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Comment & Response
October 21, 2019

Effective Stimulant Dosing in Attention-Deficit/Hyperactivity Disorder—Reply

Author Affiliations
  • 1Charles Perkins Centre Nepean, The University of Sydney, Penrith, New South Wales, Australia
  • 2The Whiteley-Martin Research Centre, Department of Surgery, The University of Sydney, Penrith, New South Wales, Australia
JAMA Pediatr. 2019;173(12):1211-1212. doi:10.1001/jamapediatrics.2019.3820

In Reply We thank Cui and Liu as well as Dravland for their thoughtful comments about our work.1 Cui and Liu point out that we did not include a Chinese study by Zheng et al.2 This omission is unfortunate because it would have partly balanced the overrepresentation of North American data. The study is interesting because although in a cohort of 153 children aged 6 to 12 years the chosen dose range for titration of osmotic-release oral system methylphenidate (OROS-MPH) was 18 to 54 mg/d, after 12 weeks, the mean titrated dose was only 22.8 mg/d, and there were no children receiving 54 mg. Whether this reflects differences in cohort selection, differences in ADHD expression, or differences in treatment is unclear. Another important study that we did not include was the Multimodal Treatment of ADHD (MTA) Study.3 This was because 10% of the included children were titrated onto receiving dexamphetamine because they had significant residual symptoms or adverse effects while receiving methylphenidate and were considered nonresponders.3

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