NEW YORK – Before starting a child on stimulants to treat attention-deficit/hyperactivity disorder, consider asking some extra questions to confirm the diagnosis and family history, Dr. Laurence L. Greenhill said at a psychopharmacology update sponsored by the American Academy of Child and Adolescent Psychiatry.
Dr. Greenhill, director of child and adolescent psychiatry at the New York State Psychiatric Institute at Columbia University, New York, presented a 10-item checklist for physicians to use as a guide before initiating stimulant therapy in children and adolescents:
▸ Is the diagnosis of ADHD accurate?
▸ Is there a history of simple tics, chronic motor tics, or Tourette syndrome? This is important to document but doesn't necessarily change the course of treatment, he said.
▸ Does the patient have comorbidities?
▸ Does the child have a history of cardiovascular problems? In May 2006, the Food and Drug Administration directed manufacturers of ADHD medications to revise their labeling to reflect concerns about adverse cardiovascular events. Since the FDA began its deliberations on this issue, there has been growing public awareness about the possible risk of cardiovascular complications, Dr. Greenhill said.
▸ Is there a family history of sudden death when young, stroke under age 40 years, or malignant hypertension? Also, does the child have a history of seeing a cardiologist or having chest pain with shortness of breath? All of these questions can serve as screening questions and should be documented in the chart, Dr. Greenhill said. “If they're all negative, most cardiologists I know don't want to see [these patients] for referrals,” he said.
▸ Is there substance abuse at home?
▸ Has there been a normal physical exam by a pediatrician in the past year?
▸ Is there a record of baseline height, weight, pulse, and blood pressure?
▸ What are the specific targets of treatment?
▸ Is the quantified ADHD severity moderate to severe?
Dr. Greenhill disclosed financial relationships with Best Practice LLC, Sepracor Inc., Eli Lilly & Co., Pfizer Inc., Johnson & Johnson, Otsuka America Inc., and McNeil Pediatrics, a division of McNeil-PPC Inc.