Kids with ADHD should get a heart test before drug treatment

Children with attention deficit hyperactivity disorder should get an electrocardiogram, or ECG, before starting medication for the problem, an April American Heart Association statement recommends. The advice stems from growing evidence that the drugs commonly used to treat ADHD can elevate heart rate and blood pressure, and may increase the risk of sudden cardiac arrest. The latest estimates suggest that ADHD occurs in 5-7 percent of school-aged children in the U.S.

For most children with ADHD those effects appear to be minimal. But they can pose serious risks to children who have certain heart abnormalities. And the standard health exam most kids get from their doctor before starting the drugs may not reveal those abnormalities. Moreover, research suggests that children with ADHD may have a higher than average risk of heart problems.

For all those reasons, the new AHA recommendation calls for children and teens to have an ECG to measure the heart’s electrical activity and look for heart rhythm abnormalities before they start ADHD drugs. Those already taking the drugs should consider getting an ECG if they haven’t previously had one. Individuals with worrisome results on that test should be referred to a pediatric heart specialist before starting the drugs, and undergo frequent follow-up exams once they do.

Common ADHD drugs include dextroamphetamine (Dexedrine, Dextrostat, and generic), methylphenidate (Concerta, Ritalin, and generic), and Adderall, which is a combination of several amphetamines and is also sold as a generic.

The new concerns shouldn't stop parents and kids from seeking treatment for ADHD. But they do underscore the importance of thorough diagnosis and careful treatment. Indeed, as we have reported previously, many children and teens labeled as ADHD either do not have it or have only mild symptoms. They may not need medication at all. So be sure to get a second opinion if you have doubts.

For more about symptoms and medications to treat ADHD, read our free Best Buy Drugs report and our treatment ratings (subscribers only) on the condition.

—Joel Keehn, senior health editor