Sunday, May 11, 2008

In case you hadn't heard: From MCPAP

I was a little annoyed at the AHA the other day-  families of children with mental illness don't need more anxiety in their life, especially anxiety unwarranted by medical facts.  I was too angry to write anything about it.  Still am.  The MCPAP program sent this around.  Nice work, MCPAP.
Dear Dr. Keller,

The American Heart Association Council on Cardiovascular Disease in the Young and the Council on Cardiovascular Nursing issued a
statement which was published in the April 21, 2008 issue of the Journal of the American Heart Association’s periodical entitled Circulation. This statement recommended that children diagnosed with ADHD receive an electrocardiogram (EKG) to rule out heart abnormalities before beginning treatment with a stimulant medication. The statement recommends that children currently taking stimulant medication who did not have an EKG prior to treatment should get an EKG.

The article goes on to agree with Pediatrics conclusions that there does not seem to be compelling findings of a medication specific risk necessitating changes in our stimulant treatment of children and adolescents with ADHD.

According to the AACAP Practice Parameter on ADHD
( J.Am. Acad. Child Adolesc. Psychiatry, 46:7, July 2007) the rate of sudden death of children taking stimulant medication for ADHD does not exceed the base rate of sudden death in the general population. According to the AACAP Practice Parameter, no evidence currently indicates a need for routine cardiac evaluation (electrocardiography, echocardiography).

The American Academy of Pediatrics (AAP) recently issued a statement in response to the AHA recommendation. The response expresses concern about the feasibility of referring all patients with an ADHD diagnosis for an electrocardiogram given the limited quantity of cardiology specialists and technicians. The response also mentioned the occasional confusing results which may occur with electrocardiograms. Please visit the entry regarding the AHA recommendation
on MCPAP website to view a copy of the email alert sent to the AAP list serve.

The American Academy of Child and Adolescent Psychiatry (AACAP) is now reviewing this issue. We anticipate a recommendation from AACAP and perhaps, a joint statement from AAP and AACAP in the near future.

We hope that this information has been helpful to you, and we look forward to providing additional information on this topic as it becomes available.

Sincerely yours,

John H. Straus, MD
Vice President, Medical Affairs\

Barry Sarvet, MD
Medical Director

Joseph Gold, MD
Medical Director

Massachusetts Child Psychiatry Access Project

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