Treatment of attention deficit/hyperactivity disorder in children with CHD

Abstract

Introduction: The prevalence of attention deficit/hyperactivity disorder in the general population is common and is now diagnosed in 4%–12% of children. Children with CHD have been shown to be at increased risk for attention deficit/hyperactivity disorder. Case reports have led to concern regarding the use of attention deficit/hyperactivity disorder medications in children with underlying CHD. We hypothesised that medical therapy for patients with CHD and attention deficit/hyperactivity disorder is safe. Methods: A single-centre, retrospective chart review was performed evaluating for adverse events in patients aged 4–21 years with CHD who received attention deficit/hyperactivity disorder therapy over a 5-year span. Inclusion criteria were a diagnosis of CHD and concomitant medical therapy with amphetamines, methylphenidate, or atomoxetine. Patients with trivial or spontaneously resolved CHD were excluded from analysis. Results: In 831 patients with CHD who received stimulants with a mean age of 12.9 years, there was only one adverse cardiovascular event identified. Using sensitivity analysis, our median follow-up time was 686 days and a prevalence rate of 0.21% of adverse events. This episode consisted of increased frequency of supraventricular tachycardia in a patient who had this condition prior to initiation of medical therapy; the condition improved with discontinuation of attention deficit/hyperactivity disorder therapy. Conclusion: The incidence of significant adverse cardiovascular events in our population was similar to the prevalence of supraventricular tachycardia in the general population. Our single-centre experience demonstrated no increased risk in adverse events related to medical therapy for children with attention deficit/hyperactivity disorder and underlying CHD. Further population-based studies are indicated to validate these findings.

Safety of stimulant medications for attention deficit hyperactivity disorder in paediatric congenital heart disease

“…The retrospective cohort study by Pierick et al 3 . is the largest and most recent study, which looked at adverse cardiovascular events in CHD patients on stimulant medications.…”

“…1 However, there have been concerns of sudden death with stimulant use based on the 2006 FDA black box warning after 11 sudden deaths were reported in paediatric patients taking methylphenidate from 1992 to 2005. 9,17 Despite the cardiovascular adverse events, 3,5,6,8,11,12 stimulant medications remain the major measure to improve ADHD symptoms thereby improving quality of life. 2,16 A literature search was performed to investigate the safety of stimulant medications in paediatric patients with CHD.…”

“…The retrospective cohort study by Pierick et al 3 is the largest and most recent study, which looked at adverse cardiovascular events in CHD patients on stimulant medications. The study found that one patient (prevalence rate 0.12%) with a preexisting supraventricular tachycardia experienced worsening symptoms while on stimulant therapy.…”

“…The above studies [2][3][4][5][6] were all from cardiac specialist centres which included input from a cardiologist for commencement of stimulant medication.…”

Altered resting state functional connectivity in youth with congenital heart disease operated during infancy

“…Thus, greater activity within the DMN when individuals are at rest is thought to be reflective of difficulties in switching from internal to external thoughts [58]. In participants with CHD, this may reflect their cognitive and attentional dysfunction in daily life [59][60][61], as they may experience difficulties switching from internal to external stimulation. However, considering that we have not evaluated attention and hyperactivity, this hypothesis remains speculative.…”