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Look at life circumstances when ADHD medications stop working :

July 9, 2019

Editor's note:The 2019 AAP National Conference & Exhibition will take place from Oct. 25-29 in New Orleans.

When a patient tells you the stimulant she’s taking for attention-deficit/hyperactivity disorder (ADHD) isn’t working anymore, your first inclination might be to increase the dose or try a different medication.

Not so fast, says Alison D. Schonwald, M.D., FAAP, a developmental behavioral pediatrician and associate professor of pediatrics at Harvard Medical School.

“When we think about medication not working, we need to think of the whole person we’re treating,” she said. “Is it really the medicine not working, or is it life circumstances have changed, new comorbidities have emerged?”

Dr. Schonwald will discuss how to approach such situations during a session titled “Refocusing Care: What to Do When ADHD Stimulants Aren’t Working” from 3-3:45 p.m. Sunday, Oct. 27 (F3204) in rooms 228-230 of the convention center and again from 8:30-9:15 a.m. Monday, Oct. 28 (F4033) in rooms 217-219.

“When stimulants don’t work, it’s not just about finding a higher dose or different stimulant. It’s about understanding what is happening and what I can offer to improve it,” said Dr. Schonwald, a member of the AAP Section on Developmental and Behavioral Pediatrics.

With her own patients, Dr. Schonwald has seen how transitions can affect their functioning. For example, a high school freshman whose stimulant worked well in middle school now has trouble focusing in class and keeping up with homework.

There are several possible reasons for the student’s struggles besides the medication’s lack of effectiveness. Academic demands increase exponentially from middle school to high school. The social milieu in high school also is more demanding. Or the student may have developed anxiety or depression.

“It’s not that they’re having problems because their stimulants aren’t working,” she said. “They are having a problem because they have a new problem.”

Despite having an enormous amount of knowledge and experience, many pediatricians lack confidence in managing behavioral disorders like ADHD, Dr. Schonwald said.

“The goal of this session,” she said, “is that they will be able to more quickly apply what they know to that moment so they can continue to provide the good care they’ve given but feel more confident and more streamlined in their care.”

For more coverage of the 2019 AAP National Conference & Exhibition, visit

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