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:

• Obtain a complete patient and family history
• Conduct a physical exam to check for heart problems, including heart murmurs and high blood pressure
• Arrange a consultation with a pediatric cardiologist if necessary
• Consider ordering an electrocardiogram (ECG) to check for heart abnormalities (in contrast, the American Academy of Pediatrics does not recommend routine use of ECGs before starting stimulant therapy)
• Monitor patients on stimulant drugs for emergence of cardiac symptoms

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:

• Methylphenidate (Ritalin, Concerta, Metadate, Daytrana)
• Dexmethylphenidate (Focalin)
• Amphetamine-Dextroamphetamine (Adderall)
• Dextroamphetamine (Dexedrine, Dextrostat)
• Lisdexamfetamine (Vyvanse)

St. John's wort Not Effective for ADHD

The herbal remedy St. John'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.