In short, we don’t know.
Yesterday, a study was released online in the American Journal of Psychiatry which demonstrated an association between stimulant medications used to treat ADHD, and sudden death in kids. The headlines generated by the release of this study are downright scary, but as parents, the question is, how worried do we need to be?
First of all, lets look at what the study did, and what it actually found. Researchers performed something called a case-control study, meaning that they found cases where healthy kids between the ages 7-19 suffered sudden deaths, and compared them to a control group of kids in the same age range who had been killed in auto accidents during the same time period. Then, they looked at medical examiner records, toxicology findings and/or death certificates to determine if these subjects had taken stimulant medications immediately prior to death.
The study included 564 children who had died sudden deaths, and 564 controls. Researchers found that 10 of the kids in the sudden death group had been taking stimulant medication, as compared to two kids in the control group.
The FDA has issued a statement saying that:
Given the limitations of this study’s methodology, the FDA is unable to conclude that these data affect the overall risk and benefit profile of stimulant medications used to treat ADHD in children.
What this means, is that while more data analysis will be done, there are specific weaknesses in the study that need to be addressed. For instance, medication use was determined by looking at medical records related to the deaths. Children who died sudden, unexplained deaths may have been more likely to have thorough investigations into cause of death than the children who were killed in auto accidents. Because of this, more information may have been collected about their medication use. Also, the fact that the deaths were sudden and were not caused by trauma may have impacted the degree to which parents remembered and reported medication use after death.
Since the overall rate of stimulant use in each group was so small, relatively minor errors in the recording of medication use could have a major impact on study results.
At this point, you’re probably wondering what in the world you’re supposed to do with this information. So far, the FDA is recommending that parents not not stop stimulant medications without talking with their child’s doctor about their specific case. This conversation should probably include the overall risks and benefits of ADHD medication, and any specific risk factors for heart disease that your child may have. Of course, if you’re child experiences any chest pain, shortness of breath or fainting while taking a stimulant medication, they should be seen by a doctor immediately.
The FDA recommends that doctors prescribing stimulant medications for ADHD should get a detailed history about their patient’s personal and family history of cardiovascular disease, and do a detailed physical exam, focusing on the cardiovascular system. If there is any concern about heart disease risk, an echocardiogram or elctrocardiogram should be considered for screening purposes.
Reference: Gould, Madelyn S., Walsh, B. Timothy, Munfakh, Jimmie Lou, Kleinman, Marjorie, Duan, Naihua, Olfson, Mark, Greenhill, Laurence, Cooper, Thomas. Sudden Death and Use of Stimulant Medications in Youths. Am J Psychiatry, Published online 15 June 2009. doi:10.1176/appi.ajp.2009.09040472
