AAP does not support routine ECG screening in children before ADHD therapy

August 8, 2008

The American Academy of Pediatrics (AAP) has stated it does not support the routine use of electrocardiogram (ECG) screening before initiating treatment with stimulants for children and adolescents with attention deficit hyperactivity disorder (ADHD).

The American Academy of Pediatrics (AAP) has stated it does not support the routine use of electrocardiogram (ECG) screening before initiating treatment with stimulants for children and adolescents with attention deficit hyperactivity disorder (ADHD).

The policy statement, published in the August Pediatrics, contrasts with a recent statement made by the American Heart Association (AHA) that stated, "It is reasonable to consider adding an ECG ... to the history and physical examination in the cardiovascular evaluation of children who need to receive treatment with drugs for ADHD."1

The AAP statement argues that sudden cardiac death (SCD) in persons taking medications for ADHD is rare and occurs just as frequently in the general population of children and adolescents. In addition, the statement points out the lack of evidence supporting the routine use of ECG screening to prevent sudden death in patients before taking ADHD medications.

However, the AAP statement notes, "The AHA statement pointed out the importance of detecting silent but clinically important cardiac conditions in children and adolescents, which is a goal that the AAP shares. The primary purpose of the AHA statement is to prevent cases of SCD that may be related to stimulant medications."2

The AAP's statement is endorsed by the American Academy of Child and Adolescent Psychiatry, the Society for Developmental and Behavioral Pediatrics, the National Initiative for Children's Healthcare Quality, the National Association of Pediatric Nurse Practitioners, and Children and Adults with Attention Deficit/Hyperactivity Disorder.

References
1.Vetter VL, Elia J, Erickson C, et al: Cardiovascular monitoring of children and adolescents with heart disease receiving stimulant drugs. Circulation 2008;117:2407
2. Perrin JM, Friedman RA, Knilans TK, et al: Cardiovascular monitoring and stimulant drugs for attention-deficit/hyperactivity disorder. Pediatrics 2008;122:451