Cardiac Screening Recommended for Kids Taking Stimulants for ADHD

However, children with underlying heart disease who take stimulants for ADHD appear to face an increased risk for sudden cardiac arrest, the AHA noted. This risk association is particularly troublesome for young ADHD patients, because heart disease often goes undiagnosed in children and may be present without noticeable symptoms.

The AHA also pointed to a number of studies that suggest that between 33 percent and 42 percent of pediatric heart patients also have ADHD.

FDA data collected for the period 1999 through 2004 revealed that 19 children following an ADHD prescription regimen had died suddenly, while 26 experienced heart complications such as stroke, heart attack, and/or heart palpitations.

Vetter noted that, in 2005, the Canadian equivalent of the FDA -- Health Canada -- decided to place a ban on Adderall, an amphetamine-based ADHD medication designed for kids over the age of 3. The Canadian decision was actually based on a review of FDA records concerning 12 reported deaths among American children taking ADHD drugs.

Vetter pointed out that the Canadian decision was based on an assessment of collected data based on family self-reports (sometimes in the absence of autopsy records), rather than a complete scientific analysis.

"But the reality is that we were faced with some kids who had ADHD who suddenly died," she said. "And a lot of them were exercising at the time, which is when most of the kids who have electrical malfunctions of the heart would have a sudden cardiac death. So we have to assume they experienced a cardiac death."

In February 2007, the FDA ordered makers of ADHD medications to develop guidelines that alert patients to the heart risks associated with their treatments.

"But it's not that these are dangerous medicines," stressed Vetter. "But by adding the ECG, and by being aware of possible heart disease, and monitoring the kids once you prescribe the medications, one can go ahead and treat the ADHD. And these kids can be very happy."

Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Schneider Children's Hospital in New Hyde Park, N.Y., agreed that the point of expanded screenings is to identify a child's underlying heart complication, not to look for problems with the stimulants themselves.

"Serious cardiac complications from stimulant medications are very rare," Adesman said. "But because there are concerns on the part of parents and some physicians, routine ECG screenings will provide greater reassurance for the vast majority of patients for whom ADHD medications are being considered."

More information

For more on ADHD treatments, visit the National Institute of Mental Health.

SOURCES: Victoria L. Vetter, M.D., head, American Heart Association statement writing committee, and professor, pediatrics, University of Pennsylvania School of Medicine, Philadelphia; Andrew Adesman, M.D., chief, developmental and behavioral pediatrics, Schneider Children's Hospital, New Hyde Park, N.Y.; April 21, 2008,Circulationonline