Stimulant dosing for children with ADHD: a medical claims analysis.
OBJECTIVE
To evaluate stimulant dosing patterns in the community treatment of children with attention-deficit/hyperactivity disorder (ADHD).


METHODS
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 doses, and treatment by a psychiatrist.
Olfson
Mark
M
New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY, USA. mo49@columbia.edu
Marcus
Steven
S
Wan
George
G
D000661:Amphetamine / Q000008:administration & dosage / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage / Q000627:therapeutic use*
D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D000661:Amphetamine