It depends, so parents have to weigh the potential risks and benefits of these medications.
Parents can’t be blamed if they’re confused whether their child’s growth could be stunted by giving him or her medications for attention deficit hyperactivity disorder.
After all, studies offer different conclusions.
For example, one study published in the March Journal of Child Psychology and Psychiatry notes that there’s a likely correlation between a child taking ADHD meds and suppression of their height as adults. It states that “short-term treatment of ADHD with stimulant medication is well justified by benefits that outweigh costs, but long-term treatment may be associated with growth-related costs that may not be balanced by symptom-related benefits.”
In response to this study, Dr. Daniel Coury, professor of pediatrics at The Ohio State University and a developmental-behavioral pediatrician at Nationwide Children’s Hospital in Columbus, Ohio, says it’s the longest and largest one to date, involving 500 children who were followed into adulthood since the 1990s. He explains that this study did its best to categorize participants based on the consistency of their ADHD medication use, including groups who took their medications regularly, half of the time or who stopped taking them altogether.
“The group taking these medications more consistently had more height suppression,” he says.
On the other hand, a study published in the 2014 journal Pediatrics suggests that ADHD medications do not lead to stunted adult height: “Our findings suggest that ADHD treatment with stimulant medication is not associated with differences in adult height or significant changes in growth.”
Dr. Jean Moorjani, pediatrician at Arnold Palmer Hospital for Children in Orlando, Florida, and a fellow of the American Academy of Pediatrics, says this 2014 study followed 350 children from the time they were diagnosed with ADHD and received stimulant medications as treatment. She says it noted that such medications “did not affect a child’s final adult height.”
Between these and numerous other studies, articles and discussions on the topic – past and present – it’s clear that different schools of thought exist. Moorjani says that especially in today’s digital age, people can search online and find helpful information, but they can also find only the details that fit within the parameters of their personal needs or beliefs. “It can be good and bad,” she says.
A slew of variables render it nearly impossible to provide a definitive yes or no about whether children taking ADHD medications will experience stunted growth that ultimately affects their adult height.
Dr. Smitha Bhandari, who specializes in adult, child and adolescent psychiatry at the Path Group of Atlanta LLC, says it’s not a cut-and-dry matter. She explains that growth varies for each child possibly based even on the foods he or she eats. “So many factors go into this,” she says. “It’s challenging to isolate this and say medications may be the sole reason behind slowed growth.”
According to Moorjani, other variables in this matter include, but are not limited to, possible inconsistencies in the growth tracking process, challenges in studying children for several years into adulthood and a child’s changing lifestyle – such as taking up sports, increased social activities or driving – which may lead to medication changes.
Weighing the Risks and Benefits
“There’s a risk-benefit balance that has to be weighed,” Bhandari says. Carefully weighing the options is important for parents, yet something she indicates may be challenging. “It’s often a tough decision for parents to make,” Bhandari says, explaining that while a physician can educate parents about ADHD medications and discuss research and options with them, “the parent ultimately has that responsibility to decide if all possible benefits a child could get out of medications are worth any potential risks.”
Therefore, whether height is a concerning enough variable in the grand scheme of things may be worth exploring. For example, a child may have severe ADHD symptoms, Coury explains, but consider the case in which he or she takes medications for the disorder and experiences the benefits of vast behavioral and educational improvements. Now consider this same child experiencing height suppression. Coury uses this example to illustrate a situation in which ADHD medication benefits may outweigh a growth risk, adding that in this instance, it may be worth staying on the medications and taking the risk that the child may be shorter.
How Short Is Short?
Coury explains those taking ADHD medications the most often may experience the greatest height suppression; he’s heard of as much of a 1.5-inch height difference occurring. However, he says it’s necessary to look at the overall picture. “If it looks like a child will grow to be an adult that’s 6 feet tall,” he says this may not be a pressing issue for families. “But if mom is 5 feet tall and dad is 5 foot 1 inch, it can make a huge difference and may cause families to consider changes in a child’s treatment.”
Parents may also find comfort knowing that Bhandari has found that “by adulthood, children with ADHD who have been taking medications usually reach their projected height.” She explains that medications could slow growth initially, but it typically returns to a height that’s appropriate for each child’s age. Coury too, adds that he’s seen children whose growth appears to drop off coinciding with the onset of taking ADHD medications, noting that it usually fell back into an expected height pattern.
Role Between Parents and Professionals
According to Moorjani, “ADHD meds work very well in helping kids with ADHD.” But she says that ADHD is chronic and when it comes to these medications, it’s not uncommon for parents to express concerns for their child over things like height, sleep difficulties or other possible side effects. “It’s best to monitor all of this with your pediatrician,” she says. “Families have to have a good relationship with them.”
This relationship, Moorjani says, should include reporting and monitoring of any side effects, and may involve dosing adjustments or perhaps the recommendation of changing to another medication altogether. Similarly, Bhandari says any observed slowed growth may result in her recommendation of a “more aggressive diet in terms of increasing fat and calories.” Slowed weight gain may be linked to the appetite reduction that some stimulants may cause – something Coury explains may affect height. Working with a pediatrician, Bhandari says, is imperative for her and for parents of a child with ADHD; together they can discuss any observed dips in growth curves and the best way to treat the situation should it persist.
What’s important is that families remain very observant and not oversimplify any concerns related to this matter, Coury advises. Once the risks and benefits are weighed and once treatment has started, he says, the focus should then become a matter of how well the medication is working for each child and their unique set of symptoms.