Skeletal Maturation Delay and ADHD Medication Use in Children with Constitutional Growth Delay: A Retrospective-Prospective Study.

Abstract

To explore whether a common pathway of maturational delay underlies both attention deficit hyperactivity disorder (ADHD) and constitutional growth delay (CGD) by comparing ADHD medication use between children with CGD and children with idiopathic short stature (ISS). Retrospective review of 362 short-statured children (265 CGD, 97 ISS) followed in a pediatric endocrinology clinic (2010-2025), plus a prospective parent-questionnaire component (n=104 CGD). ADHD medication use (Rx) was the primary outcome. Logistic regression adjusted for height, BMI, sex, and Tanner stage. ADHD Rx was significantly higher in CGD than in ISS (27.2% vs 11.3%, P=0.002) and the general population (P<0.001); ISS rates did not differ from population norms (p=0.76). ADHD Rx showed a dose-response relationship with bone age gap (BAG) across the retrospective cohort as a whole, reaching 35.1% for BAG ≥3 years (P<0.001 for trend). CGD independently predicted ADHD treatment (adjusted OR 2.17; 95% CI 1.01-4.64). Greater BAG was associated with higher inattention scores, younger-than-age behavior, and lower academic performance on prospective questionnaires. The degree of skeletal maturation delay correlates with ADHD medication use in CGD, consistent with a shared maturational delay hypothesis but not establishing causality. These findings may warrant careful re-evaluation of ADHD diagnoses as skeletal maturation progresses in affected children.