ADHD Drugs May Increase Kids' Risk of Dying
Study Raises Questions About Stimulants and Threat of Sudden Death
The study, published online in The American Journal of Psychiatry on June 15, echoes results of previous studies suggesting a higher risk for sudden heart failure when using stimulants for ADHD. At least 2.5 million children in the United States are taking Ritalin or other stimulant drugs for attention deficit disorders. The results of this new research are likely to intensify debate on whether stimulants are safe for children.
Scientists Studied Sudden Death in Childhood
Researchers compared the deaths of 564 children and teens who died of sudden heart failure to an equal number of children who died suddenly in automobile accidents. Ten of the children who died suddenly and two of those who died in automobile accidents were taking stimulants.
By comparison, the study indicates children taking ADHD drugs have more than 7 times the risk of dying suddenly than children not taking the drugs. While the actual number of deaths were small, they indicate stimulants such as Ritalin might increase the chance of cardiac arrests in some children.
Because the number of deaths is low, and the limitations of this study, the scientists noted that firm conclusions about the dangers of ADHD drugs cannot be made from this research alone.
In response to the research published today, the FDA, who helped fund the study, advised parents not to stop medicating their children who take the drugs.
Earlier Research Also Found Increased Threat of Death
Stimulants can increase heart rate and blood pressure. The FDA issued warnings about the drugs in 2006 following other studies relating ADHD drugs to increased risks of death. In 2008, the AHA issued a statement suggesting physicians consider screening children for cardiac problems before prescribing medications for ADHD to them. The AHA recommendations included:
- Taking a thorough medical history prior to treatment, with special attention given to symptoms that might indicate heart problems, such as heart palpitations, high blood pressure, heart murmur, fainting or near-fainting episodes, chest pain, or unexplained change in exercise tolerance.
- Review of all current medications including prescription, over-the-counter preparations, and health supplements.
- Careful evaluation for a family history of sudden death, serious rhythm abnormalities, heart muscle disorders (cardiomyopathy), or Marfan's syndrome.
- A physical exam, including assessment of blood pressure and heart rhythm.
- An ECG to identify or rule out heart problems. The electrocardiogram should be read by a pediatric cardiologist or a doctor with expertise in reading pediatric ECGs.
- Referral to a pediatric cardiologist if the pretreatment evaluation shows cause for concern. (Source: WebMD)
Questions About the Need and Safety of ADHD Drugs
William Pelham Jr., PhD, is the director of the Center for Children and Families at the State University of New York at Buffalo and a prominent researcher in the field of behavioral therapy for ADHD. A MedPage Today report on the study quotes Pelham, who says the study will confirm, "from a risk-benefit perspective, there is no justification for using stimulants as a first-line treatment [for ADHD]."
While ADHD drugs might have short-term benefits for a small number of children, Pelham said their only long term effects and risks include, "growth suppression, sudden death, and substance abuse." Other therapies for attention problems are available and behavior therapies have proven to be as effective as drugs for these disorders.
Scientists are calling for further studies to evaluate the risk of sudden death from stimulants. Ultimately, deciding whether or not the risks of giving kids stimulants outweigh the benefits is in the hands of their parents.
Sources:
Boyles, Salyan; ADHD Drugs: Heart Screen Recommended; WebMD Health News; Apr 21, 2008
CBS News; Are ADHD Medications Safe for Our Children?; Early Show, Health; June 15, 2009
Moses Alan, Cardiac Screening Recommended for Kids Taking Stimulants; US News & World Report; Healthday, 080421, Apr 21, 2008
Neale, Todd; Use of Stimulants is Associated With an Increased Risk of Sudden Unexplained Death Among Children and Teens, A Case-Controlled Study Showed; MedPage Today; June 15, 2009
Resources:
Dr. Greene: ADHD and the Heart
NIMH · Questions Raised About Stimulants and Sudden Death
Related article:
Drugs are Still Not the Answer for ADHD
Stimulants May Cause Heart-Related Deaths in Kids
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