Nine-year-old Nick suffers from Attention Deficit Hyperactivity Disorder or ADHD.
"A typical sibling rivalry could turn into something totally different in my house -- to windows breaking," said Julie Boisvert, whose son has ADHD.
He takes medication, but mom Julie worries about side effects -- especially heart risks.
The FDA recommends ADHD drugs carry warnings, after a small study linked the stimulants to an increased risk of heart attack or stroke.
The American Heart Association came out with its own recommendation: it's reasonable for a child to get an electrocardiogram or EKG before starting the medications.
"I don't take lightly the recommendation of expert panels," said Dr. William DeCampli, a pediatric cardiac surgeon.
Some doctors say an EKG could catch heart problems early on. Others feel being too cautious can be too costly.
"When you start having millions of kids requiring tests that cost hundreds of dollars, that begins to add up," said Dr. Thomas Carson, a pediatric cardiologist.
Doctors say before you sign your kid up for an EKG, have the doctor do a complete family history, focusing on heart health.
Children should also have a thorough physical exam, looking for heart murmurs or high blood pressure. If no red flags pop up, an EKG may not be necessary.
"There's no reason for panic here," said Dr. DeCampli.
Nick hasn't had an EKG, but his mom is considering it, if only to provide peace of mind.
"It's a maze and you're trying to fumble your way through the maze," said Boisvert.
An EKG can cost up to $150, but Dr. DeCampli says given the new recommendations, most insurers will cover the cost.
Web Extra Information:
BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) is a condition of the brain that makes it difficult for children or adults to control their behavior. It affects about 4 to 12 percent of school-age children, according to the American Academy of Pediatrics. ADHD includes three groups of symptoms: inattention, hyperactivity and impulsivity. Symptoms of inattention include being easily distracted from work or play, trouble listening, disorganization, forgetfulness and frequently losing important things.
Symptoms of hyperactivity include being in constant motion as if "driven by a motor," inability to stay seated, talking too much and frequently squirming and fidgeting. Your child may be impulsive if he or she runs into the street without looking, frequently acts or speaks without thinking, cannot wait for things or frequently interrupts others.
Not all children exhibit all of these symptoms, and they can be classified into one of three types of ADHD. Inattentive only, previously known as ADD, includes children who exhibit symptoms of inattention. Most girls with ADHD fall into this category. Hyperactive/impulsive includes those who show hyperactive and impulsive symptoms, but can pay attention. Combined inattentive/hyperactive/impulsive is the most common type of ADHD, and includes symptoms from all three categories.
TREATMENT: The National Institute of Mental Health conducted the most intensive study of ADHD treatment to date: the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA) study. Results indicated the best courses of treatment were long-term combination treatments and medication-management alone. Researchers also found in areas like anxiety, academic performance, oppositionality, parent-child relations and social skills, the combined treatment was the most effective.
This means medication still plays an important role in most cases of ADHD, and medications have been used to treat the disorder for decades. The most effective medications of this nature are stimulants, and include drugs like Adderall, Concerta and Ritalin. These drugs, when used with medical supervision, are usually considered safe.
According to the National Institute of Mental Health, the stimulants do not make the child feel "high," although some children say they feel different. To date, there is no convincing evidence that stimulant medications used for ADHD treatment cause abuse or dependence. Most side effects of these medications are minor and related to the dosage. The most common side effects are decreased appetite, insomnia, increased anxiety and/or irritability. Some children report mild stomach aches or headaches and a few develop tics during treatment.
EKGs AND ADHD MEDICATIONS: Data from the FDA showed between 1999 and 2004, 19 children taking ADHD medications died suddenly and 26 children experienced cardiovascular events such as strokes, cardiac arrests and heart palpitations. The cardiac statistics caused concern among parents. However, the American Heart Association says side effects of stimulant medications like increased heart rate and blood pressure are insignificant for most children with ADHD.
In a statement issued in April, the American Heart Association asserted that certain heart conditions increase the risk for sudden cardiac death associated with stimulant medications, and recommended adding an electrocardiogram, or EKG, to pre-treatment evaluations for children with ADHD. EKGs pick up abnormal heart rhythms that can signify a heart condition. Although doctors usually use a physical exam and medical history to detect risks associated with taking stimulant medications, some conditions associated with sudden cardiac death may not be picked up by a routine exam. Many of these types of conditions are subtle, and if symptoms show, they can include palpitations, fainting and chest pain.