Myth #6: That’s a Lot of Medicine For a Small Person!

Myth #7: That's a Lot of Medicine For a Little Person!

Some of my friends on Twitter have been following the ADHD Myth series here. I asked for their favorite myths.

From Mobile, Alabama, ADHD specialist James Wiley, MD, responded with one he hears a lot in his practice.

Let’s call it Myth #6: That’s a Lot of Medicine For a Small Person!

He explains:

The dose of stimulant medication is not dependent on the size of the individual.

Sometimes little guys absorb the medication poorly and metabolize it quickly.  So, they require higher doses than big guys that absorb well or metabolize more slowly.

I have 300-pound offensive linemen well-controlled on small doses and little gals on high doses! One size doesn’t fit all!

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16 thoughts on “Myth #6: That’s a Lot of Medicine For a Small Person!”

  1. Diagnosed with ADHD at 17, and was lucky to get a perscription for Vyvanse a week later. Slowly bringing my dose up, neither I nor my family and friend’s noticed any difference until I reached the dose of 60mg. It worked amazing, until my sleeping disorder started interfering and we had to up my perscription to 70mg. At every doctor appointment since than (not including my perscribing doctor) I have faced at least one comment being made about how high my dose is. “Is this a typo?” “Can you confirm your vyvanse dosage, I don’t think we have the correct one in here.” “Thats a high dose, have you considered lowering that?” “I honestly didn’t know they went that high.” And I even had to switch pharmacies as my previous one claimed they didn’t even keep the amount needed for a month supply of my dose on their property and they couldn’t fill it for me.

    I’m 5’3″ , 123lbs, and we are now adding a 10mg tablet of adderall for me to take in the afternoon as my doctor isn’t allowed to go higher based on information from manufacturer of vyvanse themself.

    1. HI Alivia,

      Seems you might be a rapid metabolizer. Your doc’s never heard of that, I suppose……

      But have you tried a SECOND dose, after the first wears off? Many (most?) MDs don’t think of this.

      Also, many believe you can increase the dosage to make it last longer. Nope.



  2. I’ve been on medicine for my ADD/ADHD since I was 5 now 33 I’m 4’11” and 105lbs I take 40mg of instant release Adderall a day. So size does not matter!

    1. Betsy Davenport

      When my child was thirteen or so, she took medication around the clock or could not sleep. Her smart psychiatrist understood the problem, and said more than once her liver must be made of strong stuff, because the dosage she had to take in order for it to do the job in her brain was more than he or any pharmacist said they had ever seen a child take.

      And, she was most certainly not over medicated. We got to that point a time or two, and backed off. It was completely apparent, with a great slowing of cognition, which resolved as the medication was metabolized. She might have weighed 95 pounds and took something like 240 mgs of Vyvanse in a 24 hour period. So what.

    2. Hi Betsy,

      Wow, that must have been a trick to get approved by insurance.

      BTW, I thought of you last night, at a talk by William Walsh, PhD, author of Nutrient Power.

      I’ll post the videotaping when it comes online.


    3. Betsy Davenport

      Those were the days when her Kaiser pediatrician and Kaiser neurologist put their heads together and decided they would sign off on whatever our paid-out-of-pocket child psychiatrist wrote.

      Until the day someone in the echelons of Kaiser must have audited random charts, and the pediatrician was livid, throwing accusations at her/us for abusing meds, etc. etc. It was a most ugly and unforgivable scene. We never went back. It was such a breach of trust and, to me, a clue that he hadn’t been paying attention all along, and that he didn’t trust US. Not a relationship to try to rescue when you’re living a beleaguered life already.

      No regular insurance company will pay for that, and for all I know, Kaiser wouldn’t either, nowadays.

    4. Probably the pediatrician just wanted to stay employed.

      Here in the Bay Area, KP made ADHD a “low priority” for adults.

      It’s gotten better in recent years, thank goodness, but only with specific Mds.


    5. Betsy Davenport

      That SF “low priority” for adults with ADHD thing at Kaiser served my brother ill. In spite of having two siblings both with ADD and in the field professionally, he has been woefully un-helped.

  3. Betsy Davenport

    I have explained this to many skeptics, including some with the letters, “MD” after their names. Discouraging.

  4. Our first doc told Dr. Math/The Vulcan that he had, “The most severe case of ADHD he’d ever seen,” and that he “had no idea how [Dr. Math] was able to get a PhD.” Seriously.

    Dr. Math takes a lower dose of MPH than I do. 😛

    1. My doctor said that to me. It’s an odd thing to say. Was he in Orange County?

    2. HI Carrie,

      MDs everywhere say it, being unclear on the concept of these medications. 🙂


    3. There’s another thing that definitely DOES NOT affect how much medication is requied–the ‘severity’ of the ADHD. The previously mentioned 300# offensive lineman (seriously, this is big dude) is also one of the most hyperactive guys that I’ve treated. He is on very low doses.
      My collegues are well meaning but we were never trained to take care of ADHD. Those of us who know these things have learned from a precious few mentors and the School of Hard Knocks–which is brutal (but often effective) teacher! We have to change that! Focus-MD and I are committed to making that change and I appreciated Gina and her passion for evidence based medicine. She is a great advocate!

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