What is the recommended starting dose of Adderall (amphetamine and dextroamphetamine) for a 6-year-old with Attention Deficit Hyperactivity Disorder (ADHD)?

Adderall Dosing for a 6-Year-Old with ADHD

For a 6-year-old child with ADHD, start Adderall at 5 mg once or twice daily in the morning, then increase by 5 mg weekly increments until optimal response is achieved, rarely exceeding 40 mg total daily dose. 1

Age-Specific Considerations

A 6-year-old falls into the elementary school-aged category (6 years to 12th birthday), where FDA-approved ADHD medications are recommended as first-line treatment alongside behavioral interventions. 2

Starting Dose and Titration Protocol

Initial Dosing

• Begin with 5 mg once or twice daily, given upon awakening 1
• For Adderall XR (extended-release formulation), the starting dose is 10 mg once daily in the morning 3, 4
• Morning administration is critical to minimize sleep disturbances 3, 4

Dose Escalation

• Increase by 5 mg increments at weekly intervals based on clinical response and tolerability 1, 3
• Allow at least one week between dose increases to properly evaluate response 3
• Maximum daily dose rarely needs to exceed 40 mg per day 1
• Additional doses (if using immediate-release) should be given at 4-6 hour intervals 1

Monitoring Requirements

Before Each Dose Increase

• Assess both therapeutic effects and side effects using standardized ADHD rating scales from parents and teachers 3
• Monitor vital signs including blood pressure and pulse at each visit 3
• Evaluate for common side effects: decreased appetite, insomnia, headaches, stomachaches 5, 6

Growth Monitoring

• Track height and weight regularly, as stimulants can affect growth parameters 7
• Growth attenuation is more pronounced in children who eventually require higher doses and start treatment at younger ages 7

Treatment Approach

Combination with Behavioral Interventions

• Medication should be prescribed alongside parent training in behavioral management (PTBM) and/or behavioral classroom interventions 2
• Educational supports including IEP or 504 plans are necessary components of the treatment plan 2

Clinical Response Assessment

• Use standardized rating scales to objectively measure improvement 3
• The efficacy rate for Adderall in children with ADHD ranges from 59-89% depending on whether parent and teacher criteria concur 5
• Significant behavioral improvements typically manifest by 1.5 hours after dosing and can last 10.5-12 hours with extended-release formulations 8

Common Pitfalls to Avoid

• Starting at too high a dose leads to unnecessary side effects and decreased adherence 3, 4
• Not allowing sufficient time between dose increases prevents proper evaluation of response 3, 4
• Continuing to increase beyond maximum recommendations when ineffective—consider alternative medications instead 3
• Late evening dosing causes insomnia and should be avoided 1
• Failing to systematically assess both benefits and side effects during titration 4

Side Effect Profile

Expected Side Effects

• Appetite suppression, insomnia, and headaches are the most frequently reported drug-related adverse events 6
• These side effects are typically mild and dose-related 5, 6
• Some symptoms like staring/daydreaming, sadness, and irritability may actually worsen on placebo compared to active treatment 5

When to Reduce Dose

• If bothersome adverse reactions appear (insomnia, anorexia), reduce the dosage 1
• Consider dose reduction if a dose increase provides no added benefit 7

Special Circumstances

Drug Holidays

• Interrupt drug administration occasionally to determine if behavioral symptoms recur sufficiently to require continued therapy 1
• This practice helps assess ongoing need for medication

If Maximum Dose Inadequate

• If 40 mg daily does not provide adequate symptom control, consider alternative treatments rather than exceeding recommended maximums 3
• Options include switching to different stimulant formulations or adding non-stimulant medications 4