Before prescribing stimulants, like Ritalin, for children diagnosed with attention deficit hyperactivity disorder (ADHD), doctors are now being advised to order an electrocardiogram (ECG or EKG) to make sure that kids are not at risk for heart problems related to taking these commonly recommended ADHD drugs.
The American Heart Association (AHA) now says that although stimulant drugs' side effects (like increased heart rate and blood pressure) are "usually insignificant," kids diagnosed with ADHD should get an ECG before starting stimulants — just to be on the safe side.
In kids who are to be treated with stimulant medications it's particularly important to rule out heart problems, including some that might not be found during a routine physical exam, says the AHA. In some of these situations, children may not show any obvious symptoms of heart disease.
The organization points to information from the U.S. Food and Drug Administration (FDA) showing that from 1999 to 2004, 19 kids taking ADHD medications suddenly died and 26 had cardiovascular problems like cardiac arrests, strokes, and heart palpitations.
By measuring the heart's electrical activity to help evaluate its function and identify problems, an ECG can determine the rate and rhythm of heartbeat, the size and position of the heart's chambers, and whether certain types of heart abnormalities are present, such as:
- abnormal heart rhythms (that could lead to sudden cardiac death)
- certain congenital heart defects
- heart tissue that isn't getting enough oxygen
The AHA's new recommendations also call for ECGs for kids with ADHD who are already taking stimulants. If the ECG does show an abnormality in any child with ADHD, the AHA recommends that the child be referred to a pediatric cardiologist (a kids' heart doctor), who can regularly monitor the child's heart health with blood pressure checks and routine follow-ups.
However, the new recommendations should not prevent children with ADHD from getting the treatment they need, says the organization.
More About ADHD
A condition involving a broad array of behaviors (attention, activity, and impulsivity), ADHD can affect how kids interact and function socially, academically, and at home.
Some kids with ADHD have trouble:
- paying attention or staying focused on a task or activity
- engaging in activities quietly
- finishing assignments at school or home
- focusing on instructions and following through
- paying close attention to details or often make careless mistakes
- organizing tasks and activities
- waiting their turn
Children with ADHD may also:
- jump from one activity to another
- lose or forget things (such as homework)
- become easily distracted, even when doing something fun
- interrupt or intrude on other people
- blurt out answers before questions have been completed
- fidget with their hands or feet or squirm around when sitting
- feel restless
- talk excessively
Of course, most kids (especially younger ones) act like this sometimes, especially when they're tired, anxious, or excited. But the difference is that ADHD symptoms are present over a longer period of time and regularly happen in different settings.
Although it can often be challenging to raise kids with ADHD, it's important to remember that they aren't intentionally "acting out," or being "bad" or difficult.
What This Means to You
If you think your child might have ADHD, schedule an evaluation with your doctor, who can get to the bottom of the behaviors and rule out other medical conditions. If ADHD is diagnosed, the doctor will work closely with you to create a treatment plan tailored specifically to your child's symptoms, circumstances, and medical history.
Scientists have found that certain drugs (which may include stimulants, nonstimulants, and sometimes antidepressants) can help control ADHD symptoms and allow kids and teens with the condition to concentrate, focus, and function better in several aspects of their lives.
If a stimulant is part of the proposed treatment plan, ask whether your child should get an ECG before starting to take the drug. Kids might feel better about the procedure if you explain that it's simple, quick, and painless — you just lie down and a series of small electrodes are affixed to your skin with sticky papers on your chest, wrists, and ankles; then you simply have to stay still while your heartbeats are recorded.
Medications are usually just one part of an ADHD treatment plan, which often includes behavioral therapy and making adjustments such as:
- reorganizing the home and school environment
- giving clear directions and commands
- responding appropriately to kids' most trying behaviors
- using calm disciplining techniques
- helping kids develop problem-solving skills and learn how to cope with frustrations
- setting up a system of consistent rewards for appropriate behaviors and negative consequences for inappropriate ones
ADHD can't be cured, but it can be successfully managed. Getting kids with ADHD the help they need can help them learn to control their behavior and lead much more manageable, happy lives.
Reviewed by: Steven Dowshen, MD
Date reviewed: April 2008
Source: "Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Stimulant Drugs," Circulation: Journal of the American Heart Association, published online April 21, 2008.