Investigators at University of Minnesota, Minneapolis, report cardiac autonomic dysfunction and arterial stiffness among children and adolescents with ADHD treated with stimulants. Compared with controls, ADHD patients had greater resting systolic BP, diastolic BP, and increased sympathetic tone. 
COMMENTARY. Variable pediatrician attitudes and cardiac screening practices prior to stimulant treatment of ADHD among US-based pediatricians reflect the limited evidence base and conflicting guidelines. In a survey of randomly selected US pediatricians with AAP membership, 25% agreed that the risk of sudden cardiac death (SCD) and 30% that legal liability were sufficiently high to warrant cardiac assessment; 75% agreed that physicians were responsible for informing families about SCD risk; 71% recognized interpreting a pediatric ECG as a barrier; 93% completed a routine H & P; 48% completed an in-depth cardiac H & P; 15% ordered an ECG; and 46% discussed stimulant-related cardiac risks .
Several factors influence the risks and cardiac screening practices, including: a cardiac murmur, the patient's sports activities, and an ECG with modifications of uncertain significance. We refer to a cardiologist for an opinion a child with a murmur, especially if engaged in strenuous sports activities, and an ECG abnormality of uncertain significance. Patients with a structural heart defect or prolonged QT interval are excluded from drug therapy for ADHD and are offered behavioral and alternative therapies.