Is Ritalin Too Risky for Kids With ADHD?

One study showing risk isn’t reason enough to stop medication, FDA says.

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Just when parents thought they could spend a week or two not worrying about the health effects of Ritalin, Adderall, and other drugs used to treat attention deficit hyperactivity disorder, another study comes along to raise the question once again: Are the medications used to treat ADHD safe enough for kids? Again, the answer is: Probably.

The latest worry spike comes from a report that assessed the risk in children who died suddenly between 1985 and 1996. Researchers led by Madelyn Gould, a professor of clinical epidemiology and psychiatry at Columbia University Medical Center, found that 10 of 564 children who died suddenly had been taking stimulant drugs, compared with 2 of 564 who died in car accidents. That would make you think that children taking stimulants are much more likely to suffer a sudden death. And that would square with ongoing concerns that stimulant drugs raise the risk of heart problems in children, which culminated in an April 2008 recommendation from the American Heart Association that all children be screened for heart problems with an EKG before being prescribed stimulants for ADHD.

The AHA backed off its call for universal EKGs for kids taking ADHD medications after the pediatricians howled in May 2008, saying that there’s no evidence that universal EKG screening would prevent any deaths. But parents are left wondering what they can do to reduce the risk of heart problems in kids taking ADHD drugs.

This latest study doesn’t offer much clarification, alas. Here’s why. The study looked at the history of 1,128 children, half of whom died suddenly of natural causes and half of whom died in car accidents. Of the children who died suddenly, 10 were reported to be taking a stimulant at the time of death, compared with just two of the children in the group who died in vehicle accidents. But very few children in either group were on stimulant drugs, making it more likely that the results could be in error. And parents were asked after the fact if their child had been taking stimulants, so there could be problems with correct recall. The Food and Drug Administration issued a communication saying that parents shouldn’t take children off stimulant medications as a result of the new study, which is published in the American Journal of Psychiatry.

“There’s no reason to be alarmed on the basis of a single report,” says Russell Barkley, clinical professor of psychiatry at the Medical College of Wisconsin and a research professor in the Department of Psychiatry at the SUNY Upstate Medical University in Syracuse, N.Y. “These drugs are among the safest used in child psychiatry and pediatrics. But there are children in the population that are susceptible to rare side effects.” Still, your pediatrician should give your child a full physical and take a family history before prescribing ADHD medication to screen for hidden heart problems that could be made worse by stimulant medications, according to the May 2008 recommendation from the American Academy of Pediatrics. And if he or she doesn't raise the issue, ask your pediatrician about stimulants and heart risk.