Stimulant medications currently contain a warning targeted to specific high-risk children, including those with structural heart defects, cardiomyopathy, or heart-rhythm disturbances. The medication labels also warn that stimulants may raise blood pressure and heart rate, and have been linked with stroke and heart attack in adults.
When deciding whether to put a child on stimulant medications, both clinicians and parents should weigh the seriousness of the situation, says Gould. The benefits may not outweigh the risk in cases in which attention problems may be keeping a B-student from becoming an A-student, she explains.
But with more serious cases, the choice should be clearer. Untreated ADHD can be harmful in itself, leading to poor performance in school and increasing adolescents’ risk for harmful behavior such as reckless driving, unsafe sexual practices, and substance abuse.
“I have two boys, now grown, so I can certainly relate to parents facing these decisions,” Gould says. “If my child was having problems to the extent that a neurologist or psychiatrist was recommending medication, I would want the medication—although, even though we didn’t discuss this specifically in the study, I would want my child to have an EKG.”
In 2008, the American Heart Association recommended that doctors consider routine electrocardiograms (EKGs) prior to starting children with ADHD on stimulants or other psychotropic medications, but underscored the need for future research. An EKG may help to detect cardiac abnormalities that would increase a child’s vulnerability to sudden heart problems.
Parents considering stimulant medication for their children should also provide their doctor with a detailed family history, including any heart problems or sudden deaths of close family members.
Future research should focus on new ways to detect which children are most at risk for sudden death when taking stimulants, says Gould, since not all cases seem to be detectable with routine screenings. Until then, a thorough examination and careful monitoring is the best way to reduce a child’s danger.
The study was funded by a grant from the NIMH and a contract with the FDA.
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