It is difficult when experts seem to disagree on how to manage a child health problem. Early May, 2008,the American Heart Associationn(AHA) came out with a statement advising EKGs in kids about to start stimulant medication for ADHD. While this recommendation was the result of careful and thoughtful analysis of the data at hand, it was counter to current recommendations by the American Academy of Pediatrics (AAP) and American Association of Child and Adolescent Psychiatry. To help clear the waters, all the groups have come together again and made recommendations that make more sense. In fact, shortly after the initial May 6, 2008 AHA statement, a new statement was released by the AHA and AAP that was softer and more consistent with past recommendations to not screen all kids.
There are many issues to consider and it is a bit confusing:
1. There are no studies that actually support the original recommendations by the AHA.
2. The AAP has always advocated a thoughtful approach to heart screening that takes into account family history, review of the patient’s symptoms and physical exam.
3. Widespread screening is costly to all of us in the end and will yield few positive results. It is truly searching for a needle in a haystack.
4. Screening of any kind does place unnecessary anxiety on the majority of families who do not need to go through the procedure with their child and waiting game for the results.
So, how does the this particular screening work? Simple. If a patient has known heart disease, this discussion is moot. Those patients need to get annual screening and their cardiologists will help guide the right tests and the schedule for those tests. The cardiologists will often work with the pediatricians to help arrange these tests in the community near home.
For kids who have no known heart disease, which are the majority of kids being considered for ADHD medication or are already on ADHD medication, a good evaluation of family history, the patient’s history and physical exam are all that is needed. If during any of those evaluations suspicion is raised for heart disease, the option for screening becomes more important and will be discussed based on what information turns up. This isn't a one test fits all. It is a test if needed sort of thing.
So, whenever you are faced with a situation of “to screen or not to screen" with any test, the answer always lies somewhere with the patient and the family. Tests don’t help unless there is a reason for them to help.
If you want to fall back on an “official” statement for the question of "should kids on ADHD medications get EKGs?", fall back on this one:
“Medications that treat ADHD have not been shown to cause heart conditions nor have they been demonstrated to cause sudden cardiac death.”
