Stimulant medications like those often prescribed for children with attention deficit hyperactivity disorder (ADHD) raise blood pressure and heart rate, and some drugs carry warning labels for patients with heart problems. Two professional organizations are at odds over whether routine electrocardiogram (ECG) testing is necessary before a child starts taking a medication for ADHD, reports the October 2008 issue of the Harvard Mental Health Letter.

The controversy is about whether routine electrocardiogram (ECG) testing is necessary before a child starts taking ADHD medication. ECG measures the electrical activity of the heart. In April 2008, the American Heart Association (AHA) released a statement recommending that it was reasonable—although not mandatory—for clinicians to consider ordering an ECG in children diagnosed with ADHD before beginning treatments with stimulants or other medications.

In August, however, the American Academy of Pediatrics (AAP) published a statement recommending against routine ECGs—supporting earlier recommendations made by the American Academy of Child and Adolescent Psychiatry—citing data that sudden cardiac deaths, while tragic, are rare. Such deaths occur in about two children for every million taking ADHD medications—fewer than the eight to 62 sudden deaths per million that occur in the general pediatric population.

The discussion about the relationship between heart risk and ADHD medication is likely to continue. For now, Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter, says the best advice is for doctors to assess heart disease risk by doing a physical exam and taking a careful medical history and to rely on a mental health professional to evaluate for ADHD.