A new study (June, 2014) finds that children without predisposing risk factors for heart disease were at increased risk for heart problems after taking typical stimulants prescribed for ADHD. The "cardiovascular events" experienced by the children were: hypertension, ischemic heart disease, pulmonary heart disease, arhythmia, cardiac arrest, and heart failure.
The study was published in the Journal of Child and Adolescent Psychopharmacology online edition of June 23, 2014. The research was funded by independent sources and conducted by researchers in Denmark, Norway, and the Child Study Center at the Yale University School of Medicine in the United States. Conducted in Denmark, the study is "the first nationwide cohort study of the cardiovascular safety of stimulants, and, to our knowledge, the longest prospective follow-up study of this." It included 700,000 children in Denmark, 8,300 of whom had been diagnosed with ADHD.
The researchers compared stimulant use and cardiovascular events in the entire population and in children with ADHD and found a small but statistically significant risk associated with treatment; they also report on the relationship between specific stimulant dose and risk of a cardiovascular event. The team concluded: "Cardiovascular events were rare, but associated with stimulant treatment, with a 1.8-fold increased risk in the total population and a 2.2-fold increased risk in children and adolescents with ADHD."
Of course, to be accepted by scientists as well as the lay public, research studies require replication—that is, another team of independent researchers finding similar results. But the international team found that their research has important implications for public health.
"If replicated in other studies, our findings may be of public health significance, especially given the increasing use of psychostimulants. Our findings may also be relevant for future revisions of the international treatment guidelines with regard to the use of high doses of methylphenidate, and regarding the recommendation of drug holidays."
Today in the United States, 3 to 4 million children take stimulant medications prescribed for their ADHD diagnoses. This means that a small percentage (about 2 percent) of these children are at risk for heart disease even if they have no previous heart problems.
Harold S. Koplewicz, MD, Editor-in-Chief of Journal of Child and Adolescent Psychopharmacology and President, Child Mind Institute, New York, NY. said in a press release: "This study confirms the small but real risk we have understood for some time through prior reports and clinical experience," says "But Dalsgaard et al.'s excellent design and the robust sample size make it abundantly clear that treating clinicians cannot ignore existing guidelines concerning the assessment of cardiac risk prior to treatment and monitoring key vital signs during the course."
In my experience working with children diagnosed with ADHD, doctors tend to extoll the virtues of stimulant drugs while downplaying the risks and side effects. They don't tend to prescribe alternative solutions because there is little solid research on non-pharmaceutical treatment of ADHD. This new study will hopefully lead to further research so that doctors as well as parents can become more aware of the serious risks of these drugs.
There are many healthful alternatives to medication for over active and inattentive children like keeping a calm home environment and monitoring of time that a child spends on electronic "screens." Enrolling a child in a sport like soccer or softball or taking the child on family hikes or bike rides on weekeends can go a long way toward channeling the child's extra energy. Diet, too, is an important factor in helping kids calm down and focus.
Update: Here is an informative article in the Copenhagen Post about the risk of heart problems in children who take ADHD medications.
Copyright © Marilyn Wedge, Ph.D.
Marilyn Wedge is the author of Pills are not for Preschoolers: A Drug-Free Approach for Troubled Kids (W. W. Norton) and a forthcoming book on ADHD in the United States and abroad.