Initiating Stimulant Therapy for ADHD

Initial Dosing and Titration

The American Academy of Child and Adolescent Psychiatry recommends starting with Adderall IR 2.5 mg twice daily for children and 5 mg twice daily for adults, with morning administration to minimize sleep disturbances 1, 2, 3
For Adderall XR, start with 10 mg once daily in the morning for both children and adults, providing convenience and flexibility 1, 2
The American Academy of Pediatrics suggests that Vyvanse has significantly lower abuse potential compared to Adderall, making it a preferred choice in adolescents and adults with substance abuse concerns 5
Increase Adderall doses by 5 mg weekly increments, and Vyvanse by 10 mg weekly increments, based on clinical response and tolerability 1, 2, 4

Obtain blood pressure, pulse, height, and weight before initiating medication, and monitor regularly to detect potential side effects 1, 2, 3
The American Academy of Pediatrics recommends substance abuse screening in adolescents and adults before starting treatment 5
Weekly telephone contact and monthly in-person visits are recommended during the initial phase of treatment, with assessment of target ADHD symptoms and side effects 1, 2

For adolescents with diversion risk, choose Vyvanse over Adderall due to its prodrug formulation, which makes extraction and abuse more difficult 5
In older adults, start with conservative dosing (Adderall XR 5 mg or Vyvanse 20 mg) and increase doses every 2 weeks to minimize adverse effects 2
For preschool-age children (4-5 years), methylphenidate is preferred over amphetamines due to lack of sufficient safety and efficacy evidence 5

If maximum recommended doses are reached without adequate symptom control, do not exceed maximum dosing, and consider switching to an alternative stimulant class or adding non-stimulant medications 1, 2, 5