Pre-Stimulant Testing Requirements

Required Pre-Treatment Assessment

The American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry guidelines establish that a comprehensive cardiac history and physical examination with vital signs are mandatory before initiating stimulants 2, 4
A detailed cardiac history, including family history of sudden death, Wolff-Parkinson-White syndrome, hypertrophic cardiomyopathy, long QT syndrome, or ventricular arrhythmias, must be obtained 2, 4
Physical examination with vital signs must include blood pressure measurement, heart rate/pulse, and height and weight to establish a growth baseline 1, 3, 4
Further cardiac evaluation, such as an ECG or cardiology referral, is indicated only if positive findings on history or physical examination suggest cardiac disease 2, 4

The American Academy of Child and Adolescent Psychiatry guidelines recommend documenting a history of psychotic disorders, as it is an absolute contraindication to stimulants 1, 6
A history of tics or Tourette's syndrome in the patient and family should be documented 2
Current medications, including over-the-counter drugs and supplements, should be documented 5, 7
A history of substance abuse, including stimulants or other substances, should be documented 1, 6
The presence of glaucoma, hyperthyroidism, or symptomatic cardiovascular disease should be documented 1
Current use of MAO inhibitors is an absolute contraindication to stimulants 1, 6

No routine laboratory tests are required for methylphenidate or amphetamine initiation, according to the American Academy of Child and Adolescent Psychiatry guidelines 5, 7, 8
If pemoline were being considered, baseline liver function tests would be mandatory, as recommended by the American Academy of Child and Adolescent Psychiatry 1, 9, 10

The American Academy of Child and Adolescent Psychiatry recommends establishing a monitoring plan, including vital signs checked annually during routine physical examination for children 3
For adults, blood pressure and pulse should be checked quarterly by the treating or primary care physician 1
The cardiovascular effects of stimulants are generally modest, with average increases of 1-2 beats per minute for heart rate and 1-4 mmHg for blood pressure, though 5-15% of individuals may experience larger increases requiring monitoring 2, 4