Does rapid rebound height growth come at a neurocognitive cost for previously institutionalized youth?

Brie Reid, Danruo Zhong, Bonny Donzella, Mariann A Howland, Bao Moua, Megan R. Gunnar

Research output: Contribution to journalArticlepeer-review


Background: Height growth faltering is associated with less optimal behavioral outcomes and educational achievement. Although catch-up growth after growth delay may result in developmental gains, it may also present as a double-edged sword, with consequences for neurocognitive functioning such as symptoms of inattention and hyperactivity. As previously institutionalized (PI) children experience height delays at adoption and catch-up growth after adoption, they provide a cohort to test associations between catch-up growth and attention deficit hyperactivity disorder (ADHD) symptoms. Methods: This study used latent growth curve modeling to examine how catch-up in height-for-age growth is related to attention problems in a population of PI youth followed from adoption in infancy through kindergarten. Participants were assessed within three months of arrival into their families (age at entry: 18–36 months). Anthropometrics were measured four times, approximately 7 months apart. Two visits measured behavioral outcomes with parent and teacher reports of ADHD, internalizing, and externalizing symptoms at age 5 and kindergarten. Results: The slope of growth in height z-scores, but not the intercept, was positively associated with parent- and teacher-reported ADHD symptoms in children. A one standard deviation increase in the slope of height z-scores across four assessments was associated with a 0.252 standard deviation increase in ADHD symptoms after controlling for internalizing and externalizing problems, iron status, duration of institutional care, sex, and age. The slope of growth was also associated with internalizing but not externalizing symptoms. Conclusions: This study demonstrates that PI children exhibit individual trajectories of height growth postadoption. Higher rates of change in height-for-age growth were associated with increased ADHD symptoms. These results suggest that catch-up growth comes ‘at the cost’ of poor attention regulation and hyperactive behavior.

Original languageEnglish (US)
Pages (from-to)1434-1444
Number of pages11
JournalJournal of Child Psychology and Psychiatry and Allied Disciplines
Issue number11
StatePublished - Nov 2022

Bibliographical note

Funding Information:
The authors would like to express their gratitude to the families who made their research possible. This research was supported by a grant from the National Institutes of Health [R01MH080905] to M.R.G. Research reported in this publication was also supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (T32HD101392 to support B.M.R.). The content is solely the authors' responsibility and does not necessarily represent the official views of the National Institutes of Health. The authors have declared that they have no competing or potential conflicts of interest. Key points

Publisher Copyright:
© 2022 Association for Child and Adolescent Mental Health.


  • Developmental origins
  • attention problems
  • catch-up growth
  • early childhood
  • early life adversity

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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