American Heart Association (AHA) Recommends Heart Screening For Children before taking ADHD Drugs like Ritalin

According to a new recommendation from the American Heart Association, children who have been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), also known as Attention Deficit Disorder (ADD), should be screened for heart problems with an electrocardiogram (EKG) before they are prescribed drugs such as Ritalin.

Drugs used to treat ADHD are stimulants, having the potential to increase both heart rate and blood pressure. In children with heart conditions, ADHD drugs could potentially make them more vulnerable to cardiac arrest and other heart problems. A Food and Drug Administration review of its own FDA databases found reports of 19 sudden deaths in children treated with ADHD drugs and 26 reports of other problems including strokes and rapid heart rates between 1999 and 2003.

The Cleveland Clinic estimates that the annual rate of sudden cardiac deaths among the approximately 2.5 million children in the US who take medication for ADHD is approximately one to two children per 100,000.

Prior to prescribing ADHD medication, the AHA now recommends that doctors screen children for any personal or family history of heart problems, and perform a thorough heart exam including an EKG. The AHA also recommends testing for children already taking ADHD drugs. Such testing can help identify any previously undiagnosed heart issues and detect abnormal heart rhythms that may lead to a sudden heart attack.

ADHD medications now have labels to warn patients of the possible risks to individuals who have heart defects or other heart problems.

Questions your doctor should ask in a heart screening exam:

• Has your child ever fainted during exercise or similar physical activity?
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• Does anyone in your family have a history of heart problems?
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• Has your child ever experienced chest pains?

The AHA’s heart screening recommendation is not without controversy. Some doctors question the necessity of performing an EKG to test the electrical stimulation of the heart before starting ADHD medications. Doctors note that the American Heart Association doesn’t recommended EKGs for young athletes as a preventative measure for cardiac arrest because it is not feasible or cost-effective to screen all student athletes.

The American Academy of Pediatrics (AAP) also has its doubts about the AHA’s findings and feels that the recommendation takes the issue a step too far. Robert Beekman M.D., of the AAP Section on Cardiology and Cardiac Surgery has expressed concern "that there will be a lot of needless anguish and expense because of false positive findings."

In the end, it is the parents of children prescribed ADHD drugs who must make the decision whether the “risks” of screening for heart problems outweigh the risks of potential cardiac problems.