Long term methylphenidate exposure and growth in children and adolescents with ADHD. A systematic review and meta-analysis

Background: Methylphenidate (MPH) is an efficacious treatment for ADHD but concerns have been raised about potential adverse effects of extended treatment on growth. Objectives: To systematically review the literature, up to December 2018, conducting a meta-analysis of association of long-term (> six months) MPH exposure with height, weight and timing of puberty. Results: Eighteen studies (ADHD n = 4868) were included in the meta-analysis. MPH was associated with consistent statistically significant pre-post difference for both height (SMD = 0.27, 95% CI 0.16-0.38, p < 0.0001) and weight (SMD = 0.33, 95% CI 0.22-0.44, p < 0.0001) Z scores, with prominent impact on weight during the first 12 months and on height within the first 24-30 months. No significant effects of dose, formulation, age and drug-naive condition as clinical moderators were found. Data on timing of puberty are currently limited. Conclusions: Long-term treatment with MPH can result in reduction in height and weight. However, effect sizes are small with possible minimal clinical impact. Long-term prospective studies may help to clarify the underlying biological drivers and specific mediators and moderators.

Automated summary

The study reviewed the association of long-term MPH exposure with height, weight, and timing of puberty in ADHD individuals. MPH was found to have consistent significant effects on reducing height and weight, with more prominent impacts observed in the initial months of treatment. Limited data were available on the timing of puberty. Prospective studies are needed to further explore the underlying biological mechanisms and potential clinical implications.