Updated 16 September 2019

What should you do if your child doesn't respond to ADHD medication?

Treating ADHD with medication can be a trial-and-error business. But increasing the dose isn’t always the best idea, according to new research.

Some of the most frequently asked questions about ADHD involve medication – how much should be administered and what do I do if it’s not working for my child?

The simplest course of action may appear to be to increase the dose if the medication isn't having the desired effect. New research, however, indicates that it isn't always the best solution.

An interesting result

Methylphenidate (MPH), a common stimulant which healthcare professionals often prescribe as the first line of treatment for ADHD. While it’s generally very effective, around 30% of children usually don’t respond well to the initial standard dose.

In that case, many parents return to doctors, who then increase the standard dose to improve efficacy. But research undertaken by Karen Vertessen, a medical doctor and PhD student at the Vrije Universiteit Amsterdam and colleagues, suggests that a dose increase may not have the desired effect.

According to a news report, they identified 18 studies with a total of 606 subjects with ADHD, who were grouped into low, medium and high doses of MPH. The results of these studies showed that the medium dose of MPH had the strongest beneficial effect on inhibitory control, while the higher dose did not make the drug work better.

"Scientifically, this is an interesting result. Generally, high doses of MPH do not help the child or adolescent keep their inhibitions under better control – although generally an increased dose does have a greater effect on the core behavioural symptoms of ADHD,” said Vertessen.

What this means

In essence, this research shows that we need to be medically cautious about increasing the dose immediately when a child doesn’t initially respond to MPH. Children are more vulnerable than adults, and there are many more variables and factors that need to be considered.

When doctors prescribe MPH, it’s important to keep a close eye on the child and evaluate every dose. If a higher dose is recommended, it’s vital to make sure that there is actual improvement and not an increase of side-effects.

Dr Kerstin von Plesse, from Centre Hospitalier Universitaire Vaudois, Lausanne, who was not involved in this research, said the following:

"This is an elegant and highly relevant study, which sheds light on an interesting phenomenon which has not received sufficient attention up to now. However, the study does not address the question why some children receive this higher dosage. This is probably due to the lower dose having a lesser effect.

"This means that the findings agree with the clinical reality telling us that children, who do not respond sufficiently to the regular dosages of MPH, require a second more comprehensive diagnostic examination before increasing the medication. In addition, not all children respond to MPH, and so other treatment options should also be explored.

"The conclusion of the study, that we should add neurocognitive tests to the evaluation, may be a highly useful option to further identify academic capacity and behaviour, but should not be a substitute for the clinical evaluation of impulsivity (inhibitory control) during any change of medication."

What to keep in mind when your child receives medication for ADHD

Even though some people are often hesitant to follow the MPH route, new research has shown that medication is beneficial in most cases.

In addition to helping kids calm down and concentrate at school, the research published in The Journal of Adolescent Health also found that the drugs help children avoid many long-term negative consequences associated with ADHD – including depression, substance abuse and even driving problems.

It’s important to reiterate that, while medication plays a successful part in treating ADHD, it should always be administered in conjunction with other treatment methods such as behavioural therapy, according to a previous Health24 article.

If medication is suggested for your child, this is what you can do to eliminate side-effects and make the journey as smooth as possible:

  • Don’t be hesitant to ask plenty of questions about possible side effects and doubts you may have.
  • Keep an eye on your child during the first couple of weeks and note any side effects such as stomach aches or sleeping difficulties.
  • Keep a behaviour diary to see how your child is responding to the medication.
  • Ensure that your child takes the medication exactly as directed by your doctor.
  • Be aware of your child’s diet as it plays a large role in managing ADHD. “Remember that sugar does not add to hyperactivity as much as the additives and colourants in foods and drinks. This does not mean your child can have loads of sugar as it would be unhealthy for anyone's system,” Delia Strondl said in an earlier Health24 article.
  • Stick to a routine as much as you can – use timetables to help remind your children of tasks and homework. This will help eliminate the stress that possible forgetfulness can cause.

Image credit: iStock


Ask the Expert

ADHD Expert

Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation ( She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

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