ADHD medication & children's cardiac health

About 7 percent of American children are receiving medication for ADHD. Aside from all the controversies about the diagnosis and treatment, this is the current reality. In the last several years, a small—thankfully, very small—number of children receiving one of the standard ADHD first-line medications (psychostimulants) have experienced effects on their heart, including sudden death. Because this tragic event is so rare, controversy remains among medical professionals about whether cardiac health is indeed affected by psychostimulants, or whether there is a similar incidence of cardiac events in the untreated pediatric population.

Although there are a bewildering number of products for ADHD, the front-line treatments fall into two main, very closely chemically related groups: the psychostimulant called methylphenidate (for example, Ritalin); and the psychostimulant known as amphetamine salts (for example, Adderall). A July 2009 study in the Journal of Pediatrics addresses one question of great importance to parents and physicians: Is either methylphenidate or amphetamine salts safer? Although this study did not provide the final answer, its analysis of Emergency Room visits between 1994 and 2004 for children receiving Medicaid in Florida did not show any differential in the risks associated with the two main classes of medication.

So what’s a parent to do when the medical experts can’t agree among themselves? The Lucy Daniels Center believes that the American Heart Association (AHA) struck a very sensible note with its guidelines, which have been endorsed by the Academy of Pediatrics. The AHA recommends that pediatricians and family physicians obtain a thorough cardiac history and perform a routine physical cardiac exam assessment of all children. If patient history, family history, or physical exam is suggestive of cardiac disease, further evaluation is advised, and careful thought should be given to the benefits and possible risks of using psychostimulants.

On the other hand, if there is no reason to be concerned about cardiac health on the basis of history and exam, the AHA does not recommend routine ECG’s or additional cardiac evaluation but recognizes that a pediatrician or family physician might still recommend further evaluation. The bottom line: if your child is taking psychostimulant medications, be sure that you and your child’s physician have addressed these issues of cardiac health. 

– Mental Health Matters! is written by the Lucy Daniels Center for Early Childhood and posted on the Carolina Parent Magazine's website, the Triangle's family resource - in print for over 21 years!  And online at www.carolinaparent.com.