Study: Children with ADHD and congenital heart disease can take stimulants

According to a recent study, it is safe for children with both ADHD and congenital heart disease to take stimulant medication.

A new study finds that children with congenital heart disease and ADHD can take stimulant medications without fear of significant cardiovascular side effects.

In a study to be presented at a national meeting Oct. 4, researchers at Cincinnati Children's Hospital Medical Center have found no increased risk for death or changes in cardiac vital signs, such as blood pressure or heart rate, even for children with ADHD and severe heart conditions. They also found that when treated with stimulant medications, patients had significant improvements in ADHD symptoms as measured by standardized rating scales.

"Children with congenital heart disease are at high risk for ADHD, but fears about cardiovascular side effects, including sudden death, limit the use of stimulant medications," says Julia Anixt, MD, a developmental and behavioral pediatrician at Cincinnati Children's and senior author of the study. "This study indicates that stimulants are both effective and safe when prescribed with appropriate monitoring and in collaboration with the patient's cardiologist."

The study will be presented by Pon Trairatvorakul, MD, a fellow in the division of Developmental and Behavioral Pediatrics at Cincinnati Children's, at the annual meeting of the Society for Developmental and Behavioral Pediatrics in Las Vegas.

The researchers studied 44 children between the ages of 6 and 18 seen in the Cincinnati Children's Heart Institute Kindervelt Neurodevelopmental and Educational Clinic. They compared these patients to those with similar heart disease but who were not treated with stimulants. The researchers' next step is to study the effect of stimulant medications on electrocardiograms (EKGs), which measure electrical activity of the heart.

Since 2006, the U.S. Food and Drug Administration has required labeling of stimulant medications to include a warning that they generally should not be used in children and adolescents with serious structural cardiac abnormalities, cardiomyopathy or arrhythmias. However, stimulants are the most effective medication to treat ADHD symptoms, and patient families, cardiologists, and developmental pediatricians must together weigh the risks and benefits of medication treatment options for each individual patient, according to Dr. Anixt.

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ADHD stimulants often abused by college students

This article discusses how stimulant use for ADHD is often abused by college students.

Nearly one in every five college students abuses prescription stimulants, according to a new survey sponsored by the Partnership for Drug-Free Kids. The survey also found that one in seven non-students of similar age also report abusing stimulant medications.

Young adults aged 18 to 25 report using the drugs to help them stay awake, study or improve their work or school performance. The most commonly abused stimulants are those typically prescribed for attention-deficit/hyperactivity disorder (ADHD), such as Adderall,Ritalin and Vyvanse, the survey found.

"The findings shed a new and surprising light on the young adult who is abusing prescription stimulants," said Sean Clarkin, director of strategy and program management for the Partnership for Drug-Free Kids. "While there is some 'recreational' abuse, the typical misuser is a male college student whose grade point average is only slightly lower than that of non-abusers, but who is juggling a very busy schedule that includes academics, work and an active social life."

Clarkin said the findings point to the need for parents and educators to increase their efforts to help young people develop effective time-management skills to balance academics, work and social activities.

"The profile that emerges is less that of an academic 'goof-off' who abuses prescription stimulants to make up for lost study time than a stressed out multitasker who is burning the candle at both ends and trying to keep up," Clarkin said.

The nationally representative study, conducted by independent researcher Whitman Insight Strategies, surveyed more than 1,600 young adults online this past summer, including approximately 1,000 college students.

Half of the students reported they took stimulant drugs to study or improve their academic performance, the survey noted. And, the survey found that two-thirds of those students believed the drugs helped them get a better grade or be more competitive at school or work. Around 40 percent took the drugs to stay awake. About a quarter of abusers said they took the stimulants to improve their work performance, according to the study.

These are the same reasons former user Linda Stafford said she began using the drugs.

Stafford began taking Adderall and Vyvanse without any prescriptions while she was a college student in Statesboro, Ga.

"I wanted to go to school, work and party, and Adderall helped me to focus pretty well at first," Stafford said. In reality, however, she said taking the stimulant did not change her test grades much. "Then," she said, "I got hooked."

Stafford began experiencing depression, paranoia and social anxiety and became unable to communicate even with her closest loved ones, she said.

"I was totally incapable of handling life," Stafford said. "I could not manage a simple job, my class assignments or relationships. Adderall was the center of my life."

Stafford has since been through recovery and uses a support network and support groups to manage, but her story is one that Miami University staff psychiatrist Dr. Josh Hersh has heard often.

"These survey findings have confirmed a lot of the things I have seen clinically," Hersh said. "Young adults are mainly using prescription stimulants to improve academic and work performance and to stay awake."

Although Hersh said some of the students taking these drugs may feel the invulnerability of youth, others are simply desperate to juggle everything even while they know the possible risks of taking the drugs, such as anxiety or panic attacks even with occasional use.

"The fact that students often use these drugs around deadlines, when their natural adrenaline is already high, elevates the risk even more," Hersh said. "Sporadic use can lead to severe sleep deprivation and cause stimulant-induced psychosis, when a student gets paranoid and may hallucinate."

He said snorting the pills can lead to internal nasal damage and regular use can lead to addictions that are destructive and difficult to treat.

Even young adults who are legally prescribed stimulants for specific health conditions can risk becoming more addicted, as happened to the son of Kathleen Dobbs, a retiree who co-founded the grass roots coalition Parent to Parent, Inc.

Her son was diagnosed with ADHD at age 8 and began taking Ritalin at age 10, but by high school doctors switched him to various other drugs before Dobbs requested no more prescriptions. By then, however, he was seeking out Ritalin from classmates and then moved on to cocaine to "feel normal," Dobbs said.

"Children with ADHD will do anything to fit in, to be able to learn and be like other kids," said Dobbs, adding that the addiction tore their family apart. "When you have a child who is addicted, it is like a bomb goes off in your home and everyone scatters. I prayed and did all the right things, but it creeps into your life and destroys your entire family and leaves you with pain and loss."

Her son is now married, sober and in ongoing recovery, but she recommends that parents remain vigilant and educate themselves about drugs, especially those their children are prescribed.

The survey found that 28 percent of people legally prescribed stimulants have exaggerated their symptoms to get a larger dose. The same percentage reported sharing their medicine with friends. Just over half the adults surveyed said stimulants were easy to obtain, usually from friends, and most said their friends abused them as well.

Red flags that parents can watch for in their children, Hersh said, include having dilated pupils, anxiety or manic behavior, talking about not sleeping for days and "crashing" when home from college, such as sleeping often and having difficulty concentrating.

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Study: ADHD Medications will not stunt children's growth

A study shows that taking ADHD medications will not stunt a child's growth.

Stimulant medications -- such as Adderall, Ritalin and Concerta -- used to treat attention-deficit/hyperactivity disorder (ADHD) in children, won't stunt their growth, a new study suggests.

"Stimulant medication did not affect children's final height as adults," said study researcher Dr. Slavica Katusic, an associate professor of pediatrics at the Mayo Clinic in Rochester, Minn.

Katusic noted that results of earlier studies have been mixed, with some showing these drugs retard growth and others showing they don't. But, most of the previous studies had limitations, such as having too few children or spotty information about adult height, she said.

Katusic said this study is unique because it followed a group of people with ADHD who were taking stimulant medications and compared them with a group with ADHD who were not taking medication and also a group that didn't have ADHD. These individuals were followed from childhood to adulthood, she said.

ADHD is one of the most common disorders of childhood, according to the U.S. National Institute of Mental Health (NIMH). Symptoms include difficulty paying attention or staying focused on one task, overactivity and impulsive behavior, the NIMH explains.

Stimulant medications are a mainstay of ADHD treatment, and while it may seem odd to use stimulant medication on an overactive child, stimulant drugs have a calming, focusing effect on youngsters with ADHD, according to the NIMH. Katusic said these drugs are important for improving school and social functioning.

Katusic's team studied 340 children with ADHD and 680 without the condition. "We compared the height when they were children and when they were grown up," she said.

The average follow-up time was 26 years for those with ADHD and 23 years for people without ADHD. Approximately 70 percent of those with ADHD who completed the study had taken stimulant medication for more than three months, the researchers noted.

There was no difference in adult height between those who took ADHD drugs and those who didn't, the investigators found.

"Neither childhood ADHD itself nor stimulant medication was associated with shorter stature as adults," Katusic said.

Boys with ADHD who were treated with stimulants for three or more months had a later growth spurt than boys who didn't take these drugs, but there was no difference in the size of the growth spurt, the researchers noted.

In addition, no connection was seen between the amount of time a child took stimulant drugs and adult height, the study authors found.

"But despite our findings, doctors should monitor growth when making medication decisions," she said. "Our study says don't worry at all, but human beings are all different and you always have to be careful."

The report was published online Sept. 1 in the journal Pediatrics.

Dr. Marcel Deray, a pediatric neurologist at Miami Children's Hospital, said, "This is good news, because we discuss this issue with parents of kids with ADHD."

Deray hopes the study will be replicated to prove the point that these stimulants don't affect height. "It would good to have a couple of studies showing the same thing," he said.

He also said this finding should be reassuring to parents who may be reluctant to allow their children to use these drugs because of the potential risk of stunting their child's growth.

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ADHD medication use leads to BMI rebound

A study of ADHD stimulant medication shows that its use is associated with BMI rebound later in adolescence.

A new study from researchers at Johns Hopkins Bloomberg School of Public Health found that children treated with stimulants for attention deficit hyperactivity disorder (ADHD) experienced slower body mass index (BMI) growth than their undiagnosed or untreated peers, followed by a rapid rebound of BMI that exceeded that of children with no history of ADHD or stimulant use and that could continue to obesity.

The study, thought to be the most comprehensive analysis of ADHD and stimulant use in children to date, found that the earlier the medication began, and the longer the medication was taken, the slower the BMI growth in earlier childhood but the more rapid the BMI rebound in late adolescence, typically after discontinuation of medication. Researchers concluded that stimulant use, and not a diagnosis of ADHD, was associated with higher BMI and obesity. The study was published in Pediatrics.

"Our findings should motivate greater attention to the possibility that longer-term stimulant use plays a role in the development of obesity in children," said Brian S. Schwartz, MD, MS, Professor of Environmental Health Sciences, Epidemiology, and Medicine at the Bloomberg School of Public Health and lead author of the study. "Given the dramatic rise in ADHD diagnosis and stimulant treatment for it in recent decades, this is an interesting avenue of research regarding the childhood obesity epidemic, because the rises in each of these roughly parallel one another."

Previous research has found substantial evidence that stimulant use to treat ADHD is associated with growth deficits, and some evidence of growth delays. However, the reported associations of ADHD with obesity in both childhood and adulthood was paradoxical and somewhat unexplained. The results of this study suggest it is likely due to the strong influence that stimulants have on BMI growth, with delays in early childhood and a strong rebound in late adolescence. The study also found longitudinal evidence that unmedicated ADHD is associated with higher BMIs, but these effects were small.

ADHD is one of the most common pediatric disorders, with a 9% prevalence among children in the U.S., and ADHD medication is the second most prescribed treatment among children. Over the past 30 years, treatment for ADHD with stimulants has increased rapidly. From 2007 to 2010, 4.2.% of children under age 18 had been prescribed stimulants in the past 30 days, more than five times the amount prescribed to the same-aged children between 1988 and 1984.

The study analyzed the electronic health records of 163,820 children, ages 3 to 18, in the Geisinger Health System, a Pennsylvania-based integrated health services organization. The research geographic area included 37 counties in central and northeastern Pennsylvania. There were an equal number of boys and girls. Nearly 7% -- 11,080, or 6.8% -- had an order for stimulants. (13,789, or 8.4%, received a diagnosis of ADHD. A total of 15,473 were prescribed stimulants, some for other reasons.) There were 201,854 orders for the ADHD medications used in the analysis. The median age at first stimulant use was 8.5 years. Median use was 183 days, with 50% of children taking stimulants for less than 6 months and 50% of children for more than 6 months.

The researchers compared the BMI trajectories of those who had never had a diagnosis or prescription (the "controls") with three groups: 1.) those with a diagnosis but no stimulant prescription; 2.) those with orders for stimulants without an ADHD diagnosis and 3.) those with both an ADHD diagnosis and stimulant orders.

Those in group 3 had slower rates of BMI growth in early childhood, with more rapid rates during adolescence that eventually exceeded those of the controls. Those with a diagnosis of ADHD but no stimulant orders had more rapid BMI growth after age 10 versus the controls, but the effects were small.

"Stimulant use was strongly implicated," said Dr. Schwartz. "The earlier stimulants were started and the longer they were used, the stronger was their influence on the degree of both the delayed BMI growth in early childhood and the rebound BMI growth in late adolescence. This is an important unintended consequence of stimulant use in childhood."

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