For Ann Hohmann, Oct. 21, 2004, began just about like any other day.
On that morning, the 54-year-old mother of two living in McAllen, Texas, was preparing to take her eldest son to school. She had an early appointment, so her husband, Rick Hohmann, would be dropping off younger son, 14-year-old Matthew, at his school that day.
About a month earlier, Matthew had been diagnosed with attention deficit hyperactivity disorder, or ADHD. And like an estimated 2.5 million other children in the United States, he was taking medication for the condition.
It was Ann Hohmann who gave Matthew his Adderall XR pill that morning with a glass of water. But it was her husband who later found him after he had collapsed on the bathroom floor.
"To me, he seemed fine," she recalled. "My husband had seen him walking around, brushing his teeth. Then he walked in and found him flat down on the floor in the bathroom.
"When he turned him over, his lips were blue," Hohmann said.
She said that her husband called her first, and then he called 911. He performed CPR until the ambulance arrived. But it was too late.
"They worked on him for a while, but he was dead," she said.
Ann Hohmann is one of a handful of parents across the country who believes that their children's sudden death was due to the use of drugs to control ADHD. And she said she hopes a new study released this morning, which suggests that the use of stimulants is tied to an increased risk of sudden unexplained death among children and teens, will open the eyes of the public to what she sees as the cause of her son's demise.
"When my doctor gave this to my son, I thought it was a light dose," she said. "I had no idea that it was going to kill him. It ruined our lives. ... There was no warning."
In the study of 564 children and teens who died suddenly, researchers led by Madelyn Gould of the New York State Psychiatric Institute and Columbia University in New York City found that that those who died suddenly were 7.4 times more likely than not to have been taking the stimulant medications. The results of the study are reported online in The American Journal of Psychiatry.
"Although sudden unexplained death is a rare event," the researchers said, "this finding should be considered in the context of other data about the risk and benefit of stimulants in medical treatment."
Reports of cases of sudden unexplained death among children taking stimulants for ADHD have raised concerns over use of the medications in the past. The U.S. Food and Drug Administration's adverse event reporting system identified 11 sudden deaths in pediatric patients taking methylphenidate -- the active ingredient in Ritalin and other ADHD drugs -- from January 1995 to February 2005.
While this rate of sudden death appears very low, the researchers there may be more cases that go unreported.
In 2006, the issue saw two FDA advisory committees come to opposite conclusions regarding the need to include a boxed warning of the risk of sudden death on the labels of stimulants. Later that year, information was added to the regular warnings section of the medication labels noting the association between sudden death and stimulant use at standard doses in children with serious heart problems.