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Cited by 323Attention Deficit Hyperactivity DisorderPharmaceutical studies and practicesChild and Adolescent Psychosocial and Emotional Development

Effects of Stimulant Medication on Growth Rates Across 3 Years in the MTA Follow-up

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SWANSON, JAMES M., ELLIOTT, GLEN R., GREENHILL, LAURENCE L., WIGAL, TIMOTHY, ARNOLD, L. EUGENE, VITIELLO, BENEDETTO, HECHTMAN, LILY, EPSTEIN, JEFFERY N. +16 more·2007·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1097/chi.0b013e3180686d7e
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Abstract

Objective To evaluate the hypothesis of stimulant medication effect on physical growth in the follow-up phase of the Multimodal Treatment Study of Children With ADHD.Method Naturalistic subgroups were established based on patterns of treatment with stimulant medication at baseline, 14-, 24-, and 36-month assessments: not medicated (n = 65), newly medicated (n = 88), consistently medicated (n = 70), and inconsistently medicated (n = 147). Analysis of variance was used to evaluate effects of subgroup and assessment time on measures of relative size (z scores) obtained from growth norms.Results The subgroup x assessment time interaction was significant for z height (p <.005) and z weight (p <.0001), due primarily to divergence of the newly medicated and the not medicated subgroups. These initially stimulant-naïve subgroups had z scores significantly >0 at baseline. The newly medicated subgroup showed decreases in relative size that reached asymptotes by the 36-month assessment, when this group showed average growth of 2.0 cm and 2.7 kg less than the not medicated subgroup, which showed slight increases in relative size.Conclusions Stimulant-naïve school-age children with Combined type attention-deficit/hyperactivity disorder were, as a group, larger than expected from norms before treatment but show stimulant-related decreases in growth rates after initiation of treatment, which appeared to reach asymptotes within 3 years without evidence of growth rebound.

AI snapshot

Written from the paper’s full text.

TL;DR

In the MTA 3-year follow-up, stimulant-naive children with ADHD Combined type who started and continued stimulant medication showed declines in relative height and weight compared with a stimulant-untreated clinical control subgroup, with no evidence of growth rebound. The authors conclude that stimulant-related growth slowing can persist up to 3 years and may warrant revision of monitoring recommendations.

Key findings

  • Naturalistic subgroup × assessment time interactions were significant for z height (p < .005) and z weight (p < .0001); decomposition showed the “starting medication” contrast accounted for 92% of the height interaction and 72.8% of the weight interaction.
  • The newly medicated subgroup (n = 88) diverged from the not medicated subgroup (n = 65): by 36 months, newly medicated children were 3.04 cm shorter and 2.71 kg lighter than not medicated children; the abstract reports average growth of 2.0 cm and 2.7 kg less than the not medicated subgroup. The not medicated subgroup showed slight increases in relative size.
  • At 36 months, z height/z weight were: not medicated 0.541/0.756; newly medicated 0.073/0.293; consistently medicated −0.120/0.156; LNCG 0.234/0.425. Exposure regressions showed negative slopes for years treated (z height 0.589 − 0.218[years], p < .0001; z weight 0.776 − 0.183[years], p < .0004) and dose-related height reduction (z height 0.493 − 0.0117[mg/kg], p = .0010) but not weight (p = .2486).
  • No growth rebound was supported: newly medicated children increased slightly from 24 to 36 months, but the not medicated subgroup did too, and treated groups did not exceed the untreated clinical control. Findings did not support delayed maturation; untreated ADHD children grew faster than norms/LNCG.

Methods

  • MTA follow-up of 579 children aged 7.0–9.9 years with ADHD Combined type from seven North American sites. Naturalistic subgroups were based on SCA-PI reports of stimulant use in the 30 days before baseline, 14-, 24-, and 36-month assessments: not medicated (n = 65), newly medicated (n = 88), consistently medicated (n = 70), and inconsistently medicated (n = 147); complete data were available for 370 of 485 follow-up children.
  • CDC 2000 growth norms converted height and weight to z scores. Two-way ANOVA tested subgroup, assessment time, and interaction; orthogonal decomposition compared starting medication and consistency of medication; regression related cumulative exposure/dose to 36-month relative size. A local normative comparison group of classmates provided comparison at 24 and 36 months (213 of 279).

Limitations

  • The authors state the most important limitation is lack of random assignment to the naturalistic subgroups; subgroups were formed by initial MTA assignment and later self-selection to start, stop, or continue medication, so the never-medicated group may have been selected for good behavioral response and medicated groups may have included poor behavior-therapy responders.
  • The authors state follow-up covered only 3 years, participants were 10–12 years old at the 36-month assessment, and ultimate adult size was not addressed; only immediate-release methylphenidate was systematically evaluated, while Adderall and controlled-release formulations were not evaluated.
  • The authors state medication use was defined from SCA-PI reports and the specific contributions of dose or consistency were not adequately evaluated; planned weekend/summer medication holidays were not evaluated. Evident from the text: the observational subgroup design cannot establish causality and may be confounded by selection or indication.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1097/chi.0b013e3180686d7e

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 43 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    At the 36-month assessment, there were no group differences apparent in SNAP scores.

    “at the 36-month assessment, there were no group differences apparent.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The starting medication component accounted for 92% of the interaction for height.

    “which accounted for 92% of the interaction for height (F 3,441 = 11.77;p < .0001)”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.
    • The authors state this as an assumption: z scores for height and weight are expected to remain constant over time based on an assumption of normal growth rates during the MTA protocol.
  • Findingown data

    The not medicated subgroup showed slight increases in relative size.

    “which showed slight increases in relative size.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.
    • The authors state this as an assumption: z scores for height and weight are expected to remain constant over time based on an assumption of normal growth rates during the MTA protocol.
  • Findingown data

    The newly medicated subgroup manifested a slight increase in relative size from the 24- to 36-month assessment.

    “The newly medicated subgroup manifested a slight increase in relative size from the 24-to 36-month assessment.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.
    • The authors state this as an assumption: z scores for height and weight are expected to remain constant over time based on an assumption of normal growth rates during the MTA protocol.
  • Findingown data

    Stimulant-naive school-age children with Combined type ADHD were, as a group, larger than expected from norms before treatment.

    “Stimulant-naı ¨ve school-age children with Combined type attention-deficit/hyperactivity disorder were, as a group, larger than expected from norms before treatment”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.
  • May combine two claims. 30
  • Classified as probably not a substantial claim. 19
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    At baseline, the consistently medicated subgroup was smaller than the inconsistently medicated subgroup, and this difference was maintained over time.

    “At the baseline assessment, the consistently medicated subgroup was smaller than the inconsistently medicated subgroup, and this difference was maintained over time”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.
    • The authors state this as an assumption: z scores for height and weight are expected to remain constant over time based on an assumption of normal growth rates during the MTA protocol.

  • May combine two claims.

    Findingown data

    The consistency of medication contrast was significant, due to a main effect of group without an interaction with assessment time.

    “The consistency of medication contrast was also significant, but this was due to a main effect of group without an interaction with assessment time.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.
    • The authors state this as an assumption: z scores for height and weight are expected to remain constant over time based on an assumption of normal growth rates during the MTA protocol.

  • May combine two claims.

    Findingown data

    The newly medicated subgroup at 36 months had z height 0.073 and z weight 0.293.

    “newly medicated: z height 0.073 and z weight 0.293”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.
    • The authors state this as an assumption: z scores for height and weight are expected to remain constant over time based on an assumption of normal growth rates during the MTA protocol.

  • May combine two claims.

    Findingown data

    The consistently medicated subgroup at 36 months had z height -0.120 and z weight 0.156.

    “consistently medicated: z height j0.120 and z weight 0.156”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.
    • The authors state this as an assumption: z scores for height and weight are expected to remain constant over time based on an assumption of normal growth rates during the MTA protocol.

  • May combine two claims.

    Findingown data

    By the 36-month assessment, the inconsistently medicated subgroup was significantly smaller than the not medicated subgroup, even though it was nominally larger than the LNCG.

    “By the 36-month assessment, this subgroup was significantly smaller than the stimulant-untreated clinical control group (not medicated), even though it was nominally larger than the LNCG.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.
    • The authors state this as an assumption: z scores for height and weight are expected to remain constant over time based on an assumption of normal growth rates during the MTA protocol.

  • May combine two claims.

    Findingown data

    At 36 months, the consistently medicated subgroup was 4.21 cm shorter and 3.51 kg lighter than the not medicated subgroup.

    “and 4.21 cm shorter and 3.51 kg lighter than the not medicated subgroup.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.
    • The authors state this as an assumption: z scores for height and weight are expected to remain constant over time based on an assumption of normal growth rates during the MTA protocol.

  • May combine two claims.

    Findingown data

    At 36 months, the newly medicated subgroup was 1.1 cm shorter and 0.7 kg lighter than the LNCG.

    “and 1.1 cm shorter and 0.7 kg lighter than the LNCG.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.
    • The authors state this as an assumption: z scores for height and weight are expected to remain constant over time based on an assumption of normal growth rates during the MTA protocol.

  • May combine two claims.

    Findingown data

    The inconsistently medicated subgroup was slightly smaller at baseline and did not increase in relative size as much as the not medicated group over the 3-year follow-up.

    “but was slightly smaller at baseline and did not increase in relative size as much as the not medicated group over the 3-year follow-up.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.
    • The authors state this as an assumption: z scores for height and weight are expected to remain constant over time based on an assumption of normal growth rates during the MTA protocol.

  • May combine two claims.

    Findingown data

    At 36 months, the newly medicated subgroup was 3.04 cm shorter and 2.71 kg lighter than the not medicated subgroup.

    “was at 36 months 3.04 cm shorter and 2.71 kg lighter than the not medicated subgroup”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.
    • The authors state this as an assumption: z scores for height and weight are expected to remain constant over time based on an assumption of normal growth rates during the MTA protocol.

  • May combine two claims.

    Findingown data

    At 36 months, the consistently medicated subgroup was 2.3 cm shorter and 1.5 kg lighter than the LNCG.

    “The consistently medicated subgroup was 2.3 cm shorter and 1.5 kg lighter than the LNCG”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.
    • The authors state this as an assumption: z scores for height and weight are expected to remain constant over time based on an assumption of normal growth rates during the MTA protocol.

  • May combine two claims.

    Findingreasoning

    The difference in annual growth rates may be present for up to 3 years of treatment and accumulate to a difference of about 2.0 cm in height and about 2.0 kg in weight.

    “This difference in annual growth rates may be present for up to 3 years of treatment and accumulate to result in a difference of about 2.0 cm in height and about 2.0 kg in weight.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingreasoning

    Figure 1c suggests lack of effectiveness for stimulant medication at the 36-month assessment in the presence of lingering but significant stimulant-related reduction in growth rate.

    “which suggests lack of effectiveness for stimulant medication at the 36-month assessment in the presence of lingering but significant stimulantrelated reduction in growth rate”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Self-selection to stay not medicated was based largely on satisfactory results with the assigned behavioral treatment, whereas decisions to continue or start medication were not necessarily based on satisfaction with treatment results.

    “Furthermore, the self-selection to stay not medicated was based largely on satisfactory results with the assigned behavioral treatment, whereas decisions to continue or start medication were not necessarily based on satisfaction with treatment results.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In these mice, excess dopamine is dispersed by blood flow, reaches the pituitary, and retards growth.

    “The excess dopamine is dispersed by blood flow, reaches the pituitary, and retards growth in these animals.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bosse et al., 1997 source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Study design and conductown data

    The four naturalistic subgroups did not differ in severity of ADHD symptoms or initial relative size at baseline.

    “These subgroups did not differ in severity of ADHD symptoms or initial relative size at the baseline assessment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Both randomization and self-selection operated to form the naturalistic subgroups.

    “Both randomization and self-selection operated to form these naturalistic subgroups.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    To support the hypothesis of growth rebound, the growth rates of the stimulant-treated groups would have to exceed that of the stimulant-untreated clinical control group, which did not occur in this study.

    “To support the hypothesis of growth rebound, the growth rates of the stimulant-treated groups would have to exceed that of the stimulant-untreated clinical control group, which did not occur in this study.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The naturalistic subgroups do not differ on unmeasured factors that affect growth.

  • May combine two claims.

    Study design and conductcitation

    Compliance with initial randomly assigned treatment conditions was not perfect during the treatment phase, and adherence waned during follow-up.

    “Compliance with initial randomly assigned treatment conditions was not perfect during the treatment phase, and adherence to these conditions waned during the follow-up phases of the MTA”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Consensus reviews and statements decades apart discounted the clinical significance of the hypothesis of stimulant-related decrease in physical growth rates, based on prevailing views that short-term growth suppression may occur but does not result in long-term effects on ultimate size.

    “Consensus reviews and statements decades apart (see NIH Consensus Committee, 1998;Roche et al., 1979) discounted the clinical significance of this hypothesis, based on prevailing views that short-term growth suppression may occur but does not result in longterm effects on ultimate size.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites NIH Consensus Committee, 1998

      Not checked in the free run.

    • cites Roche et al., 1979 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The comparison of the not medicated and newly medicated subgroups revealed the time course of stimulant-related reduction in annual growth rate, maximal in the first year, decreased in the second year, and absent in the third year.

    “The comparison of these two subgroups in terms of growth velocity after initiating medication revealed the time course of stimulant-related reduction in annual growth rate, which was maximal in the first year, decreased in the second year, and absent in the third year of treatment.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.
    • The authors state this as an assumption: z scores for height and weight are expected to remain constant over time based on an assumption of normal growth rates during the MTA protocol.
    • Rests on an assumption: The naturalistic subgroups do not differ on unmeasured factors that affect growth.

  • May combine two claims.

    Study design and conductown data

    The four naturalistic subgroups did not differ on initial size at birth, age, parent or teacher ratings of ADHD symptoms, sex, expected adult size, welfare status, or maternal smoking.

    “It is notable that the four subgroups did not differ on initial size at birth (birth weight), age, parent or teacher ratings of ADHD symptoms, sex, expected adult size (mid-parent size), welfare status, or maternal smoking (Table 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisereasoning

    The evidence of growth rebound is inconsistent and mostly circumstantial.

    “The evidence of growth rebound is inconsistent and mostly circumstantial.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The definition of medication use was based on information from the SCA-PI.

    “A fourth limitation was the definition of medication use based on information from the SCA-PI.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing). May combine two claims.

    Premisecitation

    The prevailing view in the literature supports short-term decrements in rate of weight acquisition but not height acquisition, and no long-term effect on ultimate height.

    “the prevailing view is stated, indicating that the literature supports short-term decrements in rate of weight acquisition but not height acquisition, and no long-term effect on ultimate height.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites p 44S

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Consistency of these classifications by medication has been considered in the naturalistic subgroups described here and in previous publications on the MTA follow-up.

    “consistency of these classifications by medication have been considered as well, as in the naturalistic subgroups described here and in previous publications on the findings of the MTA follow-up”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The use of summer or periodic holidays has been proposed as a strategy to mitigate stimulant-related reductions in growth rates.

    “the use of summer (or periodic) holidays, which represent relatively long intervals of nontreatment interspersed within blocks of medication use in clinical practice, has been proposed as a strategy to mitigate stimulant-related reductions in growth rates (Safer et al., 1975)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Safer et al., 1975 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Planned medication holidays on weekends or during the summer were not evaluated in this study.

    “A fifth limitation was the lack of evaluation of planned medication holidays on the weekends or during the summer”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The AACAP practice parameter recommends regular assessment of weight (but not height) for management of possible treatment-related side effects as a clinical guideline but not as a minimal standard.

    “for the management of possible treatment-related side effects recommends the regular assessment of weight (but not height) as a Bclinical guideline[ but not as a Bminimal standard[ (p 29S)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites American Academy of Child and Adolescent Psychiatry (2002)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    In 1998, 4 years after the initiation of the MTA, the 75:25 ratio of D,L-amphetamine was renamed Adderall and was evaluated for the treatment of ADHD.

    “in 1998, 4 years after the initiation of the MTA, another stimulant, the 75:25 ratio of D,L-amphetamine (once used for weight control [Obetrol]) was renamed Adderall and was evaluated for the treatment of ADHD”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    After 2000, controlled-release formulations of methylphenidate and amphetamine were developed and became widely used in clinical practice, rapidly replacing multiple daily doses of immediate-release stimulant medications for ADHD.

    “were developed and became widely used in clinical practice, rapidly replacing the prescription of multiple daily doses of immediaterelease stimulant medications for the treatment of ADHD”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Swanson et al., 1999 source

      Not checked in the free run.

    • cites Wolraich et al., 2001 source

      Not checked in the free run.

    • cites Greenhill et al., 2002 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    Adderall soon after became widely used in clinical practice.

    “and soon after became widely used in clinical practice”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    During the first two stages of treatment, weekly to monthly monitoring of both height and weight is suggested.

    “During the first two stages of treatment to titrate dose and select among alternative stimulants, weekly to monthly monitoring of both height and weight is suggested (Table 2, p 38S)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Table 2, p 38S

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Other definitions of medication use are possible and some have been considered here, including total exposure in milligrams consumed or days treated.

    “other definitions are possible and some have been considered here (i.e., total exposure in terms of milligrams consumed or days treated)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    At 14 months, the two groups assigned to systematic stimulant medication showed an initial reduction in growth rate for height (-1.23 cm/year) and weight (-2.48 kg/year), which dissipated by the 24-month assessment.

    “In this report the intent-to-treat evaluation of assigned treatment revealed that at 14 months the two groups assigned to systematic stimulant medication showed an initial reduction in growth rate for height (j1.23 cm/year) and weight (j2.48 kg/year), which dissipated by the 24-month assessment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites MTA Cooperative Group, 2004b

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Adderall was not available when the MTA was initiated, so its effect was not evaluated and could not be reported here.

    “Because Adderall was not available when the MTA was initiated, its effect was not evaluated and thus could not be reported here.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The AACAP practice parameter suggests that height and weight be measured before initiating treatment.

    “The practice parameter of the American Academy of Child and Adolescent Psychiatry (2002) regarding the use of stimulant medication (presently under revision) suggests that height and weight be measured before initiating treatment (p 28S)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites American Academy of Child and Adolescent Psychiatry (2002)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Two different definitions of medication use have been considered for the MTA analyses of efficacy: within 30 days before an assessment and 50% of the days since the previous assessment.

    “Two different definitions of medication use have been considered for the MTA analyses of efficacy (i.e., within 30 days before an assessment and 50% of the days since the previous assessment)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Mattes and Gittelman (1983) documented stimulant-related growth deficit that accumulated with duration of treatment and was still present during the final year in the group treated for 4 years with methylphenidate, suggesting growth slowing did not abate during continuous treatment.

    “Mattes and Gittelman (1983) evaluated groups of children with continuous treatment for 1 to 4 years and documented stimulant-related growth deficit that accumulated with the duration of treatment.It was still present during the final year of observation in the group treated for 4 years with methylphenidate, suggesting that growth slowing did not abate during continuous treatment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Mattes and Gittelman (1983)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recommendations for long-term monitoring are not explicitly provided.

    “but recommendations for long-term monitoring are not explicitly provided”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Spencer et al. (1996) proposed that maturational lag characterized ADHD, producing a reduction in growth rate correlated with but not necessarily a result of stimulant treatment.

    “Spencer et al. (1996) proposed that maturational lag characterized the clinical condition of ADHD, which produced a reduction in growth rate that was correlated with but not necessarily a result of treatment with stimulant medication.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Spencer et al. (1996) source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Controlled-release formulations were not available or used when the MTA was initiated or during the initial two follow-up phases, so they were not evaluated and could not be reported here.

    “Because these controlled-release formulations were not available or used when the MTA was initiated or during the initial two follow-up phases, they were not evaluated and could not be reported here.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    It is possible that the never-medicated group was pared down to good responders and the medicated groups enriched with poor Beh responders.

    “Thus, it is possible that the never-medicated group was pared down to good responders and the medicated groups enriched with poor Beh responders.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Adderall was shown to be effective in a double-blind study.

    “Adderall was shown to be effective in a double-blind study (Swanson et al., 1998)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Swanson et al., 1998

      Not checked in the free run.

43 of 43

  • The authors state this as an assumption.

    Baseline z scores are expected to be near zero based on an assumption of normal size at entry to the MTA.

    “Based on an assumption of normal size at entry to the MTA, the baseline z scores are expected to be near zero”

  • The authors state this as an assumption.

    z scores for height and weight are expected to remain constant over time based on an assumption of normal growth rates during the MTA protocol.

    “and based on the assumption of normal growth rates during the MTA implementation of the MTA protocol, the z scores for height and weight are expected to remain constant over time.”

  • The paper relies on this without support.

    The naturalistic subgroups do not differ on unmeasured factors that affect growth.

    “The most important limitation of this study is the lack of random assignment to the subgroups that were evaluated here.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The MTA study results identified stimulants as having a more persistent effect on decreasing growth velocity compared to most previous studies.

    “The Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) study results identified stimulants as having a more persistent effect on decreasing growth velocity compared to most previous studies.110”

    From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [110]

    The Discussion reports a stimulant-related reduction in growth velocity that was greatest in the first year, diminished in the second, and absent in the third. It also reports no evidence of growth rebound during continued treatment, contrary to the earlier consensus described in the paper. The claim overstates the comparison: the paper does not establish that the effect was more persistent than in most previous studies, and it cites earlier studies that also found persistent slowing. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Diminished growth from stimulants was in the range of 1 to 2 cm from predicted adult height.

    “Diminished growth was in the range of 1 to 2 cm from predicted adult height.”

    From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [110]

    The Clinical Implications section reports an approximately 2 cm height difference after up to three years of stimulant treatment in school-age children. It does not describe that difference as a shortfall from predicted adult height; the Results likewise compare children's heights at 36 months, not adult-height predictions. Page numbers were not available in our copy. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • The growth effects of stimulants were particularly noted among children on higher and more consistently administered doses.

    “The results of the MTA study were particularly noted among children who were on higher and more consistently administered doses of stimulants.110”

    From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [110]

    The Results report a dose-related reduction in relative height, but not weight. They also say the consistently medicated group was already smaller at baseline and did not show a greater decline over time than the inconsistently medicated group. The paper therefore does not establish that growth effects were particularly pronounced with more consistent administration. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • The growth effects diminished by the third year of treatment, but no compensatory rebound growth was observed.

    “The effects diminished by the third year of treatment, but no compensatory rebound growth was observed.110”

    From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [110]

  • The reduction in weight gain from stimulant treatment appears to be somewhat more pronounced than that for height (over a 3-year period about 3 kg less than predicted).

    “The reduction in weight gain appears to be somewhat more pronounced than that for height (over a 3-year period about 3 kg less than predicted) [39, 139].”

    From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [139]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Untreated group's 36-month weight z score differs from Table 3

    Minor

    The Results text gives the not-medicated subgroup's weight z score as 0.765, whereas Table 3 gives its 36-month mean as 0.756.

  • Inconsistently medicated rows do not match the reported 36-month count

    Minor

    The detailed rows in Table 1 list 92 inconsistently medicated children as taking medication at 36 months, not the reported 74. One row of 18 children also repeats the medication pattern assigned to the newly medicated subgroup.

    Reported 74 · recomputed 92

2 of 2

Cites

Flagged first, then by citations

1 of the 48 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Caron, 2004, Growth in the dopamine transporter knockout animal model of ADHD, Neuropsychopharmacology, 29, S55
  2. Gittelman-Klein, 1988, Methylphenidate and growth in hyperactive children, Arch Gen Psychiatry, 36, 212
  3. Swanson, 2000, Initiating Concerta (OROS methylphenidate HC1) qd in children with attention-deficit hyperactivity disorder, J Clin Res, 3, 59
  4. Wigal, 2003, Selection of the optimal dose ratio for a controlled-delivery formulation of methylphenidate, J Appl Res, 3, 46

Cited by

Sorted by citations

Related

Authors
SWANSON, J. M., ELLIOTT, G. R., GREENHILL, L. L., WIGAL, T., ARNOLD, L. E., VITIELLO, B., HECHTMAN, L., EPSTEIN, J. N., PELHAM, W. E., ABIKOFF, H. B., NEWCORN, J. H., MOLINA, B. S. G., HINSHAW, S. P., WELLS, K. C., HOZA, B., JENSEN, P. S., GIBBONS, R. D., HUR, K., STEHLI, A., DAVIES, M., MARCH, J. S., CONNERS, C. K., CARON, M., & VOLKOW, N. D.
Affiliations
  • University of California, Irvine (US)
  • McGill University (CA)
  • University of California, Los Angeles (US)
  • University of Vermont (US)
  • University of Illinois Chicago (US)
  • Duke University (US)
  • Brookhaven National Laboratory (US)
Corresponding author
SWANSON, JAMES M.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2007-08
Volume
46
Issue
8
Pages
1015-1027
ISSN
0890-8567 (ISSN-L)
DOI
10.1097/chi.0b013e3180686d7e
OpenAlex
W2082384177
Cited by
323
References
48
Citations by year
2026: 5 · 2025: 7 · 2024: 8 · 2023: 10 · 2022: 8 · 2021: 9 · 2020: 9 · 2019: 13 · 2018: 15 · 2017: 17 · 2016: 14 · 2015: 22 · 2014: 26 · 2013: 13 · 2012: 20
FWCI
19.53
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
Funders
  • U.S. Department of Health and Human Services
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • Pfizer
  • AstraZeneca
  • GlaxoSmithKline
  • Celgene
  • H. Lundbeck A/S
  • National Institutes of Health (n01mh12011-0-0-1, n01mh012009-007, n01mh012012-001)
  • National Institute of Mental Health (N01MH 12011, U01MH50461, N01MH-12012, U01MH50440, U01MH050467, MH-50467, U01 MH50477, U01MH050440, N01 MH12009, U01MH50467, U01MH050461)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
stimulant medication, physical growth, attention deficit hyperactivity disorder, combined type ADHD, height z-score, weight z-score, medication adherence
MeSH terms
Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Behavior Therapy, Child, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Male, Severity of Illness Index, Time Factors

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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