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Growth on stimulant medication; clarifying the confusion: a review
Open accessAbstract
AIMS: To get an overview of the studies of growth in height in children with attention deficit hyperactivity disorder (ADHD) treated with stimulant medication, to establish the consistencies and to try to resolve the discrepancies. METHODS: Twenty nine studies were reviewed following a Medline search: 22 related to children, six to late adolescents or adults, and one to children and adults. RESULTS: Children: Eleven studies gave results consistent with height attenuation on stimulant medication: eight were longitudinal, one was cross-sectional, and two showed growth rebound on ceasing medication. Studies with negative findings were inadequately powered (n = 3), lacked controls or statistical analysis (n = 3), measured height velocity without reference to treatment duration (n = 2), or used inappropriate growth parameters (n = 1), controls (n = 1), or normative data (n = 1). Late adolescents/adults treated with stimulant medication in childhood: Two studies associated childhood gastrointestinal side effects with attenuated late adolescent or adult height; all six cross-sectional studies had negative findings. The methodologies varied widely but there was some consistency in the degree of attenuation shown in studies with positive findings. The most sensitive methods analysed the changes in z-scores (standard deviation scores) or calculated the height deficits from paired measurements taken before and after an initial period of treatment with stimulant medication. The height deficit amounted to approximately 1 cm/year during the first 1-3 years of treatment. CONCLUSIONS: Further research is needed into the causal mechanisms, the rate of physical maturation, and the long term implications for final stature.
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“Studies providing longitudinal data suggest that treating children with ADHD with stimulant medication generally results in a reduction in both height and weight gain [37, 112].”
From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [112]
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“Periods of treatment cessation (drug holidays) seem to result in rebound growth for children who experienced deficits during treatment, with children seeming to return to their normal growth percentiles and trajectory [37, 112].”
From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [112]
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“These results are consistent with previously reported evidence that psychostimulants are associated with loss of appetite and weight loss.”
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“Studies providing longitudinal data suggest that stimulants reduce growth in height by as much as 1 cm/year during the first three years of treatment and that this reduction can be clinically significant (Poulton, 2005).”
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“Longitudinal growth data of children with ADHD treated with stimulants indicate a reduction in both height andweight gain, with a reduction in height of about 1 cm/year during the first 1–3 years of treatment (Faraone et al., 2008; Poulton, 2005; Swanson et al., 2007a).”
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Neurodevelopmental Behavioral and Cognitive Disorders
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“Introduction Children treated for attention-deficit/hyperactivity disorder (ADHD) may initially experience slower growth rates, which normalize over 3 years (Safer and Allen, 1973; Poulton and Cowell, 2003; Poulton, 2005; Faraone et al., 2005; Charach et al., 2006; Swanson et al., 2006; Swanson et al., 2007).”
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“In spite of the great amount of data regarding this topic, only a few reviews have been conducted (Poulton 2005; Faraone et al. 2008; Vitiello 2008; Ptacek et al. 2014), and a systematic review or a meta-analysis has not been published.”
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“Respondents indicating use of ADHD drugs, including (1) methylphenidate; (2) dexmethylphenidate; (3) dextroamphetamine; (4) atomoxetine; and (5) lisdexamfetamine, were assigned to the ADHD medication group.”
MethodWaxmonsky, J. G., Pelham, W. E., Campa, A. L., Waschbusch, D. A., Li, T., Marshall, R., Babocsai, L., Humphery, H., Gnagy, E. M., Swanson, J. M., et al. (2019) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2019.08.472 · Cited by 35
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Anthropometric changes in non-medicated ADHD boys.
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The adult psychiatrist's dilemma: psychostimulant use in attention deficit/hyperactivity disorder
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“A chronic effect may be growth retardation (reviewed by Poulton, 2005).”
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“Brain DA signaling is one of the determinants of the motivation to eat (Berridge 1996; Epstein and Leddy 2006), and there are dose-dependent effects of stimulants on appetite suppression and weight gain (Poulton 2005; Charach et al. 2006; Pliszka et al. 2006; Wigal et al. 2006).”
Long-Term Effects of ADHD Medication on Adult Height
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“In addition, medications used in the treatment of attention deficit hyperactivity disorder, an increasingly treated condition that is more common in boys (26), can slow growth and delay puberty (27).”
BackgroundMethylphenidate HCL for the treatment of ADHD in children and adolescents
Childress, A. C. (2016) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2016.1182986 · Cited by 23
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“Longitudinal studies suggested that, during the initial 3 years of methylphenidate usage, height growth was impaired by 1 cm annually, representing a clinically significant reduction (Poulton, 2005).”
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“…with previous studies that concluded that stimulant therapy may be associated with a reduction in expected height gain, and that the impact of stimulants on height and weight attenuated over time such that final adult height was not affected (Poulton 2005; Spencer et al. 2006; Faraone et al. 2008).”
Jasper, B. W., Conklin, H. M., Lawford, J., Morris, E. B., Howard, S. C., Wu, S., Xiong, X., Shelso, J., & Khan, R. B. (2008) · Pediatric Blood & Cancer · doi:10.1002/pbc.21770 · Cited by 21
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“Several studies have failed to detect medication effects on bone age, which is consistent with the observation that growth will not recover while medication is being used [36, 47, 63, 90].”
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Long-term outcomes of stimulant medication in attention-deficit hyperactivity disorder
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Stimulants and growth in children with attention-deficit/hyperactivity disorder
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“Further indications regarding the relationship between stimulant usage and growth are that the effects of stimulant medication on growth are dosage dependent, with higher doses of stimulant medication causing greater growth deficits [5,19,21], and that amphetamines cause more growth suppression than methylphenidate [1…”
BackgroundResultInfluentialHanć, T., Cieślik, J. J., Wolańczyk, T., & Gajdzik, M. (2012) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2010.0113 · Cited by 16
“Poulton (2005) reviewed 29 studies; 11 of them supported the suppressing effect of the drugs.”
Janols, L., Liliemark, J. O., Klintberg, K., & von Knorring, A. (2009) · Nordic Journal of Psychiatry · doi:10.3109/08039480903154534 · Cited by 15
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Self-citationMistakes and misconduct in the research literature: retractions just the tip of the iceberg
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Self-citationStimulant Medication Use and Response to Growth Hormone Therapy: An NCGS Database Analysis
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Growth perturbations from stimulant medications and inhaled corticosteroids
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“Several review papers including Poulton (2) and Faraone et al. (3) have summarized the literature on this topic and concluded there are growth deficits, but admitted to knowledge gaps warranting additional studies.”
BackgroundInfluentialTakon, I. (2011) · Annals of General Psychiatry · doi:10.1186/1744-859x-10-25 · Cited by 11
“The cause of the reduction in height velocity is not entirely clear [30].”
BackgroundCuttler, L., Misra, M., & Koontz, M. B. (2015) · Elsevier eBooks · doi:10.1016/b978-0-323-18907-1.00022-6 · Cited by 11
Selective Serotonin Reuptake Inhibitors Reduce Longitudinal Growth in Risperidone-Treated Boys
Calarge, C. A., Mills, J. A., Karaviti, L. P., Teixeira, A. L., Zemel, B. S., & Garcia, J. M. (2018) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2018.05.040 · Cited by 10
Koonrungsesomboon, K., & Koonrungsesomboon, N. (2019) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2019.0115 · Cited by 12
“Despite a number of studies conducted over the past four decades, the effects of methylphenidate treatment on child growth remain a controversial issue (Poulton 2005; Clavenna and Bonati 2017; Groenman et al. 2017).”
Cuttler, L., & Misra, M. (2010) · Elsevier eBooks · doi:10.1016/b978-1-4160-5583-9.00025-3 · Cited by 10
Rose, S. R., Reeves, G., Gut, R., & Germak, J. A. (2015) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2015.08.036 · Cited by 9
The Effects of Chronic Psychostimulant Administration on Bone Health: A Review
Nowak, J., Aronin, J., Beg, F., O'Malley, N. T., Ferrick, M. R., Quattrin, T., Pavlesen, S., Hadjiargyrou, M., Komatsu, D. E., & Thanos, P. K. (2024) · Biomedicines · doi:10.3390/biomedicines12081914 · Cited by 8
“Previous research [28] concluded that psychostimulants such as AMP and MP affect bone, especially during the remodeling cycle.”
Nutrition Management of Children With Attention Deficit Hyperactivity Disorder
Phillips, W. (2014) · ICAN Infant Child & Adolescent Nutrition · doi:10.1177/1941406414551202 · Cited by 9
Espinosa, A. L. (2006) · Hispana · Cited by 7
Effect of Stimulants on Growth of ADHD Children: A Critical Review
Ptáček, R., Kuželová, H., & Paclt, I. (2009) · Activitas Nervosa Superior · doi:10.1007/bf03379556 · Cited by 7
The Impact of an Adapted Climbing Program on Children with Attention-Deficit/Hyperactivity Disorder
Angelini, E., Oriel, K. N., Myers, G. M., Cook, K. D. A., Drawbaugh, R. M., & Price, J. (2020) · International Journal of Physical Education Fitness and Sports · doi:10.34256/ijpefs2047 · Cited by 6
“Further in that review, two studies showed that children went through rebound growth during “drug holidays,” suggesting that their growth was stunted while actively taking medication [6].”
ResultVelayutham, V., Chakrabarty, S., Greer, R. M., Cotterill, A. M., & Leong, G. M. (2024) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2024-0268 · Cited by 5
Dobie, C., Wb, D., Heim, C. C., Huxsahl, J. E., Karasov, R., Neumann, A. V., & Spinner, P. (2012) · Cited by 5
Çevikaslan, A., Parlak, M., Elli̇dağ, H. Y., Kulaksızoğlu, S., & Yılmaz, N. (2021) · Scandinavian Journal of Child and Adolescent Psychiatry and Psychology · doi:10.21307/sjcapp-2021-018 · Cited by 5
“Lack of loss in height gain may be related to MPH dose and the short-term treatment (15, 41).”
BackgroundGraham, J. S., Seth, S., & Coghill, D. (2007) · Medicine · doi:10.1016/j.mpmed.2007.01.002 · Cited by 5
Schneider, G., Banaschewski, T., Feldman, B. L., Gustafsson, P. A., Murphy, B. P., Reynolds, M. W., Coghill, D., & Spalding, W. M. (2019) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2018.0132 · Cited by 5
“…healthy controls; this resolved by late adolescence and was reported to be unrelated to exposure to ADHD medications (Spencer et al. 1996, 1998), although others have commented that the study is difficult to interpret owing to lack of information on the length of time on treatment (Poulton 2005).”
Tenore, A., & Tenore, A. (2012) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2012.08.004 · Cited by 5
Stimulant Medications and Growth
Poulton, A. S., & Nanan, R. K. H. (2009) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e31819e3f60 · Cited by 5
Self-citationPliszka, S. R. (2012) · Wiley eBooks · doi:10.1002/9781119958338.ch6 · Cited by 5
Chen, S., Wu, T. M. S., Li, H., Shou, J., Qin, J., Wu, G.-T., Cheng, W., & Yeung, W.-F. (2025) · Nutrients · doi:10.3390/nu17030513 · Cited by 4
Gender specific short stature in male adolescents with obsessive-compulsive disorder
Hu, Y.-P., Wehrly, R., Gorrindo, T., Hezel, D. M., Gironda, C. M., Jenike, M. A., & Stewart, S. E. (2012) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2012.07.009 · Cited by 3
“Two major reviews concluded that psychostimulant therapy was associated with a reduction in expected height gain, at least in the first three years of treatment (Poulton, 2005; Faraone, Biederman, Morley & Spencer, 2008).”
InfluentialBodey, C. (2011) · Clinical Medicine Insights Therapeutics · doi:10.4137/cmt.s6615 · Cited by 4
Durá-Travé, T., Yoldi-Petri, M. E., & Zardoya-Santos, P. (2011) · Revista de Neurología · doi:10.33588/rn.5305.2011284 · Cited by 4
“cide con los datos publicados [15-17,21,39] y, en consecuencia, obliga a establecer como medida preceptiva en todos los pacientes con TDAH en tratamiento con MTF un registro sistemático de sus parámetros antropométricos (peso, talla e IMC) y a que, una vez obtenidos, sean metódicamente comparados con patrones de refer…”
BackgroundNeuropsychological Effects of Stimulant Medication on Children’s Learning and Behavior
Brown, R. T., & Daly, B. P. (2008) · Springer eBooks · doi:10.1007/978-0-387-78867-8_22 · Cited by 4
Dexmethylphenidate for attention deficit hyperactivity disorder
Coury, D. (2009) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656560903386284 · Cited by 2
“A systematic review of numerous stimulant studies indicates that children will most commonly show a slowing of growth of about 1 cm/year for the first 1 – 3 years when receiving chronic treatment [25].”
BackgroundMethylphenidate and growth in ADHD children
Ptáček, R., & Kuželová, H. (2011) · Cited by 3
Jackson, G. E. (2009) · doi:10.1007/978-1-137-02058-1_10 · Cited by 3
Oxley, C. J., Moghraby, O. S., Samuel, R., & Joyce, D. W. (2018) · BMJ Open Quality · doi:10.1136/bmjoq-2017-000213 · Cited by 3
Stolzer, J. M. (2012) · Ethical Human Psychology and Psychiatry · doi:10.1891/1559-4343.14.1.5 · Cited by 2
“, 2 years or longer) are at the highest risk for cardiovascular malfunction (Poulton, 2005).”
BackgroundInfluentialClinical Practice Guideline for Patients with Attention Deficit/Hyperactivity Disorder
Carlton, T. G., Donachie, N., Frampton, K. K., Henschen, G., Kumar, P. E., Parrot, L. A., Smith, C. A., Tamil, F. A., Valenti, A. M., & Waxenberg, F. (2014) · Cited by 2
Safety of Psychotropic Drugs in Children and Adolescents
Kaguelidou, F., & Acquaviva, É. (2015) · Springer eBooks · doi:10.1007/978-3-319-24741-0_13 · Cited by 2
Pharmacological Treatment of ADHD
Yadav, P. (2020) · Advances in medical diagnosis, treatment, and care (AMDTC) book series · doi:10.4018/978-1-7998-5495-1.ch008 · Cited by 2
Panei, P., Knellwolf, A., Arcieri, R., & Vella, S. (2006) · PEDIATRICS · doi:10.1542/peds.2005-1895 · Cited by 2
Etxebarria, X. T., & Pérez, M. F. (2006) · Hispana · Cited by 1
Metadata
- Authors
- Poulton, A.
- Affiliations
- The University of Sydney (AU)
- Corresponding author
- Poulton, A
- ORCID
- Poulton, A
- Venue
- Archives of Disease in Childhood
- Publisher
- BMJ
- Published
- 2005-08-01
- Volume
- 90
- Issue
- 8
- Pages
- 801-806
- ISSN
- 0003-9888 (ISSN-L)
- 1468-2044
- PMC
- PMC1720538
- OpenAlex
- W2154426538
- Cited by
- 129
- References
- 42
- Citations by year
- 2025: 5 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 4 · 2020: 5 · 2019: 4 · 2018: 2 · 2017: 3 · 2016: 4 · 2015: 11 · 2014: 9 · 2013: 6 · 2012: 10
- FWCI
- 4.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Disease in Childhood (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Keywords
- attention deficit hyperactivity disorder, stimulant medication, height growth, gastrointestinal adverse effects, children, adolescents, adults, height velocity
- MeSH terms
- Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Body Height, Child, Child, Preschool, Cross-Sectional Studies, Depression, Chemical, Female, Growth Disorders, Humans, Infant, Longitudinal Studies, Male
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