American Academy of Pediatrics – Section on Cardiology and Cardiac Surgery

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Released November 2, 2020

Do not order a screening ECG prior to initiation of attention-deficit/hyperactivity disorder (ADHD) therapy in asymptomatic, otherwise healthy pediatric patients with no personal or family history of cardiac disease.

Many pediatricians obtain ECGs in healthy patients with no personal or family history* of cardiac disease prior to initiating stimulant therapy for ADHD out of fear of triggering an adverse cardiovascular event or worsening a previously undiagnosed cardiovascular disease. However, the probability that such screening will lead to the diagnosis of cardiac disease is low. Furthermore, when ECG abnormalities are identified, they rarely warrant a change in planned ADHD therapy. As a result, obtaining the ECG increases health care costs and can increase stress for both the patient and family.

If there is concern based on the history and physical examination, then a pediatric cardiology referral is a reasonable consideration.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items
on this list or their individual situation should consult their physician.

How The List Was Created

This list was developed initially by faculty in Pediatric Cardiology at University Hospitals in Cleveland OH. It was then revised and approved by the AAP Section on Cardiology and Cardiac Surgery. After review by other AAP sections, the AAP Executive Committee granted final approval of the list.

AAP’s disclosure and conflict of interest policy can be found at


Cooper WO, Habel LA, Sox CM, et al. ADHD drugs and serious cardiovascular events in children and young adults. N Engl J Med. 2011;365(20):1896-1904

Mahle WT, Hebson C, Strieper MJ. Electrocardiographic screening in children with attention-deficit hyperactivity disorder. Am J Cardiol. 2009;104(9):1296-1299

Perrin JM, Friedman RA, Knilans TK; American Academy of Pediatrics, Black Box Working Group, Section on Cardiology and Cardiac Surgery. Cardiovascular monitoring and stimulant drugs for attention-deficit/hyperactivity disorder. Pediatrics. 2008;122(2):451-453

Shahani SA, Evans WN, Mayman GA, Thomas VC. Attention deficit hyperactivity disorder screening electrocardiograms: a community- based perspective. Pediatr Cardiol. 2014;35(3):485-489

American Academy of Pediatrics, Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. ADHD: Clinical practice guideline
for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128(5):1007-1022