New ADHD Recommendations

The American Heart Association (AHA) published a new scientific statement about how best to identify and monitor children with ADHD who may have heart disease and could be at risk for sudden death if they were started on a stimulant medication, such as Adderall or Ritalin.

This follows the FDA adding a warning to stimulants in 2007, which states that there have been reports of "sudden death in patients who have heart problems or heart defects" and "increased blood pressure and heart rate." This warning had hopefully already led pediatricians to try and identify kids who are at an increased risk from being on a stimulant, so they could try alternative treatments, such as behavior therapy.

The guidelines are not without controversy though, as they were published without consulting the American Academy of Pediatrics, whose members would be responsible for following the guidelines. The AAP describes the AHA guidelines as "cautious" and "may not be feasible."

The new American Heart Association guidelines offers a lot of helpful things to look for to help identify a child that might be at increased risk for sudden death if he were started on a stimulant, including symptoms that the child or a family member might be having, such as chest pain, fainting, or dizziness, etc, or a family history of things like hypertrophic cardiomyopathy, long-QT syndrome, or Wolff-Parkinson-White syndrome.

The part that is a little controversial is that the AHA recommends that all children who are going to be started on a medication for ADHD first have a baseline ECG (electrocardiogram). The AAP responds that there are a "limited number of cardiology specialists and technicians available to provide these services nationally" and that ECGs are "not perfect and occasionally provide confusing results." You should likely also consider the cost involved for the test.

Perhaps an ECG for all children with ADHD is the safest way to go to treat these children, but before such a costly recommendation is implemented, it might have been a good idea to make sure it is actually going to be helpful, get some input from the AAP and the American Academy of Child and Adolescent Psychiatry, and make sure someone was going to pay for it? Will insurance companies pay for these ECGs or for a visit to a pediatric cardiologist when a child has no symptoms and is just being evaluation to be put on ADHD medicines?

Will your pediatrician get an ECG before your child is started on an ADHD medicine or because your child is already on a medicine for ADHD? They might, as the AHA recommendation is certainly something that they could follow. Don't be surprised if your pediatrician feels comfortable with his current evaluation of your child's risk for heart disease and waits for further guidance on the issue from the AAP though.

Related:
Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Stimulant Drugs.
Understanding ADHD
ADD vs ADHD
Vyvanse
Adderall XR Drug Warning