Effects of attention-deficit hyperactivity disorder on growth in children and adolescents: A systematic review and meta-analysis

Table 1 Characteristics of included studies with regard to the impact of attention-deficit hyperactivity disorder on growth

Ref.	Study design	Country	Sample size	Age (year)	Female (%)	Mean BMI	ADHD		Control		Obesity		Overweight		Normal
							n	Age	n	Age	n	Age	n	Age	n	Age
Pagoto et al[32], 2009	Retrospective study	United States	6737	31	51.6	-					1475	-	3294	-	1968	-
Fuemmeler et al[33], 2011	Retrospective study	United States	11666	28.8	49	29.1					4343	28.9	3464	28.8	3849	28.6
Aguirre Castaneda et al[37], 2016	Retrospective study	United States	1001	24.41	16.98	24.36	336	-	665	-
Hanć et al[36], 2015	Retrospective study	Poland	615	10.94	0	-	219	-	396	-
Byrd et al[34], 2013	Retrospective study	United States	3050	-	-	-	412	-	2638	-

ADHD: Attention-deficit hyperactivity disorder; BMI: Body mass index.

Table 2 Characteristics of included studies with regard to the impact of medications for attention-deficit hyperactivity disorder on growth

Ref.	Study design	Country	Sample size	Age (year)	Female (%)	ADHA drug	Dose	Duration of medication
Deng et al[42], 2021	Retrospective study	China	86	8.9	17.4	MPH and ATX	MPH: 18 mg/day; ATX: Weight < 70 kg, 0.5 mg/kg/day, weight > 70 kg, 40 mg/day	6 months
Çevikaslan et al[41], 2021	Retrospective study	Turkey	31	7.3	0	MPH	18 mg/day	6 months
Spencer et al[30], 2005	Retrospective study	United States	419	10.6	22.2	MPH	1.2 mg/kg/day	2 years
Sund and Zeiner[29], 2001	Retrospective study	Norway	91	-	0	AMP and MPH	-	5 years
Díez-Suárez et al[39], 2017	Retrospective study	Spain	342	10.7	19.9	MPH	1.25 mg/kg/day	2 years
Mellström et al[28], 2020	Retrospective study	Sweden	724	10	27.2	MPH	0.81 mg/kg/day	3 years
Fast et al[43], 2021	Retrospective study	Sweden	44	9.9	25	MPH or lisdexamfetamine	-	1 year
Germinario et al[35], 2013	Prospective study	Italy	1758	-	11.4	MPH and ATX	MPH: 0.48 mg/kg/day; ATX: 38.7 mg/day	2 years
Mei et al[44], 2022	Prospective study	China	155	8	37.58	ATX	0.5 mg/kg/day	3 months
Spencer et al[31], 2007	Retrospective study	United States	1312	11	23.5	ATX	0.5 mg/kg/day	5 years
Gurbuz et al[38], 2016	Prospective study	Turkey	89	9.75	0	ATX	0.5 mg/kg/day	3 months
Jahangard et al[40], 2017	RCT	Iran	42	8.54	28.57	MPH + RISP	MPH + RISP (1 mg/kg/d + 0.5 mg/d)	2 months
Lee et al[27], 2022	Retrospective study	South Korea	82	8.17	22	MPH	-	2 years

ADHD: Attention-deficit hyperactivity disorder; MPH: Methylphenidate; ATX: Atomoxetine; AMP: Amphetamine; RISP: Risperidone.

Table 3 Risk-of-bias assessment using the RoB 2 tool

Ref.	D1	D2	D3	D4	D5	Overall
Jahangard et al[40], 2017	Low	Low	Low	Low	Low	Low

Table 4 Risk-of-bias assessment using the Methodological Index for Non-Randomized Studies tool

Ref.	A stated aim of the study	Inclusion of consecutive patients	Prospective collection of data	Endpoint appropriate to the study aim	Unbiased evaluation of endpoints	Follow-up period appropriate to the major endpoint	Loss to follow-up not exceeding 5%	Prospective calculation of the sample size	A control group having the gold standard intervention	Contemporary groups	Baseline equivalence of groups	Statistical analyses adapted to the study design	Total
Deng et al[42], 2021	2	2	2	2	2	2	2	2	-	-	-	-	16
Çevikaslan et al[41], 2021	2	2	2	2	2	2	2	2	-	-	-	-	16
Spencer et al[30], 2005	2	2	2	2	2	2	2	2	-	-	-	-	16
Sund and Zeiner[29], 2001	2	2	2	2	2	2	2	2	-	-	-	-	16
Díez-Suárez et al[39], 2017	2	2	2	2	2	2	2	2	-	-	-	-	16
Mellström et al[28], 2020	2	2	2	2	2	2	2	2	-	-	-	-	16
Fast et al[43], 2021	2	2	2	2	2	2	2	2	-	-	-	-	16
Germinario et al[35], 2013	2	2	2	2	2	2	2	2	2	2	2	2	24
Mei et al[44], 2022	2	2	2	2	2	2	2	2	-	-	-	-	16
Spencer et al[31], 2007	2	2	2	2	2	2	2	2	-	-	-	-	16
Gurbuz et al[38], 2016	2	2	2	2	2	2	2	2	-	-	-	-	16
Byrd et al[34], 2013	2	2	2	2	2	0	2	2	-	-	-	-	14
Lee et al[27], 2022	2	2	2	2	2	2	2	2	-	-	-	-	16

Table 5 Risk-of-bias assessment using the Newcastle–Ottawa Scale tool

Ref.	Is the case definition adequate?	Representativeness of the cases	Selection of controls	Definition of controls	Comparability of cases and controls based on the design or analysis	Ascertainment of exposure	Same method of ascertainment for cases and controls	Non-response rate	Total
Pagoto et al[32], 2009	1	1	1	1	2	1	1	1	9
Fuemmeler et al[33], 2011	1	1	1	1	1	1	1	1	8
Aguirre Castaneda et al[37], 2016	1	1	1	1	2	1	1	1	9
Hanć et al[36], 2015	1	1	1	1	1	1	1	1	8