What is the starting dose of Adderall (amphetamine and dextroamphetamine) for adults and children with Attention Deficit Hyperactivity Disorder (ADHD)?

Adderall Starting Dose for ADHD

For ADHD treatment, Adderall should be started at 5-10 mg daily for both children and adults, with careful titration based on response and tolerability. 1

Recommended Starting Doses by Age Group

Children (6-12 years)

• Starting dose: 5-10 mg once daily in the morning
• Titration: Increase by 5 mg weekly as needed
• Maximum daily dose: Up to 50 mg daily
• Formulation options: Immediate-release (twice daily) or extended-release (once daily)

Adolescents (12-18 years)

• Starting dose: 5-10 mg once daily
• Titration: Similar to children, with weekly adjustments
• Maximum daily dose: Up to 50 mg daily

Adults (18+ years)

• Starting dose: 5-10 mg once daily
• Titration: May increase by 5-10 mg weekly based on response
• Maximum daily dose: Up to 50 mg daily

Dosing Considerations and Monitoring

Dose Titration Process

1. Begin with lowest effective dose (5-10 mg)
2. Assess response after 1 week
3. If inadequate response with tolerable side effects, increase by 5-10 mg
4. Continue weekly adjustments until optimal symptom control or maximum dose reached
5. Monitor vital signs, weight, sleep quality, and symptom control at each visit

Monitoring Parameters

• During titration: Every 3-4 weeks
• Once stabilized: Every 3-6 months
• Key parameters to monitor:
  • Vital signs (blood pressure, heart rate)
  • Weight and appetite changes
  • Sleep quality
  • Mood changes
  • Growth parameters (in children)

Special Considerations

Common Pitfalls to Avoid

• Inadequate dose titration: Failure to properly titrate medication to achieve maximum benefit with tolerable side effects can lead to poorer outcomes 1
• Overlooking non-pharmacological interventions: Relying solely on medication without implementing behavioral strategies significantly reduces treatment effectiveness 1
• Ignoring comorbidities: Conditions like anxiety or bipolar disorder may require different treatment approaches or medication adjustments

Formulation Selection

• Immediate-release: May be preferred when more flexible dosing is needed
• Extended-release: Provides once-daily dosing with up to 12-hour duration of effect, which may improve adherence and reduce stigma 2

Effectiveness Considerations

• Symptom improvement typically begins within the first week of treatment 3
• Long-term studies show sustained effectiveness for up to 24 months with appropriate dosing 3, 4
• For patients with severe symptoms (higher baseline scores), higher doses may provide greater symptom reduction 2

Side Effect Management

Common Side Effects

• Decreased appetite (most common) 5
• Insomnia/sleep disturbances 5
• Abdominal pain 5
• Headache 3
• Dry mouth (particularly in adults) 3

Lifestyle Recommendations

• Maintain regular sleep schedule
• Structured physical activity (≥150 minutes/week)
• Healthy diet emphasizing fruits, vegetables, whole grains
• Limit caffeine intake to less than 300 mg per day
• Avoid tyramine-containing foods

Treatment Approach by Age Group

Children under 6 years

• Not FDA-approved for this age group
• Behavioral interventions should be first-line

School-age Children (6-12 years)

• FDA-approved medications (preferably stimulants) with behavioral interventions
• Parent training and behavioral classroom interventions are essential adjuncts

Adolescents (12-18 years)

• Similar approach to children but with adolescent's assent
• May require higher doses based on body weight

Adults

• First-line stimulant medications (amphetamine or methylphenidate)
• Consider adding CBT specifically targeting inattentive symptoms

The evidence consistently supports starting at lower doses (5-10 mg) and carefully titrating upward based on clinical response and tolerability, regardless of age group 1, 2, 3, 4.