The hypothesis that stimulant medications may cause growth deficits in children with attention deficit hyperactivity disorder (ADHD) was reevaluated in 124 children and adolescents with ADHD and 109 controls at the Massachusetts General Hospital, Boston, MA. Small, significant deficits in height (average, 3 cm) were found in early but not late adolescent ADHD children, and height deficits were unrelated to weight deficits or stimulant treatment. In 10% of ADHD children cf 1% of controls, height deficits were more than 2 standard deviations (approx 14 cm in 15-yr-old males) below the average height of controls. The larger growth deficits occurred in patients with comorbid major depression but not in those with anxiety disorders. Neither recent nor past history of stimulant therapy significantly affected height measures in either early or late pubertal ADHD children. Pubertal development and weight measures of ADHD children were not different from controls. [1]

COMMENT. ADHD may be associated with a temporary delay in the rate of growth in height in early adolescence that may be corrected by late adolescence. ADHD-associated height deficits are unrelated to stimulant-associated weight loss and may represent a manifestation of ADHD, mediated by a maturational delay. The dysmaturity hypothesis of ADHD, usually confined to neurobehavioral and attentional deficits, may be extended to physical deficits that can be outgrown. Small weight deficits in some ADHD children receiving stimulant therapy can usually be offset by adjusting the timing of medication and by food supplements if indicated.

In a Northwestern University, prospective study of the growth of 36 boys with ADHD, 5 to 10 years of age, who were treated with methylphenidate, only 2 had a significantly decreased rate of annual growth, compared to normal growth patterns of children of the same age group. In 6 children under 8 years of age the growth rate was significantly increased. [2, 3]

Predictors of weight loss in children with ADHD treated with stimulant medication were studied retrospectively at the Schneider Children’s Hospital, New Hyde Park, New York [4]. Using body mass index as a measure, pretreatment weight was a significant predictor of stimulant-related weight loss, heavier children losing more weight than thinner children. In overweight ADHD children, stimulant medication may provide a secondary benefit, improving self-esteem.