ADHD Drug Does Stunt Growth
After 3 Years on Ritalin, Kids Are Shorter, Lighter Than Peers
Swanson says that children who had been taking ADHD drugs before the study began were smaller than kids who had not yet started treatment. Those who first began treatment at the start of the study were normal in size, but grew more slowly than normal kids as the study went on.
After three years, the growth suppression seemed to reach its maximum effect. That's also when the effect of the ADHD drug used in the study -- immediate-release Ritalin three times a day, every day of the year -- seemed to wear off.
"We compared the effect of medication relative to just pure behavioral treatment," Swanson says. "That effect was substantial at 14 months and reduced a bit at 24 months. But at 36 months the relative advantage of ADHD drugs over behavioral treatment is gone."
Swanson and colleagues note that the study did not test the sustained-release stimulant medications that are now the standard treatment for ADHD.
Omar Khwaja, MD, PhD, a neurologist at Children's Hospital in Boston, last year analyzed studies of different ADHD drugs and found strong evidence that ADHD drugs do, indeed, stunt children's growth. In fact, Khwaja and colleagues calculated a growth effect that almost exactly matches the effect seen in the Swanson study.
But Khwaja agrees with Swanson that nobody yet knows what the long-term results of this side effect will be.
"Whether there will be rebound growth at end of puberty, the jury is still out," Khwaja tells WebMD.
"Parents have to be aware that stimulants are an enormous benefit to a lot of children with ADHD, but there is reason to be cautious with all medicines that affect the brain," he says. "Growth monitoring should be standard practice for kids taking these medications."
Swanson and colleagues report their findings in the August issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
Other findings from this large study show that both ADHD drugs and behavioral therapy work in children.