After years of speculation and rare case reports, a study suggests that stimulant medication -- mostly used to treat attention deficit hyperactivity disorder -- may have played a role in a handful of cases of sudden, unexplained death in children and adolescents.
"The association is significant in that it's real, but that doesn't mean it's not a very low risk," says lead author Madelyn S. Gould, Ph.D., a professor of psychiatry and public health at Columbia University, in New York. "There probably does need to be more careful monitoring, but the bottom line is that parents should not take their children off stimulant medication they're currently on and should not be scared to have their child go on a stimulant if that's what they and their doctors decide is the best thing for their child."
The study, published this week in the American Journal of Psychiatry, is the first to suggest that the stimulants may pose a risk -- albeit remote -- in children without underlying heart problems. About 2.5 million children in the United States take such medications.
Gould and her colleagues compared medical records and parent interviews of children and adolescents who had died between the years of 1985 and 1996, including 564 who had died from an unexplained heart-rate abnormality or other causes, and 564 who died as passengers in motor vehicle accidents. They excluded cases with other known possible causes of death, such as asthma or congenital heart diseases.
Of all the unexplained cases, the researchers found that 10 children, or 1.8 percent of the group, had had stimulant medication prescribed. This compared with only two cases of stimulant use, or 0.4 percent, among healthy children who had died in motor vehicle accidents -- a group used to represent a general population of healthy children and adolescents.
In all 10 cases, the children were taking methylphenidate, the active ingredient in Ritalin and Concerta. A similar drug, Adderall, is composed of mixed amphetamine salts and was not included in the study results because it was first approved in 1996.
The study was funded by a grant from the NIMH and a contract with the FDA.
Bonnie - what this study shows is that the laissez aire attitude in prescribing of these medications should come to an end.