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Attention Deficit Disorder (ADD)/ADHD Medication and side effects

Expert: Dr Billy Levin - 9/4/2008

Question
Hi- My 7 1/2 year old son was diagnosed with ADHD when he was 4. He first started on Metadate and then we switched over to Focalin. He is currently taking 20 mgs a day. I don't normally give it to him on the weekends unless he seems to need it. My question is that I've noticed he's not growing quickly. I'm not so much comparing him to his peers as I've noticed that I haven't had to buy him new pants or shoes. We went to the doctor yesterday and they measured him, etc. He was on the 25th percentile a year ago for his height and has since dropped to the 10th percentile. His pediatrician said that if he crosses that percentile that she would be very concerned. He may just be getting in normal range for himself. His father is only 5 foot 6" and our son is on track for that height. We had blood drawn to rule out any other issues and are possibly looking into switching over to Straterra since one of the possible side effects on the Focalin is retarded growth. Given all of this, does it sound like Focalin could be doing this and how safe is Straterra? The doctor suggested that when we get the blood work back possibly seeing an Endocrinologist. Am I panicking or should I relax? I want my son to be successful and therefore the medication which helps him with the ADHD. But I don't want his growth stunted! What is your opinion regarding these issues? Thanks!

Answer
I can only discuss the situation in general terms as I have not examined your son.
   There are two aspects to consider. The first is the genetic family trend. At 5ft 6inch the father is certainly below average height for a man and if this is an inherited trait, it would be expected your son might also be short in stature. Next, the stimulants do tend to slow down the growth, not stunt it. There is a tendency to catch up eventually. There are no midgets caused by stimulants. At the 10 percentile from the 25th does however warrant careful consideration.
  Strattera might be a good idea as long as he responds to as well to it as the stimulants.
   A growth evaluation by an Endocrinologist would be a good idea, not because of his treatment but rather the genetic factor. Growth hormone may be an option.

Questioner's Rating

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Comment	I really apprecaite your forthwright and prompt reply. I did not understand that stimulants only slow down growth and that certainly makes me feel better. Everything that I have read has said that it may retard growth which I understood to mean that growth was stunted, not slowed down. I was extremely concerned that his growth would be forever stunted because of the medication. And of course, I would hate to have that happen to our son because of something that we put him on. Focalin has really been a help to him and we can certainly see a difference in him when he is not on the medication. I will talk to his pediatrician about seeing the Endocrinologist just to make sure that his growth is where it should be. Thank you again for the information. I love my son and only want what is best for him, never to harm him in any way, intentionally or not. Thanks!