MedWire News: Children with attention deficit hyperactivity disorder should undergo heart tests to identify any heart problems before they receive treatment with stimulant drugs, say experts.

Studies have shown that stimulant medications, such as those used to treat children with attention deficit hyperactivity disorder, can increase heart rates and blood pressure levels, explain Dr Victoria Vetter, from the University of Pennsylvania in Philadelphia, USA, and colleagues.

They add that although these side effects are insignificant for most children with attention deficit hyperactivity disorder, they may cause significant health problems, or even sudden death, among children with certain heart conditions. However, doctors are not currently required to test children for heart problems before they prescribe stimulant drugs for the behavioural disorder.

The expert American Heart Association panel therefore recommends that all children with attention deficit hyperactivity disorder undergo electrocardiogram tests before they are prescribed stimulants. An electrocardiogram evaluation measures the heart's electrical activity and can often identify hidden heart rhythm problems.

After stimulant treatment starts, children should undergo regular heart checks and blood pressure tests within the first 3 months, and every 6 to 12 months thereafter.

"Children can have undiagnosed heart conditions without showing symptoms. Furthermore, a child's body changes constantly, with some conditions not appearing until adolescence," explained Dr Vetter.

The panel also recommends heart and blood pressure tests for children and adolescents who are already taking stimulant medications, particularly if they were not evaluated when they started the treatment.

However, the experts stress that their recommendations are not meant to pose a barrier to effective immediate treatment of children with attention deficit hyperactivity disorder.

"While we feel that an electrocardiogram is reasonable and helpful as a tool to identify children with cardiac conditions that can lead to sudden cardiac death, if, in the view of their physician, a child requires immediate treatment with stimulant medications, this recommendation is not meant to keep them from getting that treatment," said Dr Vetter.

She added that some children with the behavioural disorder may not have access to a specialist who can perform electrocardiogram evaluations.

The panel concludes: "Our intention is to provide the physician with some tools to help identify heart conditions in children with attention deficit hyperactivity disorder, and help them make decisions about the use of stimulant medications and the follow-up of children who take them.

"The goal is to allow treatment of attention deficit hyperactivity disorder, while attempting to lower the cardiac risk of these products in susceptible children."

The recommendations are made in the current issue of the journal Circulation.