Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. 588 (doi:10.1542/peds.2005-2071)
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Absence of Unfavorable Effect of Atomoxetine on Growth in Pediatric Patients Is Still Not Demonstrated: In Reply

Thomas J. Spencer, MD
Joseph Biederman, MD
Department of Psychiatry,
Massachusetts General Hospital,
Boston, MA 02114

Jeffrey H. Newcorn, MD
Department of Psychiatry,
Mount Sinai Medical Center,
New York, NY 10029

Christopher J. Kratochvil, MD
Department of Psychiatry,
University of Nebraska Medical Center,
Omaha, NE 68102

Dustin Ruff, PhD
David Michelson, MD
Lilly Research Laboratories,
Indianapolis, IN 46285

In Reply.—

As we acknowledged in our article, potential differences in pubertal tempo may increase variability in the findings.1 Although we did not know the pubertal staging for individuals, it was a large sample, and we had no reason to think that the distribution of onset of puberty across the sample was likely to deviate markedly from the expected distribution. Moreover, this source of variability doesn't invalidate the study findings. The only manner in which pubertal tempo would obscure adverse results would be if atomoxetine advanced pubertal tempo so that height z scores seemed normal but growth terminated sooner than expected. There is no reason to believe that this occurred.

In our previous controlled studies of growth in boys and girls with and without attention-deficit/hyperactivity disorder (ADHD), we used self-report to determine Tanner stages.2 Studies have shown that self-assessed pubertal stages may be highly concordant with physician-assessed pubertal staging.3 In neither study were there differences between treated and untreated ADHD as well as control probands in the age of onset of estimated Tanner stages.2,4 In addition, in a separate, 18-month relapse prevention study of atomoxetine that included a group randomly assigned to receive placebo after acute treatment, there was no evidence that atomoxetine affected the onset of puberty during chronic treatment as assessed by comparisons between groups of (1) the number of patients in each group with a change of at least 1 physician-assessed Tanner stage, (2) the mean time to first Tanner-stage change, and (3) the proportion of patients in each Tanner-stage group moving to the next Tanner stage also found no affect on onset of pubertal stages.5

Despite the reassurance provided by these investigations, we agree that longer studies are needed to fully understand growth issues in children with ADHD.

REFERENCES

  1. Spencer TJ, Newcorn JH, Kratochvil CJ, Ruff D, Michelson D, Biederman J. Effects of atomoxetine on growth after 2-year treatment among pediatric patients with attention-deficit/hyperactivity disorder. Pediatrics. 2005;116 (1). Available at:www.pediatrics.org/cgi/content/full/116/1/e74
  2. Spencer TJ, Biederman J, Harding M, O'Donnell D, Faraone SV, Wilens TE. Growth deficits in ADHD children revisited: evidence for disorder-associated growth delays? J Am Acad Child Adolesc Psychiatry. 1996;35 :1460 –1469[CrossRef][ISI][Medline]
  3. Duke PM, Litt IF, Gross RT. Adolescents' self-assessment of sexual maturation. Pediatrics. 1980;66 :918 –920[Abstract/Free Full Text]
  4. Biederman J, Faraone SV, Monuteaux MC, Plunkett EA, Gifford J, Spencer T. Growth deficits and attention-deficit/hyperactivity disorder revisited: impact of gender, development, and treatment. Pediatrics. 2003;111 :1010 –1016[Abstract/Free Full Text]
  5. Michelson D, Spencer T. Developmental outcomes of long-term atomoxetine treatment in ADHD [poster]. Presented at: American Academy of Child and Adolescent Psychiatry annual meeting; October 19–24, 2004; Washington, DC; p 98
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics

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