First, theAmerican Heart Association says children taking ADHD pills should have electrocardiagrams to screen for heart problems. The move was after an FDA review found reports of 19 sudden deaths in children treated with ADHD drugs and 26 reports of other problems including strokes and fast heart rates between 1999 and 2003.
Now, though, the American Academy of Pediatrics says most children taking ADHD drugs don't need an EKG, and the new policy is certain to inflame the debate over the safety of these pills, which are powerful stimulants. More than half of the 4 million kids in the US who are diagnosed with ADD or ADHD are being treated with these pills.
The issue is that, while ADHD drugs such as Ritalin, Adderall and Concerta can help children focus more and behave less impulsively, they also can increase blood pressure and heart rate -and carry warnings about risks for sudden deaths in patients with heart problems.
But the AAP say the AHA was overzealous in recommending EKGs, because such rare deaths are more common in the general population than among children on stimulants. According to the academy, sudden heart-related deaths occur in about four out of 2.5 million US children on stimulants each year, versus between 8 and 62 such deaths yearly among all US children. Here is the AAP policy.
The AHA policy subjects healthy children to unnecessary and costly heart work-ups, and it could limit access to effective ADHD treatments, which "could have serious implications," according to the AAP.
Initially, the AHA policy caused confusion and criticism, so the organization clarified its stance in May, issuing a little-publicized statement saying docs should use their own judgment about EKG screening and that ADHD treatment should not be withheld if an EKG isn't done. The AAP agreed, but decided a more forceful stance against routine EKGs made more sense. The new policy was quietly posted online that month, but is now being published in Pediatrics, the academy's medical journal.
"We really were hearing from our members and parents that things were not at all clear," Jim Perrin, a Massachusetts General Hospital pediatrician and co-author of the policy, tells the AP. The policy makes clear there's no scientific evidence to support "this fairly dramatic practice change."
Tim Gardner, AHA's president, tells the AP his group's stance is based partly on the fact that children with heart abnormalities have a higher incidence of ADHD. But he downplayed differences with the AAP, saying both groups emphasize the importance of careful evaluations for kids starting ADHD drugs.
But Steve Nissen, the Cleveland Clinic cardiologist, says the academy appears to be dismissing concerns that stimulants are used excessively in children with insufficient evidence about long-term risks. And he adds the group's pro-drug stance is troubling, coming only a few weeks after it advocated cholesterol drug treatment for children as young as 8 years old, the AP notes.