While methylphenidate, amphetamines and atomoxetine play a significant role in the pharmacological management of ADHD, there have been some safety concerns raised over the last few years with respect to cardiovascular morbidity. The literature has been reviewed, exploring the effects of ADHD medications with respect to sudden death and alterations of heart rate (HR), blood pressure and QT interval. There is some evidence of increased HR and BP using these medications but there is no evidence of a clinically-significant impact. However, most of the published data is on average results and might mask individual cases in which there is a clinically significant change. Regular monitoring of BP and pulse, using the same procedure on each occasion, is recommended. There is no convincing evidence of an association with QT interval prolongation or sudden death. Routine ECGs before starting these medications are not considered to be necessary. However, for each child a careful personal and family history of cardiovascular problems should be taken and a cardiovascular examination should be performed before medication is commenced.