The American Academy of Pediatrics (AAP) has issued a statement contradicting the recommendation of the American Heart Association (AHA) for routine electrocardiograms (ECGs) before starting medication to treat ADHD. The AAP and the American Academy of Child and Adolescent Psychiatry (AACAP) have concluded that sudden cardiac death (SCD) in persons taking medications for ADHD is a very rare event, occurring at rates no higher than in the general population. There is no evidence that routine ECG screening would prevent SCD. The AAP recommends careful assessment by a targeted cardiac history and examination, and a cardiac consultation only if clinically indicated. The AAP urges further research on risk factors for SCD, and improved methods for detecting hidden cardiac disease. 
COMMENT. This AAP statement is endorsed by AACAP, Society for Developmental and Behavioral Pediatrics, and National Association of Pediatric Nurse Practitioners. The AAP recommends careful cardiac assessment of children with a history of cardiac disease, palpitations, syncope, or seizures; family history of sudden death; hypertrophic cardiomyopathy; long QT syndrome; or Wolff-Parkinson-White syndrome.
Risks of not treating ADHD include: 1) academic failure; 2) driving and other accidental injuries; 3) loss of self-esteem; 4) nicotine use and substance abuse; and 5) obesity, (see Ped Neur Briefs August 2008;22:64).