Attention-deficit/hyperactivity disorder (ADHD) is common: about one in nine U.S. children has received the diagnosis.1 For children aged 6 and older, guidelines recommend FDA-approved medication together with behavioral therapy.1,2 However, many children do not stay on ADHD medication long-term: one study found about two-thirds of children and fewer than 50% of adolescents remained on any ADHD medication one year after starting.3 Choosing the right stimulant often involves trial and error as even medications with the same active ingredient can deliver that medication differently, resulting in differences in symptom management throughout the day. One small study suggests that the initial medication prescribed might be linked to how long a patient remains on ADHD treatment.4 However, little is known about how which initial long-acting stimulant is prescribed might influence how long a child stays on that ADHD treatment and whether their age at initial prescribing makes a difference.
We studied 682,112 U.S. children aged 6–17 with an ADHD diagnosis who started a first long-acting stimulant between January 2018 and December 2025. We excluded children with narcolepsy or binge-eating disorder (conditions that some of these stimulants are also used to treat) and those who switched to a different long-acting stimulant within the first seven days. We checked whether children remained on their starting medication at six months, one year, and two years. We considered a child remaining on their medication if an order or pharmacy dispense was recorded at least every four months without discontinuation.
Children were much less likely to stay on their initial long-acting ADHD medication as time passed: about 58% did so at six months, 37% at one year, and 21% at two years. Among the eight most commonly used products, two-year rates were highest and very similar for Focalin XR, Concerta, Vyvanse, and Adderall XR (about 21%–22%). Rates were lower for the less commonly prescribed Metadate CD, Ritalin LA, QuilliChew ER, and Quillivant XR. Generic equivalents for each medication are considered prescriptions for the brand name medication in this analysis.
Older children were generally less likely to stay on their initial medication, especially at the two–year mark. The pattern was not a steady decline from age 6. Six-month persistence peaked at age 11 (60.3%), one-year persistence at age 8 (39.8%), and two-year persistence at age 7 (23.8%). After these peaks, persistence declined with each additional year of age with about 12% of 17-year-olds remaining on their initial medication for two years. Six-month rates varied less across ages, from 54.5% to 60.3%.
This analysis does not evaluate why a patient discontinued their initial ADHD medication. This study does not account for other mechanisms of ADHD treatment or whether a child took the medication as prescribed. Insurance coverage and prescribing preferences can influence which product a child starts and whether they switch or stop taking a medication. Additionally, medication supply shortages first announced by the FDA in October 2022 could influence whether a prescription was changed or discontinued.5,6 Some providers might recommend planned breaks from stimulant use, such as during summer holidays, but we attempted to minimize the potential impact of this by only counting a prescription as discontinued if more than four months passed between refills or orders.
