not unless you have a personal or family history of serious arrhythmia
Most patients dont need one. There was a time when we worried about stimulants causing kids to drop dead. Fortunately good research showed this was not the case. We still worry that if there is a family history of dropping dead from a fatal arrhythmia, it might be genetic and safer to get a bailine EKG before starting treatment.
Some medications pose a risk for altering heart electrical function slightly and we worry that adding a second medication that can cause palpitations could be dangerous - so an EKG within a few weeks of starting treatment is a good idea.