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

The DOI matches its Crossref record; 47 of the 48 references it cites were found in a registry or an index; none of the 43 sources its claims cite is checked for support yet.

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

Open access

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.

Overview

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.

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Integrity signals

Registry

Crossref · 10.1097/chi.0b013e3180686d7e

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

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

Show all 61 claims

  • It may state two separate claims as one. 30
  • Probably not a substantial claim. 19
  • The quote only partly states this claim. 1
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

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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

Citations

Cites

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Show all 48 references

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

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Metadata

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.
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)
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
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

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