Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-23T04:38:33.488Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment of attention deficit/hyperactivity disorder in children with CHD

Published online by Cambridge University Press:  01 February 2021

Alyson R. Pierick Open the ORCID record for Alyson R. Pierick [Opens in a new window] ,
Melodie Lynn ,
Courtney M. McCracken ,
Matthew E. Oster  and
Glen J. Iannucci
Alyson R. Pierick*
Affiliation:
Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Melodie Lynn
Affiliation:
Division of Pediatric Cardiology Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Courtney M. McCracken
Affiliation:
Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Matthew E. Oster
Affiliation:
Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Glen J. Iannucci
Affiliation:
Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, USA
*
Author for correspondence: Dr A. R. Pierick, MD, Emory University School of Medicine, Department of Pediatrics, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303, USA. Tel: +1 (319)541-8325; Fax: 770-488-9477. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Attention deficit/hyperactivity disorderCHDstimulantsarrhythmias
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 6 , June 2021 , pp. 969 - 972
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Batra, AS, Alexander, ME, Silka, MJ. Attention-deficit/hyperactivity disorder, stimulant therapy, and the patient with congenital heart disease: evidence and reason. Pediatr Cardiol 2012; 33: 394–401.CrossRefGoogle ScholarPubMed
Razzaghi, H, Oster, M, Reefhuis, J. Long-term outcomes in children with congenital heart disease: national Health Interview Survey. J Pediatr 2015; 166: 119–124.CrossRefGoogle ScholarPubMed
Yamada, DC, Porter, AA, Conway, JL, et al. Early repair of congenital heart disease associated with increased rate of attention deficit hyperactivity disorder symptoms. Can J Cardiol 2013; 29: 1623–1628.CrossRefGoogle ScholarPubMed
Shillingford, AJ, Glanzman, MM, Ittenbach, RF, Clancy, RR, Gaynor, JW, Wernovsky, G. Inattention, hyperactivity, and school performance in a population of school-age children with complex congenital heart disease. Pediatrics 2008; 121: e759–e767.CrossRefGoogle Scholar
Mahle, WT, Clancy, RR, Moss, EM, Gerdes, M, Jobes, DR, Wernovsky, G. Neurodevelopmental outcome and lifestyle assessment in school-aged and adolescent children with hypoplastic left heart syndrome. Pediatrics 2000; 105: 1082–1089.CrossRefGoogle ScholarPubMed
DeMaso, DR, Calderon, J, Taylor, GA, et al. Psychiatric disorders in adolescents with single ventricle congenital heart disease. Pediatrics 2017; 139: e20162241.CrossRefGoogle ScholarPubMed
Kirshbom, PM, Flynn, TB, Clancy, RR, et al. Late neurodevelopmental outcome after repair of total anomalous pulmonary venous connection. J Thorac Cardiovasc Surg 2005; 129: 1091–1097.CrossRefGoogle ScholarPubMed
Holland, JE, Cassidy, AR, Stopp, C, et al. Psychiatric disorders and function in adolescents with tetralogy of Fallot. J Pediatr 2017; 187: 165–173.CrossRefGoogle ScholarPubMed
Hovels-Gurich, HH, Konrad, K, Skorzenski, D, Herpertz-Dahlmann, B, Messmer, BJ, Seghaye, MC. Attentional dysfunction in children after corrective cardiac surgery in infancy. Ann Thorac Surg 2007; 83: 1425–1430.CrossRefGoogle ScholarPubMed
Cooper, WO, Habel, LA, Sox, CM, et al. ADHD drugs and serious cardiovascular events in children and young adults. N Engl J Med 2011; 365: 1896–1904.CrossRefGoogle ScholarPubMed
Vetter, VL, Elia, J, Erickson, C, et al. Cardiovascular monitoring of children and adolescents with heart disease receiving medications for attention deficit/hyperactivity disorder [corrected]: 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 2008; 117: 2407–2423.CrossRefGoogle Scholar
Winterstein, AG, Gerhard, T, Kubilis, P, et al. Cardiovascular safety of central nervous system stimulants in children and adolescents: population based cohort study. BMJ 2012; 345: e4627.CrossRefGoogle ScholarPubMed
Berger, S. Attention deficit hyperactivity disorder medications in children with heart disease. Curr Opin Pediatr 2016; 28: 607–612.CrossRefGoogle ScholarPubMed
Findling, RL, Short, EJ, Manos, MJ. Short-term cardiovascular effects of methylphenidate and adderall. J Am Acad Child Adolesc Psychiatry 2001; 40: 525–529.CrossRefGoogle ScholarPubMed
Torres-Acosta, N, O’Keefe, JH, O’Keefe, CL, Lavie, CJ. Cardiovascular effects of ADHD therapies: JACC review topic of the week. J Am Coll Cardiol 2020; 76: 858–866.CrossRefGoogle Scholar
FDA Drug Safety Communication. Safety Review Update of Medications used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in adults, 2011. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-safety-review-update-medications-used-treat-attention-0#SAhttp://www.fda.Google Scholar
Orejarena, LA, Vidaillet, H, Jr., DeStefano, F, et al. Paroxysmal supraventricular tachycardia in the general population. J Am Coll Cardiol 1998; 31: 150–157.CrossRefGoogle ScholarPubMed
Barkley, RA. International consensus statement on ADHD. J Am Acad Child Adolesc Psychiatry 2002; 41: 1389.CrossRefGoogle ScholarPubMed
Marino, BS, Lipkin, PH, Newburger, JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation 2012; 126: 1143–1172.CrossRefGoogle ScholarPubMed
Posner, J, Polanczyk, GV, Sonuga-Barke, E. Attention-deficit hyperactivity disorder. Lancet 2020; 395: 450–462.CrossRefGoogle ScholarPubMed
Tripathi, A, Black, GB, Park, YM, Jerrell, JM. Factors associated with the occurrence and treatment of supraventricular tachycardia in a pediatric congenital heart disease cohort. Pediatr Cardiol 2014; 35: 368–373.CrossRefGoogle Scholar