Friday, April 25, 2008

ADHD Drugs: Do They Really Cause Heart Attacks?

Do ADHD stimulant drugs such as Ritalin cause heart attacks? Yes, they can--in a small number of children. Children who have a pre-existing heart condition.

Since 1999 thirty kids have died from sudden death attributed to stimulant drugs. And more have suffered heart-related problems. Again, all of these children had a pre-existing heart condition. The drugs didn't cause the heart condition!

As my readers know, I’m not crazy about giving drugs to kids for ADHD Lots of strategies help enormously with ADHD that don’t involve Ritalin. However, I don’t want to be part of the over-reaction and scare tactics running amok on the Web. Most children will not have a cardiovascular problem with ADHD stimulant drugs.

But the American Heart Association's doing the right thing! They're recommending that every child have an electrocardiogram (ECG) before a prescription for a stimulant drug is written. Some people--mainly bean counters--think this is extreme and way too expensive.

Total cost could be as high as $250 million--that's assuming 250 million kids have ECGs at the cost of about $100 per child. Hmm. Am I missing something here? A hundred bucks per kid sure doesn't sound all that expensive to me--given that it could save a child's life!

Keep in mind that a child can have a heart "problem" that your pediatrician isn't aware of. Exactly the reason the AHA's saying "get an ECG" first before taking an ADHD drug. And, yes, there's a strong possibility of a false positive since children's ECG's are hard to read. So have a second ECG, a second opinion, more cardiac screening. But don't skip this important evaluation.

In addition to an ECG, an ADHD cardiac checklist would also include

  • Patient and family history with attention to fainting, palpitations, dizziness, difficulty with exercise
  • Physical exam including blood pressure and a check for abnormal hearbeats.
  • Consultation with a pediatric cardiologist if necessary.

For me, that a drug requires an ECG first is enough to "just say no." I say do Brain Gym, Brain Breaks in the classroom (we'll have some of those in future posts), get dopamine-increasing foods on the table, establish routines and schedules and boundaries. Look into non-drug programs for ADHD like Tomatis, Dore, and Cog Med. Let drugs be the very last resort.


P.S. The next "They're Driving Me Crazy: How to Manage ADHD at Home and in School" telechat starts Thursday, May 1. Includes discussion of the non-drug strategies mentioned above and lots more. Check out all the topics covered at

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