Retrospective Cohort Study Explores Long-Term Growth Outcomes Following Pediatric Methylphenidate Use
A large retrospective cohort study published in JAMA Network Open suggests that children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD)—especially those treated with methylphenidate (MPH)—may be at greater risk of higher body mass index (BMI) and may have slightly shorter stature in adulthood compared with their peers without ADHD.1
Study Design and Baseline Characteristics
The study analyzed nationwide health insurance and examination data from the Republic of Korea involving 34,850 youths with ADHD, including 12,866 prepubertal children aged 6 to 11 years (mean age ± standard deviation [SD]: 9.3 ± 1.4 years; 72.5% male) and 21,984 adolescents aged 12 to 19 years (mean age ± SD: 14.5 ± 1.8 years; 66.6% male). MPH use was confirmed through prescription claims data, and cumulative exposure was calculated over the first 4 years after diagnosis. BMI and height outcomes at 20 to 25 years of age were compared between those with ADHD and matched controls without ADHD.1
Study Findings
Adult BMI was significantly higher in children with ADHD compared with matched controls (adjusted mean [95% confidence interval (CI)]: 24.3 [24.2-24.4] vs 23.3 [23.2-23.4], respectively; P < .001). This increase in BMI was more pronounced among children with ADHD treated with MPH (24.5 [24.4-24.6] vs 24.0 [23.9-24.2] without MPH). Further, there was a significant positive association between cumulative MPH dose and BMI, suggesting a dose-response relationship between MPH and body composition. Overall, children with ADHD had a 51% increased risk of overweight and obesity in adulthood compared with their peers (adjusted odds ratio [AOR]: 1.51; P < .001), and this increased risk was even greater with MPH usage (AOR: 1.60 vs matched controls; P < .001).1
Similar results were observed in the adolescent population, with adjusted mean BMI [95% CI] in adulthood of 24.2 [24.2-24.3] among those with ADHD compared with 23.7 [23.6-23.7] in matched controls (P < .001). Again, the increase in BMI was more pronounced with MPH usage (24.4 [24.3-24.4] vs 24.1 [24-24.2] without MPH). Adolescents with ADHD, especially those treated with MPH, were at increased risk of overweight or obesity in adulthood compared with their peers (AOR in ADHD population: 1.25; P < .001; ADHD + MPH: 1.29; P < .001).1
Adult height outcomes were not significantly different in the overall population of children or adolescents with ADHD. However, there was a significant reduction in height among those with ADHD treated with MPH versus matched controls (adjusted mean height [95% CI] at adulthood among children: 167.6 cm [167.5-167.8] vs 167.9 cm [167.8-168.0], respectively; P = .004; adolescents: 168.0 cm [167.9-168.1] vs 168.1 cm [168.1-168.2], respectively; P = .049). Children with ADHD who were treated with MPH had an 8% increased risk of short stature in adulthood compared with children without ADHD (AOR: 1.08, P = .01). However, the AOR among adolescents with ADHD, regardless of MPH usage, was not statistically significant.1
Clinical Implications
In this retrospective cohort study, children and adolescents with ADHD, especially those who received MPH therapy, had greater odds of being classified as overweight or obese in adulthood. These associations appeared stronger among children and those with longer-term MPH exposure. Further, the effects of ADHD diagnosis and MPH usage on adult stature were more pronounced in prepubertal children than in adolescents. Collectively, this suggests that the potential association between MPH usage and increased BMI and shorter height may be relevant to long-term MPH usage in childhood.1
Several mechanisms may contribute to these findings. Irregular eating patterns, reduced physical activity, and sleep disturbances among children with ADHD may influence long-term growth and metabolic outcomes. These effects may be compounded by MPH, which is known to suppress appetite in the short term but may be followed by compensatory overeating that could contribute to weight gain over time. Further, sleep disruption, which is associated with both ADHD and stimulant treatment, may affect growth hormone release, leading to reduced growth velocity.1
Although the observed differences in adult height were modest and may not be clinically significant for many patients, the overall results highlight the importance of routine monitoring of growth trajectories, alongside counseling on nutrition and exercise, in children and adolescents with ADHD, especially those receiving long-term stimulant treatment. Further research is needed to clarify the biological and behavioral factors underlying the association between ADHD, stimulant exposure, and long-term physical health outcomes.1
Click here to test your knowledge of this article with a short quiz!
Reference
Song J, Park SJ, Yu J, et al. ADHD and methylphenidate use in prepubertal children and BMI and height at adulthood. JAMA Network Open. 2026;9(1):e2552019. doi:10.1001/jamanetworkopen.2025.52019
