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Column originally published Mar 28, 2023

ADHD Stimulant Medications Can Be Safe For Those With Heart Conditions

Question: Our ten-year-old daughter is very active. We thought that she was just trying to keep up with her older siblings. When her teachers told us that she was daydreaming in class, and asked us to have her assessed for possible ADHD, we were upset with them. Her marks were still very good, except for math. She didn’t like the subject, and refused to do math homework. To our surprise, the child psychologist diagnosed her with ADHD after several sessions of questioning and testing. We did see a psychiatrist on zoom recently. He talked to our daughter for several minutes, and told us that she doesn’t have ADHD because she is doing so well in school. Our family doctor has referred us to a developmental paediatrician since. I have done a lot of reading since her diagnosis, and actually filled out some online questionnaires myself. I now realize that I likely have ADHD as well; many of my report cards said that I was a daydreamer. I am now worried about stimulant medications; I read that it can increase heart rate and blood pressure. Both of these run in our family. Is it better to use non-stimulant medications instead?


It is interesting that you recognize that you likely have ADHD after your daughter’s diagnosis. After all, she inherited half of her genes from you, and the other half from her father. Girls are often less physically hyperactive compared with boys, and they don’t disrupt the class as much. As a result, girls are often not recognized to have ADHD while they are growing up.

Many doctors, including paediatricians and psychiatrists, are reluctant to diagnose children with ADHD unless they are doing poorly in school. Unfortunately, by the time these children started failing in school, they have already lost their self esteem. They are more likely to befriend “bad kids,” start skipping school, and use drugs to self-medicate. ADHD is a mental health condition that often leads young people down the path of addiction.

Long-acting stimulant medications are very effective in helping children, teenagers, and adults, with ADHD. They work on neurotransmitters in the front part of our brain that regulates executive function. As a result, they can pay better attention, with less distraction, when they are in school and doing homework. Their academic performance often greatly improves. They are also better organized, and procrastinate less with assignments and study. They become less impulsive, and less likely to get into trouble.

The side effects of long-acting stimulant medications are usually mild. The most common one is loss of appetite at lunch, some may have dry mouth. These medications can increase heart rate and blood pressure, by just a little. When children run or get excited, their heart rate and blood pressure increase a lot more than what the medicine can do. Unless there is an underlying heart condition, we don’t recommend doing an ECG. Over the years, I have treated children with serious heart conditions who also have coexisting ADHD. With careful monitoring, they can take stimulant medications that help them greatly, without any harm to their heart.

There are two non-stimulant medications that are recommended for ADHD: Strattera (atomoxetine) and Intuniv XR (guanfacine). Both of these can help long-acting stimulants to work better and longer, but they really don’t work well by themselves most of the time.

I suggest to parents to try a low-dose long-acting stimulant, gradually increase the dose and gauge benefits as well as side effects. There are several good long-acting stimulants to try. If a long-acting stimulant is helpful, but optimal benefits cannot be achieved without significant side effect, then a non-stimulant medication can be added to assist. This approach can help these children most of the time.

Finally, since you recognize that you likely have ADHD, you may want to explore and see whether there are physicians in your area that are specialized in adults with ADHD. In recent years, many adults have been diagnosed with ADHD and treated successfully with medications. Some told us that it has transformed their lives. This is something for you to consider.