Abstract
The routine clinical use of lengthy treatment with psychostimulant medications in children with attention-deficit hyperactivity disorder (ADHD) has raised concerns about its possible long-term adverse effects. In a prospective 21-month open-label outpatient study with high compliance rates (mean 87%), 23 boys with DSM-III-R ADHD were treated with methylphenidate (mean daily dose 23 mg, 0.55 mg/kg) and compared with 23 unmedicated ADHD boys (aged 7 to 12 years at entry). Growth and cardiovascular parameters were measured at the start and finish of the 21 months. The results suggested that extended methylphenidate treatment at doses around 0.5 mg/kg daily did not produce clinically or statistically significant changes in weight, height, heart rate, or diastolic or systolic blood pressure (although transient changes, lasting weeks or months, might have occurred that did not persist in extended treatment). There was a small and statistically insignificant association between total cumulative dosage of methylphenidate and weight at the end of the treatment period, suggesting that high doses over a longer time might lead to reduced weight gain. A small subgroup of the boys in the sample (four medicated and two unmedicated) showed a weight gain of less than 5 kg during the treatment period. Since it remains possible that methylphenidate treatment extended for more than 2 years in such children could lead to clinically significant weight reductions, children with low weight gain on extended stimulant treatments should be closely monitored regarding possible drug discontinuation or dose adjustment.
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