Effect of methylphenidate on physical growth indicators in children and adolescents with attention-deficit/hyperactivity disorder: a systematic review and meta-analysis.

Background: Methylphenidate (MPH) is the first-line medication for attention deficit hyperactivity disorder (ADHD). The results regarding its potential negative impact on the physical growth of children and adolescents with ADHD are inconsistent. Accordingly, the present research aimed to systematically evaluate the influence of MPH monotherapy on physical growth parameters in children and adolescents with ADHD. Methods: A systematic search was conducted across the Cochrane Library, Embase, PubMed, and Web of Science up to December 2025 to identify clinical studies reporting pre- and post-treatment measurements of physical growth parameters-including height, weight, and body mass index (BMI)-in children and adolescents with ADHD receiving MPH monotherapy. EndNote was employed for literature screening. Eligible studies underwent data extraction and quality evaluation. Cohort studies were evaluated utilizing the Newcastle-Ottawa Scale, whereas randomized controlled trials were assessed with the RoB 2.0. The certainty of evidence was assessed using the GRADE approach. Statistical analyses were implemented in STATA 18.0. Results: Thirty-three studies were incorporated, of which 16 were rated as high quality and 17 as moderate quality. Meta-analysis indicated that MPH-treated children with ADHD exhibited significant reductions in height Z-score (mean difference [MD] = -0.13, 95% confidence interval [CI] = -0.18 to -0.09; I² = 91.1%, p < 0.001), weight Z-score (MD = -0.25, 95% CI = -0.36 to -0.15; I² = 96.8%, p < 0.001), short-term mean weight (MD = -0.34, 95% CI = -0.51 to -0.18; I² = 0.0%, p = 0.449), and body mass index Z-score (MD = -0.26, 95% CI = -0.32 to -0.20; I² = 96.3%, p < 0.001), while mean BMI showed no statistically significant difference (MD = 0.20, 95% CI = -0.24 to 0.64; I² = 96.0%, p = 0.449). For outcomes with substantial heterogeneity, subgroup and regression analyses were conducted, but no clear sources were identified. Conclusions: MPH use is significantly associated with reductions in growth parameters in children and adolescents with ADHD. Even though the effect sizes were small, clinicians should prioritize individualized monitoring. Future research should employ more standardized prospective designs to minimize potential confounders. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251117485, identifier CRD420251117485.