Complete Children’s Health Response to News from the American Heart Association*
On April 21, 2008, the American Heart Association (AHA) released a new statement that advocates screening children for cardiac conditions before and during treatment with stimulant drugs for ADHD. Many CCH patients and families are asking questions regarding the statement.
The AHA statement recommends heart rate and blood pressure checks and screening (obtaining a family history of cardiac problems and a cardiovascular exam) before prescribing stimulant medication for ADHD. The statement also recommends that each child diagnosed with ADHD be given an electrocardiogram (ECG, EKG) before prescribing a stimulant medication.
ADVICE FOR CCH PATIENTS ON STIMULANT MEDICATION:
1. Our patients are routinely screened for heart problems and risk factors as part of the well child/adolescent preventative care check-ups. Therefore, it is important for your child to follow your doctor’s recommended schedule for well child visits.
2. We recommend monitoring all ADHD patients on stimulant medications for known side effects of the medications, including possible heart problems. Therefore, it is important for our patients to attend the follow-up ADHD visits as recommended by their doctor so that blood pressure and heart rate can be monitored, the heart exam can be completed, and your doctor can learn of any changes to family history.
3. While electrocardiograms are helpful in diagnosing certain heart conditions, they are not perfect and occasionally provide confusing results. The decision by a pediatrician not to obtain an ECG based on his/her analysis of your child’s examination and history, or the inability to obtain an ECG, does not preclude the use of stimulant medication in a child diagnosed with ADHD (as per the AHA statement).
4. There is no reason to stop the stimulant medication if it is working well and there are no adverse side effects. ADHD can be safely and effectively treated with medications and close collaboration between you and your child’s pediatrician.
5. If there is any concern for cardiac or other adverse effects of your child’s medication, please schedule a follow-up visit with your provider to discuss other options.
Note: The American Academy of Pediatrics (AAP) is currently revising the Diagnosis and Treatment Guideline for ADHD that will incorporate evidence-based research regarding the possible need for initial and/or intermittent ECG’s in ADHD patients on stimulants.
*Adapted from current AAP treatment guidelines for ADHD and statement issued 4/22/08