Stimulants and Childhood Stroke: a Population-Based Nested Case-Control Study
Location(s): United States
As of 2007, attention deficit/hyperactivity disorder (ADHD) had been diagnosed in 5.4 million U.S. children 4-17 years of age, an increase of 22% from 2003. At least 66% were being treated with stimulant medications. The use of stimulants has long been associated with both hemorrhagic and ischemic stroke in adults, and may increase stroke risk in children.
Recent studies primarily have addressed the safety of ADHD medications by comparing cohorts of children taking stimulants to others who do not. Stroke in children is an extremely rare disease, however, which lends itself to a case-control study design with a focus on childhood stroke.
We hypothesize that usage of ADHD stimulant medications is a risk factor for first childhood stroke, with longer use, and use more proximate in time, linked to higher risk.
Our study will utilize a case-control design including 258 children enrolled in Kaiser Permanente Northern California and diagnosed with stroke between the years of 1993-2007, along with 4 population-based, age-matched controls each. This cohort will be linked to electronic pharmaceutical data to collect information on all ADHD medications and antidepressants with stimulant properties. Data will also be collected on potentially confounding medications, as well as risk factors known to be associated with childhood stroke in order to study this potential association.