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Non-Stimulant Medication Approved for Treatment of ADHD

The FDA has approved a new medication for the treatment of ADHD (Attention Deficit Hyperactivity Disorder). Kapvay is the first non-stimulant approved to treat ADHD in children and adolescents. It can be used either with or one of the traditional stimulant medications or can be used alone in the treatment of ADHD.

Clonidine extended-release tablets (Kapvay) acts on the brain in a different way, and acts in a different part of the brain, than the stimulants. Taken twice a day, Clonidine, in these early studies, improved core ADHD symptoms. In clinical trials, the most common adverse effects were sleepiness and sedation.

We will need more experience with this medication in order to know its long term usefulness. Clonidine in its original form has been around for years. It is used primarily in adults as a treatment for high blood pressure. This older form has been used off label by some psychiatrists to treat oppositional behavior and certain types of sleep problems in children with ADHD.

Most likely, the primarily use of Kapvay will be as an adjunct medication used along with stimulants when the involved child has more impulsive behavior and or/has sleep problems. Those of us treating children with ADHD are pleased to have an additional option available in the management of children with various forms of ADHD.

ADHD, Medication, and Growth

Over the years, there has been concern that children with ADHD taking stimulants do not grow normally due to the appetite effects of the medication.  Various studies over the years have looked at this issue and the results suggest that there are little, if any, stunting of growth from the stimulants. But questions persist in some circles.

A recent study performed at Massachusetts General Hospital in Boston and reported in the Journal of Pediatrics (October 2010) clarifies the growth tendencies of children with ADHD. This study looked at the growth patterns of over 240 boys and girls with ADHD and compared their growth with that of matched controls without ADHD.

The subjects were observed over a ten year period. No difference was noted in the trajectory of growth in height or weight in the children with ADHD compared with those without ADHD. In addition, there were no significant difference in height growth in those treated with stimulants and those who were not. Nor were there any associations between duration of stimulant treatment and growth patterns.

This carefully done study demonstrates that kids with ADHD, whether treated with medication or not, grow at the same rate as the non-ADHD population.

Editor’s Note: This study is re-assuring to parents and to physicians treating children with stimulants. In spite of this, it is important for children taking stimulants to be seen by their physician on a regular basis with monitoring of appetite and growth factors. Among other observations, their height and weight should be measured and plotted on a growth curve regularly. If there is any evidence in loss of appetite or fall off in the growth pattern, the physician and parents can make appropriate adjustments in type, amount, or timing of the medication.

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