If the teacher is pushing you to prescribe more stimulants for a child, he or she obviously feels that the treatment isn’t working. The best thing to do in such circumstances is to find out exactly what the problem is. If the behaviour and attention span is still problematic, there are several things to consider, such as:

• Is the dose of medication indeed optimal?
• Has the child grown or gained a lot of weight, necessitating a higher dose?
• Is there an alternative medication that hasn’t been tried?
• Is the child on other meds that are causing an interaction?

Keep in mind that there may be factors that medication isn’t able to address. For instance, the child may be dealing with bullying at school or parental conflict at home. If the dose is optimized and the pupil has tried more than one medication, you might want to look for an alternative diagnosis or a comorbid condition that’s complicating the picture. Consider depression, bipolar disorder, anxiety disorder, conduct disorder or oppositional defiant disorder. If none of this applies, a consultation with a specialist in child psychiatry may be in order, preferably someone with expertise in ADHD.

Regarding pressure to over-prescribe stimulants, remember that the teacher doesn’t bear the medico-legal risk. You must do what you think is reasonable practice. If ADHD is indeed the problem and the child is receiving an appropriate dose, then prescribing more simply won’t help, and the teacher should be educated about this.

There are additional approaches for ADHD that can complement medical treatment. There’s educational support such as one-on-one teaching, use of technology, etc. Social skills training is often helpful. Finally, a counsellor who can help the student understand and deal with the problems caused by ADHD is tremendously useful.