CHICAGO — The nation's largest pediatricians' group says most children getting attention-deficit drugs don't need heart screening with electrocardiogram tests, challenging advice from a leading heart doctors' association.
The new policy from the American Academy of Pediatrics renews a debate over the safety of the powerful stimulants. More than half of the 4 million U.S. children diagnosed with attention-deficit disorders are being treated with stimulant drugs.
As Seattle heart specialist Peter Hesslein put it, the dispute among influential doctors "is more than a tempest in a teapot."
ADHD drugs like Ritalin, Adderall and Concerta can help children focus more, behave less impulsively and perform better in school. But they also can increase blood pressure and heart rate, and they carry warnings about risks for sudden deaths in patients with heart problems.
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The pediatricians' group says advice earlier this year from the American Heart Association recommending EKGs was overzealous because these 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 U.S. children on stimulants each year, versus between 8 and 62 such deaths yearly among all U.S. children.
The heart doctors' advice 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 pediatricians' policy.
The academy says children starting stimulants should get a careful physical exam and be checked for family history of heart problems including sudden death, but that routine EKGs aren't needed in most cases.
When the heart association's policy was announced in April, its advice was widely construed as a mandate.
Because of the confusion and criticism, the heart association clarified its stance in May, issuing a little-publicized statement that said physicians should use their own judgment about the screening and that ADHD treatment should not be withheld if an EKG isn't done.
The pediatricians' academy joined in that statement, but decided that a more forceful stance against routine EKGs made more sense. With little fanfare, their new policy was posted online later that month; it's now being published in the August edition of the academy's medical journal, Pediatrics.
On the Net
• American Academy of Pediatrics: www.aap.org
• American Heart Association: www.heart.org
