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Duke Medicine: Attention deficit disorder and electrocardiograms

Posted July 5, 2010 11:52 p.m. EDT

Attention deficit hyperactivity disorder, or ADHD, is a commonly diagnosed condition in school-age children, especially boys. It is characterized by difficulty concentrating at a given task, increased and unwanted physical activity, and poor school performance.

The American Academy of Pediatrics has repeatedly emphasized the importance of identifying and treating children with ADHD, due to the higher likelihood of school failure if untreated.

Pediatricians are especially competent at diagnosing ADHD. The treatment for ADHD consists of both behavioral approaches and medication.

Through scientifically sound clinical trials, medications known as amphetamines and amphetamine-like stimulants have been proven to help many children with ADHD, says Dr. Ronald J. Kanter, director of pediatric electrophysiology in Duke Pediatrics Division of Cardiology. It is currently estimated that more than 2.5 million youngsters in the United States receive these drugs.

The medications are chemically similar to the natural human stress hormones, adrenalin and noradrenalin; to the decongestants long used in over-the-counter cold remedies, pseudephedrine (“Sudafed”) and phenylpropanolamine; and to the now banned weight-losing dietary supplement, ephedra (also known as ma huang). These chemicals all have the effects of raising blood pressure, raising heart rate, and increasing the oxygen requirements by body organs, especially the heart.

In 2005, sudden unexpected deaths in 12 children receiving one of these drugs, Adderall, were reported to the United States Food and Drug Administration. Five of those 12 children turned out to have underlying and previously undiagnosed structural heart disease. This event, plus the report of seven additional deaths in children receiving methylphenidate, prompted the federal agency to require distribution of a parental guide to the parents of any child for whom one of these medications has been prescribed.

This guide lists certain medical conditions that disqualify a child from receiving a stimulant drug: moderate-to-high blood pressure, overactive thyroid gland, a history of drug abuse, and certain psychiatric conditions. It also recommends careful consultation with the child’s provider, if the child has known heart, liver, or kidney disease; certain other psychiatric disorders; or seizures.

For the vast majority of children, the medications are quite safe. The tragic deaths reported above were from among tens, perhaps hundreds, of thousands of children using stimulant drugs. Nevertheless, health care officials and investigators are developing techniques to screen children prior to initiating medical therapy, in hopes of identifying those who are at special risk, especially of heart disease. A major study sponsored by the food and drug administration is expected to be available later this year.

Would an electrocardiogram help to determine if a child is at risk for serious side effects from the drugs? Read Dr. Kanter's full piece in the Your Child's Health section on