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January 9, 2024
A commonly reported risk associated with ADHD medication is reduced growth in height. But studies to date have generally not adequately described or measured possible confounders, such as genetic factors, prenatal factors, or socioeconomic factors. What if ADHD were associated with reduced height even in the absence of medications?
An international study team explored this question by performing a nationwide population study comparing data from before (1968-1991) and after (1992-2020) the adoption of stimulant therapy for ADHD in Sweden.
The country’s single-payer health insurance system that connects patient records with all other national registers through unique personal identification numbers makes such analysis possible. Sweden also has military service conscription, which records the heights of 18-year-old males.
The participants were all 14,268 Swedish males with a diagnosis of ADHD who were drafted into military service at any time from 1968 through 2020.
Up to five non-ADHD controls were identified for each ADHD case, matched by sex (they had to be male), birth year, and county. The total number of controls was 71,339.
Among 34,586 participants in the period before adoption of stimulant medications (1968-1991), those diagnosed with ADHD had roughly 30% greater odds of being shorter than normal (166-172 vs. 173-185 cm) than typically developing controls. That dropped to 20% greater odds among the 34,714 participants in the cohort following adoption of stimulant medications.
The odds of those diagnosed with ADHD being much shorter than normal (150-165 vs. 173-185 cm) remained identical (about 55% greater) among the almost 30,000 participants in both cohorts.
In other words, there was no increase in the odds of ADHD individuals being shorter than normal after adoption of stimulant therapy in Sweden compared with before such adoption.
Furthermore, after adjusting for known confounders, including birth weight, inflammatory bowel disease, celiac disease, hypothyroidism, anxiety disorders, depression, substance use disorder, and highest parental education, the odds of those diagnosed with ADHD being shorter than normal or much shorter than normal in the 1992-2020 cohort dropped to roughly 10% and 30% greater, respectively.
Could it be the disorder itself rather than stimulant treatment that is associated with reduced height in individuals diagnosed with ADHD?
To address effects of environmental and familial/genetic confounding, the team then compared the entire cohort of males diagnosed with ADHD from 1968 through 2020 with typically developing male relatives, ranging from first cousins to full siblings.
Among full siblings, the odds of those with ADHD diagnoses being shorter (over 90,000 participants) or much shorter (over 77,000 participants) were a statistically significant 14% and 18%, respectively.
The authors concluded, “Our findings suggest that ADHD is associated with shorter height. On a population level, this association was present both before and after ADHD-medications were available in Sweden. The association between ADHD and height was partly explained by prenatal factors, psychiatric comorbidity, low SES [socioeconomic status] and a shared familial liability for ADHD.”
Rickard Ahlberg, Miguel Garcia-Argibay, Ebba Du Rietz, Agnieszka Butwicka, Samuele Cortese, Brian M. D’Onofrio, Jonas F. Ludvigsson, and Henrik Larsson, “Associations Between Attention-Deficit/Hyperactivity Disorder (ADHD), ADHD Medication and Shorter Height: A Quasi-Experimental and Family-based Study,” Journal of the American Academy of Child & Adolescent Psychiatry (2023), https://doi.org/10.1016/j.jaac.2023.03.015.
Background:
One of the more persistent concerns among parents of children with ADHD is whether stimulant medications will stunt their child's growth. A large Israeli cohort study now offers some of the most rigorous reassurance to date, and its methodology sets it apart from earlier research.
The question has long been complicated by a more fundamental uncertainty: do growth differences in children with ADHD stem from the condition itself, from stimulant treatment, or from factors present before any medication is ever prescribed? Without a clear answer, clinicians and families have faced a genuine dilemma when weighing the benefits of stimulant therapy against potential long-term physical costs.
Most previous studies compounded this difficulty by comparing group-average heights, which ignores the crucial variable of genetic potential. A child who is short relative to the general population may simply have short parents. Failing to account for this introduces systematic bias and can make medications appear more harmful than they are.
The Study:
The Israeli research team addressed this directly. Using health records from a nationwide provider, they assembled a retrospective cohort of children born between 1995 and 2003, following them through 2023. This amount of time was long enough for all participants to have reached adult stature (defined as 17 or older for females, 19 or older for males). Their sample included 5,671 children with untreated ADHD, 11,846 who received stimulant treatment, and 47,258 non-ADHD controls. Children who took stimulants for only one to two months, or who had chronic medical conditions requiring long-term medication, were excluded to avoid confounding the results.
Crucially, adult height was evaluated not against population norms but against each individual's expected height, calculated from parental heights using the Tanner-Goldstein-Whitehouse method, a standard approach for estimating genetic height potential via mid-parental height.
When the researchers compared adult heights across the three groups using analysis of variance (ANOVA), they did find statistically significant differences. But statistical significance, particularly in studies with tens of thousands of participants, does not automatically translate into clinical significance. The effect sizes were consistently very small, and the absolute differences were under one centimeter, which is a margin considered clinically negligible.
Their conclusion is measured but clear: after accounting for genetic growth potential, neither an ADHD diagnosis nor stimulant treatment was associated with meaningful reductions in adult height. The findings, they argue, support prioritizing behavioral and functional outcomes when making treatment decisions, since the risk of clinically significant height loss appears to be minimal.
The Take-Away:
For families navigating ADHD treatment, the practical implication is significant: concerns about permanent growth suppression, while understandable, should not be the primary driver of whether or how long a child receives stimulant therapy.
A recent meta-analysis examined how well cognitive behavioral therapy (CBT) improves not just symptoms, but everyday functioning and quality of life in adults with ADHD.
The Background:
ADHD in adults affects far more than attention or impulsivity. It often disrupts key areas of life:
These broad impacts highlight a key issue: reducing symptoms does not automatically translate into better day-to-day functioning.
CBT is a structured, skills-based therapy that helps people:
While both medication (especially stimulants) and CBT improve core ADHD symptoms, CBT is particularly aimed at improving real-world functioning.
The Study:
The researchers analyzed studies involving adults diagnosed with ADHD (or showing clinically significant symptoms). They included:
They focused specifically on outcomes beyond symptoms:
The Results:
1. Strongest Effects: Occupational functioning
CBT showed consistently strong improvements in work-related functioning compared to control groups, both immediately after treatment and at follow-up. This was the most robust finding across domains.
2. Moderate Improvement: Global Functional Impairment
CBT led to moderate improvements in overall daily functioning, with some evidence that gains persist over time. In studies tracking individuals over time, improvements were even stronger at follow-up.
3. Modest Gains: Social Relationships
CBT produced small to moderate improvements in social functioning. Benefits were present both after treatment and at follow-up, but were less pronounced than in work-related outcomes.
4. Limited Effects: Academic Functioning
There were moderate short-term gains when CBT was compared to control groups, but these did not persist at follow-up. Within-subject studies showed only small improvements overall.
5. Modest and Inconsistent Effects: Quality of Life
Improvements in quality of life were small when compared to control groups and often did not last. However, studies tracking individuals over time showed moderate improvements, suggesting some benefit that may not always show up clearly in between-group comparisons.
Overall, the findings suggest:
One notable nuance: CBT did not always outperform other active treatments (like medication or other therapies). This suggests that while CBT is effective, its benefits may partly overlap with broader therapeutic or support effects rather than relying on a single, unique mechanism.
The Take-Away:
CBT is a valuable, evidence-based treatment for adults with ADHD, especially for improving work functioning and overall daily life management. However, its impact on relationships, academic outcomes, and quality of life is more limited and less consistent, pointing to the need for more targeted or combined approaches in those areas.
The Background:
ADHD and epilepsy are the two most common neurological disorders in children and adolescents. Additionally, they appear as co-diagnoses more often than chance would predict. Roughly a quarter of children with epilepsy also have ADHD, and children with ADHD face a 2.5-times greater risk of developing epilepsy than their peers.
Clinicians have long suspected that carrying both diagnoses compounds cognitive difficulties, but no rigorous quantitative review has mapped out exactly how much, or in what ways. This new meta-analysis now fills that gap.
The Study:
The team pooled data from peer-reviewed studies that included children and adolescents diagnosed with both conditions alongside at least one comparison group: children with neither condition, children with epilepsy alone, or children with ADHD alone. To capture the breadth of thinking skills, they constructed a general intelligence factor drawing on six cognitive domains:
The Results:
Across eleven studies (995 participants), children and adolescents with both conditions scored moderately lower on general intelligence than those with epilepsy alone. The same pattern held across all six cognitive domains. Seven studies (785 participants) comparing the dual-diagnosis group with those who had ADHD alone found an equally consistent moderate deficit, replicated in every domain.
The clearest signal emerged when researchers compared children and adolescents carrying both diagnoses to typically-developing peers. Seven studies covering 427 individuals revealed a substantially larger gap in general intelligence, with the effects of the two conditions appearing to be roughly additive, meaning the combined burden was approximately equal to the sum of each condition's individual impact. This pattern held across five of the six domains.
The Interpretation:
The results come with meaningful caveats. Variability across individual studies was moderate in the first two comparisons and high in the third, reflecting real differences in how studies were designed, which populations they sampled, and how they measured cognition. While there was no sign of publication bias in the first group, it was not assessed in two of the three analyses.
The authors describe “a widespread profile of cognitive dysfunction” in children and adolescents with both epilepsy and ADHD, while underscoring that the substantial variability between studies warrants caution in drawing overly precise conclusions. The findings nonetheless carry practical weight: children managing both conditions may need more intensive cognitive screening and support than current clinical practice routinely provides.
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