Study: Ritalin Stunts Growth

Research Shows That After 3 Years On ADHD Medication, Kids Are Shorter And Lighter Than Peers

(WebMD)  After three years on the ADHD drug Ritalin, kids are about an inch shorter and 4.4 pounds lighter than their peers, a major U.S. study shows.

The symptoms of childhood ADHD (attention deficit hyperactivity disorder) usually get dramatically better soon after kids start taking stimulant drugs. But this benefit may come with a cost, says James Swanson, Ph.D., director of the Child Development Center at the University of California, Irvine.

"Yes, there is a growth-suppression effect with stimulant ADHD medications," Swanson tells WebMD. "It is going to occur at the age of treatment, and over three years it will accumulate."

Whether these kids eventually grow to normal size remains a question. Kids entered the study in 1999 at ages 7 to 9. The current report is a snapshot taken three years later. The 10-year results — when the kids are at their adult height — won't be in for two more years.

"The big question now is whether there is any effect on these kids' ultimate height," Swanson says. "We don't know if by the time they are 18 they will regain the height."

The finding appears to end decades of debate over whether stimulant medications affect children's growth. Less than 10 years ago, a National Institutes of Health panel concluded that the drugs carried no long-term growth risk.

That opinion was so widely accepted that the study authors — who include most of the leading ADHD researchers in the U.S. — did not warn parents that the study medication might carry this risk.

At the time, researchers thought that any short-term stunting of growth would be made up by a hypothesized "growth spurt" that would occur with continued treatment. But Swanson and colleagues saw no evidence of such a growth spurt.

Another widely accepted theory was that ADHD itself stunted kids' growth. But in a surprise finding, the study found that ADHD kids who do not take stimulant drugs are much larger than kids without ADHD, and these untreated kids continued to grow much faster than kids taking stimulant drugs.

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, M.D., Ph.D., 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.

[ecuadoriana]

"Ritalin has been referred to as the 'spanking of the 21st century.'" Posted by seer999 at 12:40 PM : Jul 21, 2007

I never heard that one before, Seer999, but that certainly makes sense. Too many parents are caught up with their own soap opera lives, using TV as the baby sitter, blaming every misbehaviour on an allergy to something, a syndrome, the teachers, the coach, etc., that they really can't be bothered to go back to good old fashioned discipline. And by that I do not mean actual spanking, but taking away privleges & teaching the kid to be responsible for himself.

I used to hear parents brag about how soon their kids learned to walk, potty train, read, etc. Now they compare syndromes & allergies. They do this within full hearing range of their kids who absolutely love to use this bit of info to their advantage (as any kid will do). Working in a school I had kids flat out tell me "You can't make me do that work. My mom says I have OD & ADHD!"

[seer999]

This is a crime! The diagnosis of ADD is thrown out like the diagnosis of "fatigue". The results
being that millions of children have been treated with this "benign" drug. In many states, parents receive a check from the State if their kids are dxed with ADD. This only adds to the problem. Ritalin has been referred to as the "spanking of the 21st century." I wonder what other surprises we'll get bout Ritalin in the future?

[jerry_in_va]

(Part 2) At the age of 16, my son was 5'-7" and weighed just 137 lbs. At the age of 19, my son is 6'-3" and weighs 205 lbs and is coninuing to grow. If these meds have any permanent growth stunting affects, I can't imagine what size my son would be today. As a child at 5, he underwent a thorough 6 month testing regime for everything from neurological to physical to allergic affects. The conclusion of the team of doctors was ADHD and that is why we placed him on meds. ADHD is a real affliction and the irresponsible way in which some children are placed on meds through shoddy diagnosis is insulting and provides the general public with a very distorted view of this condition and its treatment. My son continues to use meds but the dosage he requires has dropped considerably as he matures and recognizes his abilities and needs. As someone else stated, when these meds are administered orally to a person who truly needs them, there is no zombie affect nor is there a "high" achieved. Just like other news events, the truth is not really sensational enough to sell so the distorted and mis-used is presented in its place.

[jerry_in_va]

There are so many comments I'd like to present but I'll stick to the main topic to start. My son took ritalin for 7 years (from age 5 to 12) and I believe there was definitely some growth stunting taking place. But the benefit of the meds far outweighed this side affect. The combination of meds with behavioral modification allows the child to reap the benefits of both treatments. The long term benefits are social bahavior coupled with the ability to exhibit self control when not medicated as well as the immediate benefit of focusing in school and attaining good foundations in basic learning concepts. My son was switched to adderall at age 12 and continues on it today as a college student. He has never received any disability advantages in school, just the affects of the meds which helped him to focus and perform as a normal child and student. (Second part to follow shortly.)

[ecuadoriana]

I worked for an elementary school a few years ago as a para-educator. The percentage of kids on Ritilin was mind boggling. Most of the kids had parents who were always "too busy" to spend time with them so they were enrolled in every before & after school program possible. Many kids didn't get home until after 9pm, having ate McD's in the back of the car. They then were sent to their rooms to watch TV or play video games. Kids would describe to me in detail the shows they watched the night before- programs aired well after midnight (yet they could never remember to do their homework!).

After they'd return from the nurse's office to get their "meds", they'd be almost comatose. Ritilin surprises the appetite so at lunch they'd sit staring at or playing with their food. When they did eat it was only the sugary junk like fruit roll-ups (good grief!) so then they'd bounce off the walls all afternoon until 3:00 (those yellow busses never looked so good as they did at that hour!)
(cont.)

[ecuadoriana]

(cont.)
Since schools have systematically eliminated recess & PT, is it any wonder that kids today bounce out of their seats, especially when they live on a diet of junk food & video games? The schools, ever so afraid of lawsuits should they tell the parents that their kid is a flip out all day, diplomatically suggest the kid get tested & the doctors are more than happy to comply.

I'm 50. Why is it that juv. diabetes, fat kids, & ADD, et al, were almost non existent 50 yrs ago? I went to school in a major city. One teacher (no assistants) handled a class of 35 kids. No one was disrespectful, no one cursed at or hit teachers, the ultimate threat to keep us in line was a call to our parents. Today it's pointless to call the parents- either they're "too busy" or they'll threaten a lawsuit.

[brianbwb-2009]

We want children to learn, we don't want children to become controlled zombies!
Posted by Terryeo1,

You and I don't want to see a nation of zombies, but there are those that do...

[tmittelstaed]

I'm a man over 40 who has never taken Viagra/Cialis/Levitra thank you very much.

Most people don't understand the ADHD problem.

The real issue is the school systems pushing ADHD diagnosises onto parents. If a kid misbehaves they label them ADHD and push the parents to sign them up for special ed. They do this because the laws have defined ADHD as a disability, and any kids with disabilities that are signed up to special ed in a school bring money from the federal government into the school as a result of the ADA.
Yes there are severe ADHD cases where the kid's brain has a chemical imbalance or some such where drugs are justified. But the majority of kids taking Ritalin today could be handled with behavior therapy - the problem is behaviour therapy is far more labor intensive and difficult, it is also much more stressful on the parents, and most importantly it does not show immediate benefits. Give the kid his dose and instantly he's quiet does what you tell him to do - it makes the parent feel as though they are accomplishing something. Give the kid behaviour therapy and it takes years to see the difference and feel any sense of accomplishment.

[samthetvcat]

"The drug that suppresses emotions also supresses physical growth. What a surprise! No wonder it is called "Kiddy Coke" on the street. Proposed next study question: What percent of cocaine's suppression of height does a person taking kiddy cocaine experience? But don't subject human beings to these cruel mind control experiments that suppress children into zombie like trances where they can not learn. That they are then prone to use street drugs or sell the perscription of ritalin as Kiddy Coke on the street should be expected. We want children to learn, we don't want children to become controlled zombies!"
Posted by Terryeo1

Well I guess we understandably have different concerns because if you don't have ADHD then Ritalin to you serves no purpose and for you to take it, it would be cocaine, and if your kids were to take it then it would be kiddie-cocaine.

But imo to advocate depriving other kids of medically proven treatments because your kids aren't sick is like people insisting on freedom to eat peanut butter around kids who might suffer from anaphylactic shock because the burden's on them to not touch anything. Like at what point do all parents share responsibility of providing all kids with the opportunity to learn, and not expect learning-disabled kids to take on the burden for the other parents who can't control their kids who want to misuse the drug for kicks, and oversight for overperscribing physicians? That's just selfish imo

[terryeo1]

The drug that suppresses emotions also supresses physical growth. What a surprise! No wonder it is called "Kiddy Coke" on the street. Proposed next study question: What percent of cocaine's suppression of height does a person taking kiddy cocaine experience? But don't subject human beings to these cruel mind control experiments that suppress children into zombie like trances where they can not learn. That they are then prone to use street drugs or sell the perscription of ritalin as Kiddy Coke on the street should be expected. We want children to learn, we don't want children to become controlled zombies!

[samthetvcat]

Well who here has not taken an aspirin for a headache, or Viagra/Cialis/Levitra if you're a man over 40, or Lipitor etc if you're over 60, or an epidural or pain-killers before/after giving birth, or even insulin for weight-related diabetes?

Like are people against those types of medication as well or is there a distinction that can be made? There is NO amount of vitamins, exercise of behavioral therapy that can successfully treat a legitimate case ADHD.

[leidhold]

YEAH, MD's GIVE SOME MORE TOXIC MEDS OUT TO KIDS AND WOMAN!!! WE ARE THE ONES WHO PAY!! PAY FOR YOUR CARS AND NICE HOUSES. YOU ARE WHITE COAT CRIMINALS!!

GIVE MORE TOXIC MEDS LIKE CANDY!!!

WCC, with caps!!!

LEIDHOLD...
ALWAYS MY OPINION!!!

[samthetvcat]

"That's also when the effect of the ADHD drug used in the study %u2014 immediate-release Ritalin, three times a day, every day of the year %u2014 seemed to wear off.

But at 36 months the relative advantage of ADHD drugs over behavioral treatment is gone."

If the efficacy of the Ritalin wore off then these kids must not have had ADHD in the first place. You don't build a tolerance if you actually have ADHD and behavioral treatment doesn't work.

So then the question ought to be whether those who are actually being treated with Ritalin for ADHD who actually have ADHD are still experiencing stunted growth. And even so, if one truly has ADHD then isn't it a quality of life issue? Kids who have ADHD who aren't treated have a much greater risk of trying to self-medicate with street drugs, especially if they've gotten frustrated with school. So if a kid truly has ADHD wouldn't being like an inch shorter be a worthwhile sacrifice if it's the difference between being able to keep up in school and having a questionable future?

I just feel like sometimes peoples fears prevent them from seeking out proven treatments and these types of articles really don't help.