Attention Deficit Hyperactivity Disorder and Heart Problems

Attention deficit/hyperactivity disorder (ADHD) is a condition characterized by problems paying attention, hyperactivity and impulsive behaviors. The Centers for Disease Control and Prevention estimates about 4.4 million school children (4 to 17) have been diagnosed with ADHD. It’s three times more common in boys than in girls.

There are three main types of ADHD. Children with the inattentive type tend to have problems paying attention and are less likely to be hyperactive or disruptive in the classroom. They are often seen as the “quiet child.” They are easily distracted and have trouble staying focused, following instructions or completing assignments. The inattentive type of ADHD is more common in girls than in boys.

The hyperactive/impulsive type child has a hard time sitting still. They may fidget, get up from their desks or run around the classroom. They act without thinking, have a hard time waiting their turn and interrupt conversations.

Children with the combined type of ADHD have symptoms of inattentiveness, hyperactivity and impulsiveness. There is not one predominant type of behavior. This is the most common type of ADHD.

The CDC estimates 2.5 million school children are taking medications for ADHD. The treatments most commonly prescribed are in a class of drugs called stimulants. It may take trials of different medications or dosages to find the drug that works best for the child. Some of the drugs are short-acting and need to be taken at least twice a day. Other forms are extended release or long-acting, providing an even dose of medication throughout the day.

ADHD medications can make a big difference in a child’s behavior. The drugs can help a child maintain attention and focus, complete assignments, sit still and be less impulsive. However, the drugs can have side effects, like changes in appetite, sleep problems and increased irritability or anxiety.

Issues at Heart
Some children taking stimulant medication experience an increase in blood pressure and heart rate. For a minority of patients, those side effects can lead to sudden death. The American Academy of Pediatrics (AAP) reports there are about four incidents of sudden death/year among children taking stimulant medication.

Last April, the American Heart Association issued a consensus statement recommending heart disease screening for children who are being considered for stimulant medication. The initial statement urged doctors to consider an electrocardiogram (ECG) as part of the screening process.

A few months ago, the AHA and the AAP issued clarifications on those recommendations. Both organizations now say physicians should perform a thorough physical exam and family history to screen for heart disease or sudden death. In most cases, a routine ECG isn’t necessary. An ECG may be deemed reasonable for children who have underlying health problems or a family history suggestive of an increased risk for sudden death. However, ECG is not considered a necessity and a child should not be denied medication if the test is not performed.

Paul Matherne, M.D., a Pediatric Cardiologist at University of Virginia Health System, says the decision to have an ECG should be made on a case-by-case basis. Parents who have concerns should speak with their health care provider. Experts say the risk of sudden death is extremely small, occurring in fewer than 2 out of every million children and adolescents taking stimulant medications. That’s still a much lower rate of death than among the general population (estimates of sudden death in all children and adolescents range from 8 to 62 cases per million). The risk of taking medications needs to be weighed against the risks of NOT taking them. Researchers say children with ADHD who are untreated are more likely to experience school failure and higher rates of substance abuse and automobile accidents.

News 2 Viewer Inquiry
If you have any concerns about medication use for your child, speak with your health care provider.
For general information about attention-deficit/hyperactivity disorder:
American Academy of Child and Adolescent Psychiatry, http://www.aacap.org
American Academy of Pediatrics, http://www.aap.org/publiced/BR_ADHD_FAQ.htm
Centers for Disease Control and Prevention, http://www.cdc.gov/ncbddd/adhd/default.htm
CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder, http://www.chadd.org
National Institute of Mental Health, http://www.nimh.nih.gov