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Cardiovascular Perspectives

Reexamining the Emperor’s New Clothes

Ambiguities in Current Cardiac Screening Recommendations for Youth With Attention Deficit Hyperactivity Disorder

Laurel K. Leslie, MD, MPH; Mark E. Alexander, MD; Thomas A. Trikalinos, MD; Joshua T. Cohen, PhD; Susan K. Parsons, MD, MRP and Jane W. Newburger, MD, MPH

From the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center (L.K.L., S.K.P., T.A.T., J.T.C.), and Departments of Medicine (L.K.L, S.K.P., T.A.T., J.T.C.) and Pediatrics (L.K.L., S.K.P.), Tufts University School of Medicine, Boston, Mass; Department of Cardiology (M.E.A., J.W.N.), Children’s Hospital Boston, Boston, Mass; and Department of Pediatrics (M.E.A., J.W.N.), Harvard Medical School, Boston, Mass.

Correspondence to Laurel K. Leslie, MD, MPH, Center on Child and Family Outcomes, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Tufts-MC #345, Boston, MA 02111. E-mail lleslie@tuftsmedicalcenter.org

Key Words: screening • ADHD • sudden cardiac death • electrocardiogram • pediatrics

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
On April 21, 2008, the American Heart Association (AHA) released a policy statement that was widely interpreted as recommending routine ECGs as part of the evaluation of children for whom stimulant medications were being considered for treatment of attention deficit hyperactivity disorder (ADHD).¹ The rationale was to improve the identification of rare but clinically important cardiac conditions that might predispose children and adolescents with ADHD who are taking stimulant medications to sudden cardiac death (SCD). This recommendation contradicted existing ADHD treatment guidelines published by the American Academy of Pediatrics (AAP)^2,3 and the American Academy of Child and Adolescent Psychiatry,^4,5 as well as the conclusions of the Food and Drug Administration’s Pediatric Advisory Committee,⁶ none of which had recommended routine ECGs before instituting stimulant medication treatment. On May 16, 2008, the AHA and AAP, cosponsored by the American Academy of Child and Adolescent Psychiatry, jointly issued a news release clarifying that obtaining an ECG before starting medication was "reasonable" but not mandatory.⁷ An erratum to the AHA’s statement was next published, downgrading the classification and level of evidence regarding the cardiac effects of medications used to treat ADHD.¹ On May 28, 2008, the AAP published its own policy statement contending that medications used to treat ADHD have not been shown to cause SCD, sufficient evidence for routine ECG before starting stimulant medications is not available, and that "until these questions are answered, a recommendation to obtain routine ECGs for children receiving ADHD medications is not warranted."⁸

These conflicting statements and their . . . [Full Text of this Article]