An FDA advisory panel has recommended a strong warning on stimulant drugs used to treat Attention Deficit Disorder.  The risks cited were those of cardiovascular complications among both adults and children.  The retrospective case review did reveal other suggested causes of the heart attack, stroke and other vascular complications such as undiagnosed congenital heart disease in children or atherosclerotic heart disease in adults.

Stimulant medications have been used with caution by many physicians for years because of the perceived danger of placing the heart under additional stress as well as the potential for prescription drug recreational use and abuse.  These drugs are highly monitored to make sure that patients and families are using the correct dose and the patient is not developing signs of complications.  Measurements of blood pressure and weight as well as history of any changes in behavior, neurologic symptoms or physical signs of excessive stimulant effects should be performed periodically, at least once per semester of school.  If doses are being adjusted or if signs of toxicity are present, monitoring should be more frequent.  Failure to correctly follow up with your physician could increase the risk of these medications. 

These are links to related articals related to treatment of attention deficit:

Canadian experience

In this article, the Canadian Government removed Adderall from the market due to risk of cardiovascular complications and yet reinstituted it's use with guidelines similar to the FDA advisory committees recommendation.

Forbes magazine article

This article contains appropriate responses by clinicians who view the risk as being part of the treatment and even if every case of death was directly related to the use of the drug and NO OTHER contributing factor the numerical risk is less than 1:100,000 because 3 million patients are taking these medications annually and the deaths reported were from 1999 to 2003.  Making the annual risk 2 deaths for every 1 million patient years of use.

It's clear that adults and children with known heart disease should be encouraged not to use these medications.  Some adults with severe limitations (narcolepsy) may certainly feel that the risk is worth the benefit and still others with less severe limitations (sleep apnea) may feel their quality of life benefits with medication outweigh the risks.

In children, the risk is present but exceedingly small but any harm to children must be weighed more heavily often the risk/benefit decision is by a parent.  Behavioral methods to treat ADD can be beneficial but in small children can be very impractical in the public school system for example.  If school failure is the expected outcome, then intervention with medication that carries some risk is reasonable.  Each family must reach this decision based on their value of education, fear of medication adverse events, and their childs degree of impairment.