Pediatric Attention Deficit Hyperactivity Disorder (ADHD) Differential Diagnoses
- Author: Maggie A Wilkes, MD; Chief Editor: Caroly Pataki, MD more...
Anxiety Disorder: Obsessive-Compulsive Disorder
Learning Disorder: Reading
Learning Disorder: Written Expression
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|Medication||Initial Pediatric Dose||Pediatric Dosage Range and Maximum Dose*||Common Pediatric Dose*||Preparations|
|Methylphenidate immediate release (IR) (Ritalin, Methylin, generic)||2.5-5 mg||0.1-0.8 mg/kg/dose PO qd to 5 times/d; not to exceed 60 mg/d||0.3-0.5 mg/kg/dose PO tid/qid||All preparations available as 5-mg, 10-mg, or 20-mg scored tabs; Methylin also available as 2.5-mg, 5-mg, or 10-mg chewable tab and PO solution (5 mg/5 mL and 10 mg/mL)|
|Methylphenidate sustained-release (SR) (Ritalin LA, Metadate CD)||Convert from IR or use 10 mg.||0.2-1.4 mg/kg/dose PO qd/tid; not to exceed 60 mg/d||0.6-1 mg/kg/dose PO qd/bid||10-mg, 20-mg, 30-mg, or 40-mg tabs (Metadate also has 50-mg and 60-mg tabs.); can be sprinkled into soft food (Do not cut, crush, or chew.)|
|Methylphenidate extended release (ER)‡ (Ritalin SR, Methylin ER, Metadate ER, Quillivant XR, generic SR)||Convert from IR|
May initiate treatment with Quillivant XR
|0.2-1.4 mg/kg/dose PO qd/tid; not to exceed 60 mg/d|
Quillivant XR: Once daily dosing
|0.6-1 mg/kg/dose PO qd/bid||20-mg Spansules (Do not cut, crush, or chew)|
Quillivant XR 5 mg/mL suspension
|Methylphenidate OROS tablets (Concerta)||Convert from IR or use 18 mg.||0.3-2 mg/kg PO qd; not to exceed 54 mg/d||0.8-1.6 mg/kg PO qd||18-mg, 27-mg, 36-mg, and 54-mg tabs (Do not cut, crush, or chew.)|
|Methylphenidate transdermal patch (Daytrana)†||Convert from IR or use 10 mg (12.5 cm2 patch) released over 9 h and titrate up prn.||0.3-2 mg/kg released over 9 h; not to exceed one 30-mg patch||10-30 mg released over 9 h||10-mg, 15-mg, 20-mg, 30-mg patches, applied to the hip|
|Dexmethylphenidate IR (Focalin)||2.5-5-mg||0.1-0.5 mg/kg/dose PO qd to qid; not to exceed 20 mg/d||0.2-0.3 mg/kg/dose PO bid/tid||2.5-mg, 5-mg, or 10-mg scored tabs (Do not cut, crush, or chew.)|
|Dexmethylphenidate extended release (Focalin-XR)||5-10-mg||0.2-1 mg/kg/dose PO qd to bid; not to exceed 20 mg/d||0.4-0.6 mg/kg/dose PO qd/bid||5-mg, 10-mg, or 20-mg scored tabs; can be sprinkled into soft food (Do not cut, crush, or chew.)|
|Dextroamphetamine (Dexedrine, Dextrostat)||2.5-5 mg||0.1-0.7 mg/kg/dose PO qd/qid; not to exceed 60 mg/d||0.3-0.5 mg/kg/dose PO qd/tid||Dexedrine: 5-mg scored tabs; Dextrostat: 5-mg and 10-mg scored tabs|
|Dextroamphetamine Spansules (Dexedrine CR)||5 mg||0.1-0.75 mg/kg/dose PO qd/bid; not to exceed 60 mg/d||0.3-0.6 mg/kg/dose PO qd/bid||5-mg, 10-mg, or 15-mg Spansules; can be sprinkled into soft food (Do not cut, crush, or chew.)|
|Mixed amphetamine salts IR (Adderall, generic)||2.5-5 mg||0.1-0.7 mg/kg/dose PO qd/qid; not to exceed 40 mg/d||0.3-0.5 mg/kg/dose PO tid/qid||5-mg, 7.5-mg, 10-mg, 12.5-mg, 15-mg, 20-mg, or 30-mg scored tabs|
|Mixed amphetamine salt XR (Adderall-XR)||Convert from IR or use 5-10 mg||0.2-1.4 mg/kg/dose PO qd/tid|
Not to exceed 30 mg/d
|0.6-1 mg/kg/dose PO qd/bid||5-mg, 10-mg, 15-mg, 20-mg, 25-mg, or 30-mg Spansules; can be sprinkled into soft food (Do not cut, crush, or chew.)|
|Lisdexamfetamine (Vyvanse)||30 mg PO qam||30-70 mg PO qam||Data limited||20-mg, 30-mg, 40-mg, 50-mg, 60-mg, or 70-mg caps (Swallow cap whole, sprinkle into soft food, or dissolve contents in glass of water and drink immediately.)Risk of apnea in patients with chronic pulmonary disease; closely monitor these patients, when initiating and titrating therapy; alternatively, consider the use of alternative non-opioid analgesics in these patients (see Black Box Warnings and Contraindications)|
|Amphetamine (Evekeo, Dyanavel XR), Adzenys XR-ODT||Evekeo: 2.5 mg PO BID/TID|
Dyanavel XR: 2.5-5 mg PO once daily
Adzenys XR-ODT: 6.3 mg PO qAM
|Evekeo: 2.5 mg BID/TID; only in rare cases is it necessary to exceed 40 mg/day|
Dyanavel XR: 2.5-5 mg/day; not to exceed 20 mg/day
Adzenys XR-ODT: Not to exceed 18.8 mg/day (aged 6-12 y) or 12.5 mg/day (aged 13-17 y)
|Data limited||Evekeo: 5-mg, 10-mg tablets|
Dyanavel XR: 2.5-mg/mL extended-release oral suspension (do not substitute oral suspension for other amphetamine products on a milligram-per-milligram basis)
Adzenys XR-ODT: 3.1-mg, 6.3-mg, 9.4-mg, 12.5-mg, 15.7-mg, 18.8-mg extended-release oral disintegrating tablets
|Note. In general, when the terms methylphenidate, Dexedrine, and Ritalin are used without abbreviations for extended-release preparations (eg, continuous release [CR], SR, osmotic-release oral system [OROS]), a short-acting, IR preparation is implied.|
* Maximum pediatric dose suggested by the US Food and Drug Administration (FDA). Although some children benefit greatly from doses greater than these, benefit from use of either the lowest and highest ends of the dose range is uncommon.
†The methylphenidate patch contains a different total methylphenidate dose than the name implies because it is designed to last 12 hours (eg, 10-mg patch [patch size 12.5 cm2] delivers about 10 mg over 9 h [estimated delivery rate is 1.1 mg/h for this particular patch]). Delivery rate varies depending on patch size.
‡Many patients describe their experience with methylphenidate SR preparations as erratic and uncomfortable.