For several years, health care providers have warned parents about pediatric heart problems associated with ADHD (attention-deficit hyperactivity disorder) drugs. Medical wisdom said children should be given cardiac testing prior to being placed on stimulant drugs like Ritalin or Adderall. A new survey published by the American Academy of Pediatrics now shows that doctors are ambivalent about the necessity of cardiovascular counseling and testing before prescribing ADHD medications. Here are facts for parents about ADHD, drug therapy and heart problems in children.
* ADHD is a childhood condition that may last into adulthood. It is characterized by inattentiveness, impulsiveness and uncontrollable behavior. Children generally show a preponderance toward either focusing (attention deficit) or behavioral issues, but may exhibit both, says the National Institute of Mental Health.
* ADHD diagnosis is typically made based on symptom reports by parents. It is one of the most common childhood conditions and incidence of ADHD is increasing. The CDC says that in 2003, 7.8 percent of children ages 4-17 were diagnosed with it and by 2007 nearly 10 percent of kids had been diagnosed with ADHD at some point in their life.
* Stimulant medications have been used to successfully manage symptoms in about 70 percent of children with ADHD, say WebMD. Ritalin and Adderall are the most commonly prescribed drugs but Concerta, Metadate CD and Daytrana are becoming more popular, too.
* Ritalin Side Effects says that among the various concerns for children from taking stimulants are increased risk of heart palpitations, high blood pressure, SCD (sudden cardiac death) and other cardiac problems.
* Non-stimulants ADHD medications like atomoxetine (Stattera) have also been used. Doctors have prescribed anti-hypertensives and antidepressants such as bupropion (Wellbutrin) to treat ADHD symptoms, too. However, several years ago, the FDA placed "black box" warnings for parents alerting them to watch children taking Strattera or antidepressants for signs of suicide.
* In 2006, the New York Times reported on FDA advisory panel findings that 25 people, mostly children, had died from taking stimulants. Pediatricians were urged to administer cardiac tests to uncover any underlying heart conditions before prescribing ADHD stimulants.
* In 2008, the AAP declared that routine cardiac testing prior to ADHD drug prescription was unnecessary, unless the child's health history or current health condition warranted it.
* In 2011, Vanderbilt University reported on findings from the New England Journal of Medicine which tested 1.2 million children and found no link between ADHD medication and cardiovascular problems. Study authors cautioned parents to work closely with physicians and report any issues, especially if the child has other chronic health conditions.
* The recent Pediatrics study asked pediatricians how they addressed cardiac testing with their ADHD patients. Most doctors agreed that given the 24 percent risk to children of SCD (sudden cardiac death) and the 30 percent risk of legal liability, physicians should tell parents about heart problems as a side effect of ADHD medications. Nearly all the doctors did a routine health and physical screening, but less than half did in-depth cardiovascular testing or discussed cardiac risks with parents.
Marilisa Kinney Sachteleben writes about parenting concerns from 23 years raising four children and 25 years teaching K-8, special needs, adult education and homeschool.
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