中枢神经系统兴奋剂治疗注意缺陷/多动障碍儿童生长抑制的干预措施随机对照试验。
A Randomized Controlled Trial of Interventions for Growth Suppression in Children With Attention-Deficit/Hyperactivity Disorder Treated With Central Nervous System Stimulants.
机构信息
Penn State College of Medicine, Hershey, Pennsylvania.
Arizona State University, Tempe.
出版信息
J Am Acad Child Adolesc Psychiatry. 2020 Dec;59(12):1330-1341. doi: 10.1016/j.jaac.2019.08.472. Epub 2019 Aug 29.
OBJECTIVE
To examine the impact of central nervous system (CNS) stimulants on the growth of children with attention-deficit/hyperactivity disorder (ADHD), and to assess the efficacy and feasibility of weight recovery interventions on growth.
METHOD
A total of 230 children aged 5 to 12 years with ADHD with no history of chronic CNS stimulant use were randomly assigned to receive daily CNS stimulants (78%, primarily osmotic release oral system-methylphenidate [OROS-MPH]) or behavioral treatment (22%) for 30 months. After 6 months, children evidencing a decline in body mass index (BMI) of >0.5 z-units were randomized to 1 of 3 weight recovery treatments (WRTs): monthly monitoring of height/weight (MON) plus continued daily medication; drug holidays (DH) with medication limited to school days; or daily caloric supplementation (CS) with a 150-kcal supplement plus daily medication.
RESULTS
Before WRT assignment, medication was associated with significant reductions in standardized weight and height (p values <.01). Adherence to CS and DH during WRT was high, with significant increases in daily caloric intake and decreases in weekly medication exposure (p values <.05). Across all WRT participants (n = 71), weight velocity increased significantly after WRT randomization (β = 0.271, SE = 0.027, p < .001).When analyzed by what parents did (versus what they were assigned to), CS (p < .01) and DH (p < .05) increased weight velocity more than MON. No increase in height velocity was seen after randomization to any WRT. Over the entire study, WRT participants declined in standardized weight (-0.44 z-units) and height (-0.20 z-units).
CONCLUSION
Drug holidays, caloric supplementation, and increased monitoring all led to increased weight velocity in children taking CNS stimulants, but none led to increased height velocity.
CLINICAL TRIAL REGISTRATION INFORMATION
Novel Approach to Stimulant Induced Weight Suppression and Its Impact on Growth; https://clinicaltrials.gov/; NCT01109849.
目的
研究中枢神经系统（CNS）兴奋剂对注意缺陷/多动障碍（ADHD）儿童生长的影响，并评估体重恢复干预对生长的疗效和可行性。
方法
共有 230 名年龄在 5 至 12 岁、无慢性 CNS 兴奋剂使用史的 ADHD 儿童被随机分为接受每日 CNS 兴奋剂（78%，主要为渗透压释放口服系统-哌醋甲酯[OROS-MPH]）或行为治疗（22%）治疗 30 个月。治疗 6 个月后，体重指数（BMI）下降>0.5 z 单位的儿童被随机分为 3 种体重恢复治疗（WRT）之一：身高/体重的每月监测（MON）加持续每日用药；药物假期（DH），仅在上学日限制用药；或每日热量补充（CS），加 150 卡路里补充剂和每日用药。
结果
在 WRT 分配前，药物治疗与标准化体重和身高的显著下降相关（p 值<.01）。WRT 期间 CS 和 DH 的依从性很高，每日热量摄入量显著增加，每周药物暴露量减少（p 值<.05）。在所有 WRT 参与者（n=71）中，WRT 随机化后体重速度显著增加（β=0.271，SE=0.027，p<.001）。当按父母所做的（而非所分配的）进行分析时，CS（p<.01）和 DH（p<.05）增加体重速度比 MON 更多。随机分配至任何 WRT 后，身高速度均未增加。在整个研究过程中，WRT 参与者的标准化体重（-0.44 z 单位）和身高（-0.20 z 单位）下降。
结论
药物假期、热量补充和监测增加都导致服用 CNS 兴奋剂的儿童体重速度增加，但均未导致身高速度增加。
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