Your Children's Health

By Roy Benaroch, MD

About 5% of American children have Attention-Deficit Disorder. Apart from the frustration of poor school performance, difficult home lives, and sometimes trouble making and keeping friends, there may be some serious long-term consequences. Kids with ADD are more likely to fail school and become involved with drugs. As adults, they may be less successful with their jobs and adult relationships. Though there is effective therapy for ADD, there is increasing concern that the medications being used may have lasting effects on the way children grow.

The most effective, well-established medicines for ADD are known as “stimulants”. This group includes well-known brands like Ritalin, Concerta, Adderall and Vyvanse. They all work essentially the same way: they increase activity in the brain that helps control or modulate attention and focus. One predictable side effect of all of these is decreased appetite—and, if that leads to a sustained decrease in eating, eventually decreased weight and height growth. (There may be other ways these medications affect height, but that’s probably the main way.) The effect is stronger with higher doses of medication, even moreso with medications that last for more hours each day. That makes sense—medicines that wear off by dinnertime, allowing the appetite to return, can make it more likely that a big dinner can make up for a small lunch.

Research has looked at the growth trajectory of children on ADD medicines, and for the most part it’s reassuring. The biggest effect on weight and height is seen when first starting medication, and many of these kids seem to “catch up” back to their expected weight curves within a few years. However, we can’t predict which kids are the most likely to catch up. So what can parents do?

First, physicians should stress that there are important non-medicine things that ought to be done first to help kids with their attention. A good night’s sleep is essential, as is time for active play and exercise. Decreasing time in front of a video screen may also help kids stay focused. While there is no “magic bullet” dietary change, there is some evidence that a diet that relies on a lot of processed food and additives may make ADD symptoms worse. Though most of the supplements sold to help with ADD have very little medical backing, an omega-3 (or “fish oil”) supplement may provide at least modest benefit. Also, working with tutors and therapists might help with academic skills, even without taking any medication.

If medication is necessary, lower doses are less likely to affect growth. Parents should also try to take advantage of times when medication isn’t in the system to provide extra-big meals. There are some FDA-approved medications for ADD that don’t affect appetite—though they’re not as effective for core ADD symptoms and have other side effects. Parents should work with their child’s doctor to come up with a plan that minimizes side effects while helping their child succeed.

ADD medicines aren’t placebos—they can really help kids focus. At the same time, as with any real medicine, there are side effects. The benefits and risks both need to be considered to make a good choice about the best way to treat children with ADD.