Is it necessary to perform an electrocardiogram in all children with attention deficit disorder before starting treatment with psychostimulants?

The authors didn’t find differences on the rate of cardiovascular events or death between children exposed and unexposed to stimulant medication. They don’t find appropriate to perform an electrocardiogram (EKG) or referral to cardiology of all children with attention deficit and hyperactivity disorder (ADHD) before starting stimulant medication. Cardiology referral should be considered only if cardiac risk factors are detected.

Reviewer’s commentary: at present there isn’t enough evidence to justify the performance of an EKG as screening previous to initiate medical stimulant medication in children with ADHD. It seems reasonable to perform a careful history and physical examination (blood pressure and cardiac frequency included) and referral to cardiology only when cardiac risk factors or cardiac diseases are detected.