ADHD, Stimulant Use, and Failure to Thrive in Pediatric Patients

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CONFERENCE REPORTER

Addressing attention-deficit/hyperactivity disorder (ADHD) while ensuring the proper physical development of child and adolescent patients can be a challenge. A holistic, multidisciplinary approach to managing failure to thrive (FTT)—a condition in which children do not grow at a rate for their age—is critical. This includes a psychiatric consultation to address comorbidities.

The poster, “Stimulant Use in Pediatric ADHD: Balancing Behavioral Management and Physical Development - A Case Study and Literature Review,” presented at the 2024 American Psychiatric Association Annual Meeting, reviewed the current literature on the relationship between stimulant use and FTT. To demonstrate findings, it presented a new case involving an adolescent patient with comorbid ADHD and conduct disorder.¹

The investigators used methylphenidate as an example, a commonly prescribed ADHD medication for children aged 6 and older that is known for its appetite-suppressing effects. A young patient taking methylphenidate for their ADHD could experience appetite-suppression, thus leading to lower body mass index (BMI) and inadequate weight gain; inadequate weight gain could in turn lead to the patient experiencing FTT, also known as weight faltering.² In cases of pediatric patients with both FTT and ADHD, clinicians must carefully balance the management of ADHD symptoms against the risk of appetite suppression associated with stimulants. Alternatively, not treating ADHD can increase the potential of depression and conduct disorders; in fact, 1 analysis suggested that depression was 20% less common during periods of time when patients received ADHD medication compared with periods when they did not.³

The study presents “Patient K,” a 14-year-old boy with ADHD, conduct disorder, and intellectual disability exhibited FTT. He was diagnosed with ADHD and conduct disorder early in childhood and has been prescribed methylphenidate since the age of 6. The use of stimulants initially improved his conduct, but slowed his growth trajectory with a significant BMI decrease. His clinicians identified methylphenidate as a potential cause and discontinued it, then putting him on guanfacine for ADHD and cyproheptadine to increase appetite. Unfortunately, the stimulant discontinuation resulted in behavioral and intellectual functioning issues; he displayed worsening aggression and intellectual regression. This led to reintroduction of methylphenidate at a reduced dose. While his behavior improved modestly, he experienced significant weight loss and did not recover the full extent of intellectual capacity. When consulted, psychiatry recommended to simplify his medication regimen for concerns of polypharmacy and to reduce adverse effects.

The literature review used articles published in English from databases such as PubMed, PsycINFO, and Psychiatry Online. Cases not involving ADHD or stimulant use were excluded.

This study illuminates the complex relationship between stimulants, behavioral management, and physical wellness, and contributes to a more complete understanding of ADHD treatment in pediatric populations.

Additional research indicates long-term ADHD medication use is associated with increased risk of incident of cardiovascular disease regardless of age, indicating clinicians should not only carefully consider medication options for patients with this disorder, but also closely monitor those taking ADHD medications, especially in higher doses.⁴

How do you handle adverse effects like insufficient weight gain in child and adolescent patients? Let us know at PTEditor@MMHGroup.com!

References

1. Nguyen JPA, Leavitt D. Stimulant use in pediatric ADHD: balancing behavioral management and physical development - a case study and literature review. Poster presented at: 2024 APA Annual Meeting; May 4-8, 2024; New York, NY. Accessed April 25, 2024. https://s7.goeshow.com/apa/annual/2024/poster_search.cfm?session_key=8E8E549C-90B1-1C06-DFD2-76A0D47AF330&session_date=Saturday,%20May%2004,%202024#

2. Homan GJ. Failure to thrive: a practical guide. Am Fam Physician. 2016;94(4):295-299.

3. Chang Z, D’Onofrio BM, Quinn PD, et al. Medication for attention deficit/hyperactivity disorder and risk for depression: a nationwide longitudinal cohort study. Biol Psychiatry. 2016;80(12):916-922.

4. Miller B. ADHD medications and long-term cardiovascular risk. Psychiatric Times. March 29, 2024. https://www.psychiatrictimes.com/view/adhd-medications-and-long-term-cardiovascular-risk