Attention Deficit Disorder (ADD): No Heart for the Meds?

The American Heart Association wants doctors to do an electrocardiogram (EKG) — a measure of heart health — in order to determine whether a child is fit to take stimulant medication for attention deficit disorder (ADD). The AHA recently published this statement online. It says there are conditions that a typical physical exam might not pick up, but that would contraindicate the use of these medications.

There isn’t any proof that stimulant medications have caused heart attacks or stroke, but the AHA wants physicians to evaluate for heart disease. There is the theoretical possibility that structural heart conditions that normally would go undetected, could cause a vulnerability to stimulants. If a structural problem shows up, the child may still be able to take the medications, but would require monitoring.

Some of you are wondering why anyone in their right mind would consider medications when this kind of concern exists. Even if you are well-informed, and not affected by alarmists who compare stimulants to cocaine and meth, you might wonder. For many parents and mental health workers, the answer lies in the problems that children with ADD have that can profoundly affect their development. But, you might argue, look at the successful people who also happen to have ADD. Alas, comes the response, those examples don’t erase what we detect in research. There is even some evidence that children with ADD who received stimulant medication have been less likely to abuse drugs later in life. Presumably, this is because they have had richer developmental experiences and feel less marginalized.

So am I an apologist for Big Pharma? No; I understand that it is a difficult decision in an unpredictable world. But I also know that in speaking with scores of people with ADD over about two years, many have said that they were quite thankful that their parents put them on meds. Many who were not on meds as children said they wished they had been, because they were aware of the connection between their difficulties and the academic, employment, or social problems that they had, or were having.

To really understand this issue, one must delve into a number of topics, such as the kinds of adaptations that work for people with ADD, the similarities between ADD and other conditions, such as deafness, that create a sense of community, the state of research and enlightened opinion on various treatments and supplements for ADD, and issues of identity. Among the most important is the nature of developmental windows, and what is lost when they are not navigated successfully.

Reference

Vetter, V.L., Elia, J., Erickson, C., Berger, S., Blum, N., Uzark, K., Webb, C.L. (2008). 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, 117(18), 2407-2423. DOI: 10.1161/CIRCULATIONAHA.107.189473

Further Reading

Best Supplements for ADD are described at ADD Supplements vs. Medication, a page I maintain, based on what people tell me.