Attention-Deficit Hyperactivity Disorder - Medications

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• Get a complete patient and family history.
• Conduct a physical exam to check for heart problems, including heart murmurs, high blood pressure, and signs of Marfan syndrome (a genetic disorder that affects the heart valves).
• Arrange a consultation with a pediatric cardiologist if necessary.
• Consider ordering an electrocardiogram (ECG) to check for heart abnormalities (however, the American Academy of Pediatrics does not recommend routine ECG tests before starting stimulant therapy).
• Monitor patients on stimulant drugs for emergence of cardiac symptoms.

The AHA notes that stimulant drugs remain a reasonable option for children with stable heart disease or those who are currently receiving care from a pediatric cardiologist.

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The FDA is currently conducting a large-scale study of the potential cardiovascular risks associated with stimulant medication for children, and adults. In the meantime, the FDA recommends that parents discuss any concerns about stimulant medications with their children’s’ doctors.

Stimulant drugs may also:

• Worsen behavior and thought disturbance in patients with a pre-existing psychotic disorder. These drugs may also slightly increase the risk for auditory hallucinations, paranoia, and psychotic and manic behavior even in patients who do not have a history of psychiatric problems.
• Cause a mixed or manic episode in patients who have both ADHD and bipolar disorder.
• Increase aggressive behavior or hostility. Patients beginning stimulant drug treatment should be monitored for worsening of these behaviors.
• Slow growth and weight gain in children. Children who take stimulant drugs should have their growth monitored. If they do not gain height or weight at a normal rate, they may need to stop taking the drug.

The FDA has directed manufacturers of ADHD medications to warn all patients taking these medicines of their potential cardiovascular and psychiatric risks.

Side Effects. All stimulants have a number of side effects:

• The most common side effects of any stimulant are decreased appetite, nervousness, and sleeplessness, although some parents report that stimulants improve sleep patterns in their children.
• Tics or jerky, disordered movements occur in about 9% of children.
• Other side effects include irritability, stomach pain, headache, depression, hair loss, and lack of spontaneity.