REVIEW ARTICLE Attention-Deficit/Hyperactivity Disorder, Stimulant Therapy, and the Patient with Congenital Heart Disease: Evidence and Reason Anjan S. Batra • Mark E. Alexander • Michael J. Silka Received: 4 August 2011 / Accepted: 16 August 2011 / Published online: 2 February 2012 Ó Springer Science+Business Media, LLC 2012 Abstract Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood, and congenital heart disease (CHD) is the most common form of birth defect. Children with CHD are at increased risk for neurodevelopmental disorders such as ADHD. Stimulant medications, specifically methylphenidates and amphetamines, are frequently prescribed and effective in reducing the symptoms of ADHD. Despite their efficacy and long history of use, the safety of these medications has recently come into question due to isolated reports describing sudden unexplained death of children undergoing treatment. This review summarizes the current literature on the cardiovascular risks associated with the use of pharma- cologic therapy for ADHD, with an emphasis on patients who had CHD. Keywords Attention-deficit/hyperactivity disorder Á Congenital heart disease Á Stimulant medications Á Sudden death Introduction Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood [6]. It is characterized by developmentally inappropriate levels of hyperactivity, inattention, and impulsivity. The prevalence rates for ADHD are reported to be in the range of 4–12% in community-based samples of school-aged children in the United States [3, 6]. Congenital heart disease (CHD) is the most common form of birth defect, occurring in 8 per 1,000 live births [14]. As treatments for more complex forms of CHD have progressed, most patients currently are surviving to school age and adulthood. Thus, clinicians are now confronted with issues such as quality of life and long-term develop- ment for this rapidly expanding group of patients. At the same time, the literature shows that children with prior surgical treatment of CHD are at increased risk for neu- rodevelopmental disorders such as ADHD [20]. Stimulant medications, specifically methylphenidates and amphetamines, are frequently prescribed for ADHD and effective in reducing its symptoms. Despite their efficacy and long history of use, the safety of these medications has recently come into question due to isolated reports describing the sudden unexplained death (SUD) of children undergoing treatment, which has raised concerns in various advisory and regulatory bodies. Despite consensus that all patients treated with stimulant therapy require continued surveillance of heart rate and blood pressure, current practice guidelines in the area of further cardiovascular screening for risk assessment before initiation of pharmacologic therapy for ADHD remain con- troversial. The practice guidelines are even more unclear regarding the assessment of risk for patients with CHD. This review summarizes the current literature on the cardiovascular risks associated with the use of A. S. Batra (&) Division of Pediatric Cardiology, Children’s Hospital of Orange County, University of California at Irvine, 455 S Main Street, Orange, CA 92868, USA e-mail: abatra@uci.edu M. E. Alexander Arrhythmia Service, Children’s Hospital Boston, Harvard Medical School, Boston, MA, USA M. J. Silka Division of Cardiology, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA 123 Pediatr Cardiol (2012) 33:394–401 DOI 10.1007/s00246-012-0162-6