Imagine if your child was diagnosed with attention deficit disorder (ADHD) and was started on a course of stimulant psychiatric medications (like Ritalin), a standard treatment used for ADHD.
Now imagine that suddenly, your child dies for no apparent reason.
Your child would be in a very small but significant group of children who die while on stimulant medications. I cannot emphasize this enough, however — this is a tiny, tiny group. This fact is likely to be glossed over in many mainstream media reports about this study.
Gould et al. (2009) studied state vital statistics from 1985-1996 and found that in 564 cases of sudden death in children ranging from ages 7 through 19, 10 (1.8%) of the sudden unexplained death cases were treated with a stimulant at the time of their death, as compared with only two (0.4%) of the motor vehicle accident victims.
Ten victims over an eleven year period hardly seems like the stuff of headlines. And it wouldn’t be, except that the rate was four times higher than the rate of the motor vehicle accident victims. This is a significant difference, despite the small numbers involved.
Remember, we’re talking about an extremely rare event here. The finding is of greater interest in trying to understand why it’s occurring at all, not for anyone to make a treatment decision based upon it.
The accompanying editorial highlights some of the important limitations of this study:
However, important confounders may remain. For example, the methods did not allow the investigators to learn whether, independent of stimulant treatment, ADHD itself increased the risk for sudden unexplained death. This is a plausible hypothesis given the association between ADHD and engagement in high-risk behaviors, such as substance abuse. Although history or postmortem toxicological evidence of substance abuse was reason for exclusion from the study, the sensitivity of these screening procedures is not perfect, and other drugs could have been ingested or inhaled. Furthermore, the parents of 40% of eligible cases could not be found or would not provide information. As the investigators point out, there is also a risk of inequality in the effort to search for medical explanations (including medication use) in sudden unexplained death, given its unexplained nature, compared to death from motor vehicle accidents, so that stimulant use might have been missed in the motor vehicle accident comparison population.
If the Gould et al. study reminds us of anything, it’s that psychiatric medications are not like candy, nor are they not without their downsides. It reminds us, too, that ADHD is a diagnosis that is probably the most over-used and mis-diagnosed malady affecting children today. Many children are being prescribed stimulants who do not meet the diagnostic criteria for ADHD.
Additionally, children on stimulants should be regularly monitored by the doctor that prescribed the medication, especially for heart issues.
The new study shows an unmistakable link, however, of sudden unexplained death and the stimulant medication used to treat ADHD. However, such deaths are very rare events and this is the very first study to look at this issue across such a large-scale child population.
Concerned? Talk to your doctor further about the study, or check it out yourself at the link below.
Read the full editorial accompanying the article: Stimulant Treatment of ADHD and Risk of Sudden Death in Children
Reference:
Gould MS, Walsh BT, Munfakh JL, Kleinman M, Duan N, Olfson M, Greenhill L, Cooper T. (2009). Sudden death and use of stimulant medications in youths. Am J Psychiatry, 166, 992 — 1001.