The American Academy of Pediatrics and the American Heart Association have issued a joint statement clarifying recent recommendations made by the AHA on evaluating and treating children and adolescents with attention-deficit/hyperactivity disorder.
The original AHA recommendations suggested that a child's risk for adverse cardiac outcomes be evaluated before initiating pharmacologic treatment of ADHD (“Screen ADHD Patients First, Heart Group Says,” CLINICAL PSYCHIATRY NEWS, May 2008, p. 17).
However, the joint statement, issued May 16, clarifies that treatment of a pediatric patient with ADHD should not be withheld because an electrocardiogram has not been done. The statement also says that certain heart conditions in children may be difficult, or in some cases impossible, to detect. So “the AAP and AHA feel that it is prudent to carefully assess children for heart conditions who need to receive treatment with drugs for ADHD,” according to the statement.
In a separate policy statement, the AAP said on May 28 that it does not recommend screening ECGs “unless the patient's history, family history, or the physical examination raises concerns.”
Both statements came in the wake of huge public reaction to the AHA's original recommendations.
The AHA statement, “made it seem to the public as if the policy had changed, when in fact it had not,” Dr. Richard Friedman, coauthor of the 11-page AAP policy statement, said in an interview. “It was so highly publicized–that was the problem. It was on “The Today Show” and in the Wall Street Journal and the New York Times. People the next day were calling for appointments and saying 'My kid is on this medication and never had an ECG.'”
Dr. Friedman said the AAP thought it needed to respond quickly, given the huge response.
“The AHA statement created a tremendous amount of anxiety for parents and for physicians considering or ordering ADHD medications,” said Dr. Friedman, professor of pediatrics, Texas Children's Hospital, Houston.
Dr. Timothy K. Knilans, also a coauthor of the AAP statement, said the AHA's recommendations were surprising “given the absence of any new scientific information.”
ADHD, which is common in the congenital heart disease population, “is severely undertreated, as cardiologists aren't fully aware of the problem and pediatricians are afraid to use the drugs in this population. This is the problem that the AHA group should have focused on–not screening for all kids,” said Dr. Knilans, director, clinical cardiac electrophysiology and pacing, Cincinnati Children's Hospital Medical Center.
On the same day the joint statement was released, the AHA released an erratum to its scientific statement, Dr. Rose Marie Robertson, chief science officer of the AHA, Dallas, said in an interview.
The erratum lists 19 corrections. For example, the original news release stated that children diagnosed with ADHD “should” have an ECG before beginning treatment with stimulant drugs.
“The recommendation in the scientific statement was intended to indicate that it is reasonable for a physician to consider ordering an ECG in children with ADHD if they feel it is warranted,” Dr. Robertson said.
The American Academy of Child and Adolescent Psychiatry; the American College of Cardiology; Children and Adults with Attention-Deficit/Hyperactivity Disorder; the National Initiative for Children's Healthcare Quality; and the Society for Developmental and Behavioral Pediatrics also endorsed the clarification.
“In practical terms, there is no change in policy for getting ECGs for patients,” Dr. Friedman said.
The documents cited in this article are available online at www.aap.org/new/ecg-adhd.htm