Do common ADHD medications pose a cardiac risk for your child?
The answer: Not usually.
Attention-Deficit Hyperactivity Disorder (ADHD) is a well-known topic, often discussed between parents and teachers, identified by common symptoms such as persistent inattention, hyperactivity and impulsivity. ADHD affects three to seven percent of school-age children and approximately four percent of adults.Left untreated, ADHD can lead to poor school performance, illegal substance abuse, strained relationships and low self-esteem. These results can carry into adulthood with lasting effects.
ADHD is commonly treated with stimulant medications such as methylphenidate and mixed amphetamine salts (including Adderall and Ritalin) with great success. However, concerns whether these stimulant medications have potential for adverse cardiac effects in pediatric ADHD patients is often brought to question. Do the benefits outweigh the risks? It’s a question worth discussing.
What are some of the benefits?
Stimulant medications help ADHD patients better focus their thoughts and ignore distractions, helping them pay better attention and control their behavior. According to the American Academy of Pediatrics (AAP), about 80% of pediatric ADHD patients treated with stimulants experience improvement with the right medication and dosage. Outcomes may include improved relationships, better school performance, increased independence and improved self-esteem.
What are some of the risks?
While side effects are usually mild and short-lived, some children may experience decreased appetite/weight loss, sleep problems and social withdrawal. Few children may experience increased activity or mood changes as their medication wears off, transient muscle movements, or sounds called tics, or minor growth delay. Mild increases in both blood pressure and heart rate are common. More serious cardiac side effect related to the electrical function of the heart are fortunately much less common.
From a clinical standpoint, both the American Heart Association and American Academy of Pediatrics recommend careful cardiac evaluations of all children who have a history of cardiac disease and are being considered for stimulant therapy, and referral to a pediatric cardiologist if cardiac problems are suspected.
As a parent of a child with ADHD, what does this recommendation mean to you? It means your child’s physician may perform a comprehensive health exam, complete with medical history. Often your primary care physician will either order an electrocardiogram (ECG, which is a non-invasive test which evaluates the electrical activity of the heart) or refer your child to a pediatric cardiologist for screening.
If your child has any of the following cardiac risk factors, his or her physician will commonly seek consultation with a pediatric cardiologist:
- Increased blood pressure or heart rate
- Chest pain
- Unexplained fainting
- Thyroid problems
- Personal or family history of heart disease
A pediatric cardiologist is a board certified pediatrician with at least three years of advanced training that provides the skills needed to treat heart conditions in children and teens. During a pediatric cardiology evaluation, the cardiologist may conduct a baseline ECG to measure your child’s heart rhythms to determine if his or her heart is beating as it should. The results may be used later as a comparison with future ECGs to see if any changes have occurred.
The additional oversight of a pediatric cardiologist for high-risk ADHD patients is a proactive approach that helps to alleviate concerns as to whether stimulant medications are causing heart damage. If your child’s physician refers your child to a pediatric cardiologist, the cardiology team can work collaboratively with the physician’s office. This supportive approach help can your child’s physician make fully informed decisions regarding your child’s ADHD medication and any potential risks.
Pediatrix Cardiology, an affiliate of MEDNAX, is a national provider of pediatric cardiology services with 22 practices. Visit mednax.com/cardiology to find a location close to you.
For additional information on ADHD in children, please visit the AAP’s HealthyChildren.org resource center.
Clinically reviewed by Jeffrey Skimming, MD.