Stimulant Dosing for Children With ADHD: A Medical Claims Analysis
Abstract
Objective To evaluate stimulant dosing patterns in the community treatment of children with attention-deficit/hyperactivity disorder (ADHD). Method Claims data from U.S. managed care organizations (2000-2004) were analyzed for patients ages 6 to 12 years treated for ADHD with osmotically released oral system (OROS) methylphenidate (MPH; n = 3,815), immediate-release (IR) MPH (n = 1,960), mixed amphetamine salts extended-release (MAS XR; n = 1,847), or IR MAS (n = 1,937), and who filled prescriptions covering at least 72 of the first 90 days of treatment. Results The mean initial and maximum dosages were 23.8 and 33.4 mg/day for OROS MPH, 14.8 and 21.8 mg/day for IR MPH, 12.7 and 17.4 mg/day for MAS XR, and 11.2 and 16.5 mg/day for IR MAS. Dose titration occurred in 51.8% (MAS XR) to 61.6% (IR MPH) of patients. Lower initial dose and three or more visits for the treatment of ADHD during the first 90 days of treatment were associated with dose titration. Maximum dose was significantly related to higher initial dose and titration for all four stimulants. For children treated with OROS MPH or IR MAS, treatment by a psychiatrist was significantly related to higher maximum dose. Conclusions Among children with ADHD who continue stimulants through the first 3 months of treatment, dosing in the community treatment of ADHD tends to be lower than doses used in clinical trials. When titration does occur, it is linked to lower initial dosing, clinical monitoring, higher final stimulant d…
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The mean dosage of OROS-MPH may be small relative to current prescribing practices.
“First, the mean dosage of OROS-MPH may be small relative to current prescribing practices (Olfson et al., 2009), and perhaps higher dosages are necessary to improve learning.”
From The effect of stimulant medication on the learning of academic curricula in children with ADHD: A randomized crossover study. (2022) · cites this paper as Olfson et al., 2009
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Review of Medication Adherence in Children and Adults with ADHD
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- Authors
- Olfson, M., Marcus, S., & Wan, G.
- Affiliations
- New York State Psychiatric Institute (US)
- Corresponding author
- Olfson, Mark
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2009-01
- Volume
- 48
- Issue
- 1
- Pages
- 51-59
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2018245820
- Cited by
- 39
- References
- 8
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 2 · 2019: 3 · 2015: 2 · 2014: 4 · 2013: 2 · 2012: 8
- FWCI
- 2.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- attention deficit hyperactivity disorder, methylphenidate, mixed amphetamine salts, OROS methylphenidate, dose titration, children, managed care claims data, initial dose, maximum dose, psychiatric treatment, community-based treatment
- MeSH terms
- Amphetamine, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Humans, Male, Methylphenidate
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