From the Editor-in-Chief's Desk

Iam proud that this journal consistently features both incisive, cutting-edge investigations of novel compounds and circumstances as well as the broader epidemiological work that bolsters our field and our best practices. Dalsgaard et al.'s contribution in this issue belongs in both camps, and I enthusiastically recommend this article on the cardiovascular safety of stimulant medications—even as I am sure many of you have already read it in its early online release.

The impressive size of this Danish registry study, at more than 700,000 subjects, not only buoys the results but also allows these investigators to compare multiple groups, including non-ADHD non-stimulant-naïve subjects. Their basic result is familiar, though the thoroughness of their methods brings authority: Stimulant use is a safety signal for a small but significant increase in sudden cardiac events, suggesting once again that earlier research and guidelines concerning medical monitoring during treatment are prudent, sensible, and should be followed.

Now is an appropriate time to review some of the previous literature. In JCAP 22.6 (December 2012), we published Arcieri et al.'s similar investigation of cardiac events and stimulant medication in an Italian population. They also reported a “small but significant impact on the cardiovascular system,” and made recommendations for taking proper histories and instituting baseline monitoring and pre-treatment cardiovascular exams.

Lest we think this is a European fixation, let us remember the American Academy of Pediatrics 2008 treatment guidelines (Pediatrics 22.2), which are functionally identical: Stimulant prescribing for ADHD based on “history and physical assessment” of cardiovascular risk.

The work that Dalsgaard et al. have done is invaluable to our field, both in cementing the wisdom and need to follow best practices and in opening up new avenues of inquiry that may well lead to safer, more effective treatment in the future. It is encouraging that the science is supporting our clinical consensus, and pointing towards a practice of pediatric psychopharmacology that includes healthy respect for our tools and a dedication to providing the best treatment.