Parents needn't panic about today's announcement that children need cardiac screening before they can safely take stimulants like Ritalin and Adderall, cardiologists say. The announcement, made by the American Heart Association in the journal Circulation, affects the 2.5 million or more children who take stimulants to treat attention deficit hyperactivity disorder, as well as children who are newly diagnosed with ADHD.
The recommended screening involves a physical exam and an electrocardiogram, or ECG. The idea of getting an ECG for a 10-year-old may sound freaky, but it's a painless and inexpensive test that poses no risk to the child. For most families, the biggest issue will probably be corralling the kid and getting to the doctor's office. Cardiologists say it's worth the hassle; they're worried about rare but potentially deadly heart problems that can be made worse by the use of stimulants.
"You want to avoid giving this drug to children who have heart disease," says Steven Nissen, chairman of the cardiology department at the Cleveland Clinic, who calls the new screening recommendations "very solid advice." Nissen helped push the Food and Drug Administration to require warning labels about cardiovascular risk with ADHD drugs in February 2007. For a pediatrician's advice to parents, you can read this related story.
Doctors don't know how many children have undiagnosed heart problems, but preliminary research presented in 2007 found that about 2 percent of seemingly healthy school-age children had potentially serious undiagnosed heart problems that were detected only by an ECG. That could mean that 50,000 kids now taking stimulants are unknowingly at risk of cardiovascular problems.
Stimulant drugs increase heart rate and blood pressure, which can cause problems for children and adults with underlying heart disease. Two disorders prompt the most concern: valvular heart disease, in which one of the heart's four valves fails to open or close properly; and hypertrophic obstructive cardiomyopathy, in which the wall between the heart's chambers is abnormally thick. Between 1999 and 2004, the FDA received reports of 19 children who died suddenly from unrecognized heart problems while taking ADHD medications. Twenty-six other children suffered strokes, cardiac arrests, or heart palpitations.
An electrocardiogram, which takes about five minutes, looks for abnormalities in heart function by reading electrical impulses from the heart's muscles. Small adhesive pads are attached to the chest, and the results are recorded on a strip of paper, which is then read by a physician. Combined with a thorough physical exam, it can detect abnormal heart rhythms and muscle weakness. The AHA recommends that children who have abnormalities get further screening with a pediatric cardiologist but adds that children shouldn't be barred from treatment for ADHD just because they haven't had an ECG. Insurance should cover the test, but it is inexpensive—less than $25 in most cases.
"There's no question that there are children who benefit from [ADHD] therapy," Nissen says. "Like all therapies, there are benefits and risks. We need to make sure that the ones who have the most to gain get the drugs and the ones who have increased risk avoid the drugs."
Parents should ask their child's pediatrician for advice on when and how to go about getting their child screened.