In 2008 the American Heart Association released new guidelines concerning ADHD medications. It is now recommended that screening electrocardiograms (EKGs) be part of the work-up for all children taking stimulant medications for Attention Deficit Hyperactivity Disorder (ADHD.)

Children in the following categories should call our office to schedule an EKG:

  1. All children starting ADHD medications.
  2. All children on ADHD medication who have never had an EKG.
  3. All children on ADHD medication who have had and EKG before 12 years of age, but are now past 12 years old.

Stimulant drugs can increase blood pressure and heart rate. For most children, that isn’t a problem. But in those with heart conditions, it could make them more vulnerable to sudden cardiac arrest – an erratic heartbeat that causes the heart to stop pumping blood through the body – and other heart problems.

About 2.5 million American children and 1.5 million adults take medication for attention-deficit hyperactivity disorder, or ADHD, according to government estimates. Stimulant drugs, like Ritalin, Adderall and Concerta, help children with ADHD stay focused and control their behavior.

The medications already carry warnings of possible heart risks in those with heart defects or other heart problems, which some critics said were driven more by concerns of overuse of the drugs than their safety.

The American Heart Association is now recommending a thorough exam, including a family history and an EKG, before children are put on the drugs to make sure that they don’t have any undiagnosed heart issues.

The label warnings were added after a review by the Food and Drug Administration of its databases found reports of 19 sudden deaths in children treated with ADHD drugs and 26 reports of other problems including strokes and fast heart rates between 1999 and 2003. There were also reports of heart problems in adults; the committee didn’t look at adults.

An EKG can detect abnormal heart rhythms that can lead to sudden cardiac arrest. Children who are already on ADHD drugs should also be tested. Screening of about 1,100 healthy children found that about 2 percent of them had some kind of heart problem If problems are found, the child should be sent to a pediatric cardiologist. With careful monitoring, children with heart problems can take the medicines if needed.

At PHA, we agree children should not be kept from being treated. But it should be done as safely as possible.