Further research is needed to clarify the effects of continuous treatment from childhood to adulthood and to determine the optimal treatment strategies for children with ADHD 3, 5, 6.