ADHD drugs and your child’s health
Many children with attention deficit hyperactivity disorder (ADHD) are treated with drugs designed to improve their behavior by helping them focus and concentrate.
The evidence suggests these drugs can be a huge help when it comes to helping ADHD kids calm down and get better grades at school. However, several studies have suggested that stimulant medications like those used to treat ADHD can increase heart rate and blood pressure. Don’t panic – these side effects are insignificant for most children with ADHD. But they’re an important consideration for children who have a heart problem, because certain heart conditions increase the risk for sudden cardiac death (SCD), which occurs when the heart rhythm becomes erratic and doesn’t pump blood through the body.
Surveys indicate that ADHD affects an estimated 4-12% of all school-aged children in the US, and it appears more common in children with heart conditions. Studies report that depending on the specific cardiac condition 33-42% of pediatric cardiac patients have ADHD. The number of undiagnosed children with heart conditions is unknown, as routine heart screening isn’t performed, but a recent pilot study indicates that up to 2% of healthy school-aged children have potentially serious undiagnosed cardiac conditions identified by an ECG. Data from the Food and Drug Administration (FDA) shows that between 1999 and 2004, 19 children taking ADHD medications died suddenly and 26 children experienced strokes, cardiac arrests and heart palpitations. Since February 2007, the FDA has required all manufacturers of ADHD drugs to develop medication guidelines to alert patients to possible cardiovascular risks.
With all this in mind, American Heart Association (AHA) has recommended that children with ADHD should get careful cardiac evaluation and monitoring – including an electrocardiogram (ECG) – before treatment with stimulant drugs. Doctors usually perform a physical exam and check patient and family history to detect the risk for or presence of health problems before beginning new treatments, including prescribing medication. But some of the symptoms associated with SCD may not be noticed in a routine physical exam because they’re subtle or vague – palpitations or fainting, for example, which you may just put down to your child overdoing things in hot weather. If your child has an undiagnosed heart condition, he’s particularly at risk – which is why the AHA is also recommending that children currently taking these medications who didn’t have an ECG prior to treatment should have one.
“After ADHD is diagnosed, but before therapy with a stimulant or other medication is begun, we suggest that an ECG be added to the pre-treatment evaluation to increase the likelihood of identifying cardiac conditions that may place the child at risk for sudden death,” says Dr Victoria L Vetter, Professor of Pediatrics at the University of Pennsylvania School of Medicine in Philadelphia.Vetter also says that doctors should evaluate children and adolescents already taking these medications if they were not evaluated when they started the treatment. If heart problems are suspected after the evaluation, children should be referred to a pediatric cardiologist.
Once stimulant treatment begins, children should have their heart health monitored periodically, with a blood pressure check within one to three months, then again at routine follow-ups every six to 12 months. “Children can have undiagnosed heart conditions without showing symptoms,” Vetter continues. “Furthermore, a child’s body changes constantly, with some conditions not appearing until adolescence.” This means that if the initial ECG was taken before age 12 years, it may be useful to do a repeat ECG once your child is over 12 years.
Widespread use of ECGs to detect heart abnormalities, isn’t routinely recommended by the AHA but it regards ECG screening for children prescribed ADHD medication as medically indicated. That said, however, lack of an ECG or lack of access to a pediatric cardiologist who can evaluate an ECG shouldn’t mean that kids who need ADHD treatment can’t get it. “While we feel that an ECG is reasonable and helpful as a tool to identify children with cardiac conditions that can lead to SCD, if, in the view of their physician, a child requires immediate treatment with stimulant medications, this recommendation isn’t meant to keep them from getting that treatment,” says Vetter.