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A Preliminary Study of One Year Safety and Tolerability of Attention-Deficit/Hyperactivity Disorder Medications in Youth with Fontan Palliation or Heart Transplant

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Abstract

There are no published studies that examine the safety and tolerability of medication to treat attention-deficit/hyperactivity disorder (ADHD) in children with histories of Fontan palliation (Fontan) or heart transplant (HT), despite the high prevalence of ADHD in these populations. To address this gap, we examined the cardiac course, somatic growth, and incidence of side effects for one year after medication initiation amongst children with Fontan or HT and comorbid ADHD. The final sample comprised 24 children with Fontan (12 medication-treated, 12 control) and 20 children with HT (10 medication-treated, 10 control). Demographic, somatic growth (height and weight percentile-for age), and cardiac data (blood pressure, heart rate, results of 24 h Holter monitoring, electrocardiograms) were extracted from electronic medical records. Medication-treated and control subjects were matched by cardiac diagnosis (Fontan or HT), age, and sex. Nonparametric statistical tests were utilized to compare between- and within-group differences prior to, and one year post, medication initiation. There were no differences in somatic growth or cardiac data when comparing medication-treated participants to matched controls, regardless of cardiac diagnosis. Within the medication group, a statistically significant increase in blood pressure was observed, though the group average remained within clinically acceptable limits. While results are preliminary in nature due to our very limited sample size, our findings suggest that ADHD medications can be tolerated with minimal cardiac or somatic growth effects amongst complex cardiac patients. Our preliminary results favor treating ADHD with medication, which has considerable implications for long-term academic/employment outcomes and quality of life for this population. Close collaboration between pediatricians, psychologists, and cardiologists is essential to individualizing and optimizing interventions and outcomes for children with Fontan or HT.

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Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Children’s Hospital Colorado, 13123 East 16Th Avenue, Aurora, CO, 80045, USA

    Yasmine R. Jassal, Rebecca Slomowitz, Melanie D. Everitt, Elizabeth S. Christofferson, Johannes C. von Alvensleben, Michael Di Maria & Kelly R. Wolfe

  2. University of Colorado School of Medicine, Aurora, CO, USA

    Yasmine R. Jassal, Melanie D. Everitt, Elizabeth S. Christofferson, Johannes C. von Alvensleben, Michael Di Maria & Kelly R. Wolfe

Authors
  1. Yasmine R. Jassal
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  2. Rebecca Slomowitz
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  3. Melanie D. Everitt
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  5. Johannes C. von Alvensleben
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  6. Michael Di Maria
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Contributions

J and W, and S: collected data, carried out analyses, and wrote and edited the manuscript. vA, DM, C, and E: contributed substantially to study conceptualization and design, identified eligible participants, collected data, contributed to the interpretation of data, and critically revised the article for intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Yasmine R. Jassal.

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Jassal, Y.R., Slomowitz, R., Everitt, M.D. et al. A Preliminary Study of One Year Safety and Tolerability of Attention-Deficit/Hyperactivity Disorder Medications in Youth with Fontan Palliation or Heart Transplant. Pediatr Cardiol 45, 673–680 (2024). https://doi.org/10.1007/s00246-023-03128-7

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  • DOI: https://doi.org/10.1007/s00246-023-03128-7

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