Heart Testing Before Starting Stimulant Drugs
In 2008, the American Heart Association issued a scientific statement recommending that children with ADHD should receive careful heart evaluation and monitoring, including having an electrocardiogram (ECG, also called EKG), before beginning stimulant drug therapy. The American Academy of Pediatrics issued a response, stating that routine ECG testing prior to initiating stimulant drug therapy is not necessary.
In addition to ECG, the American Heart Association recommends that doctors:
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.
Stimulant drugs for ADHD include:
St. Johnâ ' s wort Not Effective for ADHD
The herbal remedy St. Johnâ ' s wort does not work any better than placebo in improving ADHD symptoms in children and teens, according to a 2008 study in the Journal of the American Medical Association. To date, no scientific evidence has demonstrated the effectiveness of any herbal or dietary supplement in helping relieve ADHD symptoms.
Biederman J, Melmed RD, Patel A, McBurnett K, Konow J, Lyne A, et al. A randomized, double-blind, placebo-controlled study of guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder. Pediatrics. 2008 Jan;121(1):e73-84.
Braun JM, Kahn RS, Froehlich T, Auinger P, Lanphear BP. Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. children. Environ Health Perspect. 2006 Dec;114(12):1904-9.
Hamilton SS, Armando J. Oppositional defiant disorder. Am Fam Physician. 2008 Oct 1;78(7):861-6.
Heinrich H, Gevensleben H, Strehl U. Annotation: neurofeedback - train your brain to train behaviour. J Child Psychol Psychiatry. 2007 Jan;48(1):3-16.
Jensen PS, Arnold LE, Swanson JM, et al. 3-year follow-up of the NIMH MTA study. J Am Acad Child Adolesc Psychiatry. 2007 Aug;46(8):989-1002.
Millichap JG. Etiologic classification of attention-deficit/hyperactivity disorder. Pediatrics. 2008 Feb;121(2):e358-65.
Nigg JT, Breslau N. Prenatal smoking exposure, low birth weight, and disruptive behavior disorders. J Am Acad Child Adolesc Psychiatry. 2007 Mar;46(3):362-9.
Perrin JM, Friedman RA, Knilans TK; Black Box Working Group; Section on Cardiology and Cardiac Surgery. Cardiovascular monitoring and stimulant drugs for attention-deficit/hyperactivity disorder. Pediatrics. 2008 Aug;122(2):451-3.
Pliszka S; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007 Jul;46(7):894-921.
Steiner H, Remsing L; Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry. 2007 Jan;46(1):126-41.
Swanson JM, Elliott GR, Greenhill LL, et al. Effects of stimulant medication on growth rates across 3 years in the MTA follow-up. J Am Acad Child Adolesc Psychiatry. 2007 Aug;46(8):1015-27.
Valera EM, Faraone SV, Murray KE, Seidman LJ. Meta-analysis of structural imaging findings in attention-deficit/hyperactivity disorder. Psychiatry. 2007 Jun 15;61(12):1361-9. Epub 2006 Sep 1.
Vetter VL, Elia J, Erickson C, Berger S, Blum N, Uzark K, et al. Cardiovascular monitoring of children and adolescents with heart disease receiving stimulant drugs: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing. Circulation. 2008 May 6;117(18):2407-23. Epub 2008 Apr 21.
Weber W, Vander Stoep A, McCarty RL, Weiss NS, Biederman J, McClellan J. Hypericum perforatum (St John's wort) for attention-deficit/hyperactivity disorder in children and adolescents: a randomized controlled trial. JAMA. 2008 Jun 11;299(22):2633-41.
Wilens TE, Upadhyaya HP. Impact of substance use disorder on ADHD and its treatment. J Clin Psychiatry. 2007 Aug;68(8):e20.
Williams JH, Ross L. Consequences of prenatal toxin exposure for mental health in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry. 2007 Jun;16(4):243-53. Epub 2007 Jan 2.