4.3 A Smart Design Examining the Impact of CNS Stimulants On the Growth Trajectories of Children With Attention-Deficit/Hyperactivity Disorder

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Objectives

There is increasing evidence that central nervous system (CNS) stimulants may lead to growth suppression in children who are prescribed these drugs long-term to treat ADHD. Few studies have used unmedicated youth with ADHD for comparison; previous work primarily has examined the effects of immediate release stimulants often in previously treated children. Emerging evidence suggests that inconsistent medication usage produces less suppression than consistent usage throughout adolescence.

Methods

An adaptive intervention was used to mimic clinical practice where efforts to improve weight gain in children with ADHD occur after evidence of weight loss or growth suppression is seen.

Results

Treatment medication naïve youth with ADHD (n = 230) were assigned randomly to either treatment with extended release methylphenidate (ER-MPH) and a low-intensity behavioral intervention (78 percent) or more intense behavioral services without pharmacological treatment (22 percent). Weight, height, ADHD symptoms, and impairment were measured biweekly until medication was optimized (a maximum of 12 weeks), then monthly for 3 months, and then at least every 3 months for a total of 30 months.

Conclusions

The presentation will discuss the rationale and relative benefits of the SMART design for addressing study aims, as well as methodical considerations for implementing the design.

ADHD Medication Adverse Effects STIM

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