When and How Should We Adjust Treatment?

How Do We Know the Treatment Is Working?

Almost no one gets it right on the first try. Research shows that most ADHD treatment plans need liberal up-front tweaking. Use this ADHD rating scale to detect early warning signs that symptoms are no longer under control.

An out-of-control child whose parent isn't properly monitoring her medication
An out-of-control child whose parent isn’t properly monitoring her medication
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A Moving Target

Whether a child's ADHD treatment plan includes medication, neurofeedback, and/or vitamins and supplements, tracking progress and setbacks is absolutely critical. Parents can typically assess a rise or fall in inattentive or hyperactive-impulsive behavior at home, but what goes on outside the home can be a mystery. The ADHD Monitoring System describes what you need to know, and how you can work with your child's teacher to learn it. Find out more about it here.

Different ADHD medications that require monitoring
Different ADHD medications that require monitoring
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Is It Working? What About Now?

When a child starts a new treatment plan, parents and health care providers normally set goals related to academic, behavioral, or social functioning – whatever specifically needs improvement. Determining whether the treatment plan is moving a child closer to these goals is critical for a child's long-term success. However, parents need to recognize that a child's response to treatment can and does change over time. If things are going well in January, come February, the situation may have changed. Which is why careful monitoring and tracking is so key.

A doctor filling out a medication monitoring form
Doctor filling out form on clipboard
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Monitoring Treatment

Learning how, why, and what to keep track of can help parents ensure that their child has an ADHD treatment plan that keeps symptoms under control, even when growth, hormones, and other changes complicate things.

[Free Expert Resource: The Essential ADHD Monitoring System]

Parents working with their young child on medication monitoring
Photo of excited little girl finishing her homework and get applause from her parents at home
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Why Monitoring is Critical

In a major multi-modal treatment study, researchers examined the effect of both behavior therapy and medication on more than 500 7- to 11-year-olds with ADHD. Most of these children required treatment adjustment within three months. Multiple adjustments over 12 months were common. More than half of the children who received careful monitoring in the study "normalized" their ADHD symptoms. Among children receiving treatment without frequent monitoring, only 25 percent normalized their symptoms.

Doctor discussing medication monitoring with mother and child
Girl at the doctors office with her mother.
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What Is Treatment Monitoring?

Both the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry recommend collecting data systematically at regular intervals (e.g., weekly or monthly), in three primary domains:

  • Academic functioning
  • Behavioral functioning
  • Social functioning
A teacher observing students to help with medication monitoring
Teacher looking at unruly classroom of students
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What Should We Monitor?

When monitoring a treatment plan, parents need to know the following, ideally on a weekly basis:

  • How well are the core symptoms of ADHD (inattention, hyperactivity, and impulsivity) being managed?
  • How well is the child functioning in important domains?
  • Are any adverse effects emerging?
Hands all raised in classroom as teacher discusses medication monitoring
Rear view of a happy little school boy raising his hand in the classroom
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Assessing Behavior at School

Parents need the information below from their child's teacher on a regular basis.

  • How well are inattention and hyperactivity being managed in the classroom?
  • Can your child with ADHD meet expectations and conform to classroom rules?
  • Is he having trouble making friends?
  • Are grades OK?
  • Is your child better in the morning or afternoon?

[Free Download: A Parent's Guide to ADHD Medications]

Children with poor behavior who require medication monitoring
Kids standing in front of chalkboard with drawn faces in front of their faces
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How to Coordinate Monitoring

Though parents initiate treatment monitoring, the cooperation and support of the teacher is essential. Here is how to ensure it:

  • Download the ADHD Monitoring System.
  • Meet with your child’s teacher in person, and ask the teacher to complete the form at the end of each week.
  • Explain that it shouldn’t take more than 5-10 minutes, how it will help you as parents understand how well your child’s ADHD symptoms are being managed, and how it will impact treatment decisions.
A list of adjectives on a medication monitoring form
Medication monitoring form with checkboxes
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Understanding the Monitoring System

Questions 1-12: Assess how well controlled ADHD symptoms of hyperactivity, impulsivity and inattention are on a scale of 1-3. For children whose symptoms are well-managed, the majority of questions should have low scores (a 0 or a 1) circled.

Questions 13-15: These items screen for behavioral, social, or emotional difficulties. When a child’s treatment plan is working, there will be
high scores (2’s or 3’s).

Page 2 of Assessment: This part of the rating form evaluates academic performance based on assigned work completed, general quality of work, and homework completion. The ideal is turning in all assignments and homework.

Teacher working with parents on medication monitoring
Teacher shaking hands with family
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Getting the Teacher's Help

Provide more than enough copies of the ADHD Monitoring System. If your child's teacher is unwilling to provide weekly feedback, ask her to complete the monthly monitoring report. This information can still be quite helpful.

Put a plan in place for completing the form at the end of each month. If your child has more than one teacher provide copies to each one that spends a large portion of the day with your child.

Once they understand parents are trying to improve the child's school performance and the physician is taking their input into account, most teachers are happy to participate. If a teacher is unwilling, parents can ask to add the evaluation to the IEP.

Adults using online medication monitoring program
Three adults using computer
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Monitoring Treatment Online

In addition, parents can use the online treatment monitoring system made available by AttentionPoint. An online exchange of data and observations can make ongoing monitoring much easier. This web-based system allows you to send automatic reminders to teachers and physicians, which is convenient for everyone.

When students enter middle and high school, the web-based system can make it easier to receive feedback from the most important teachers your child has contact with.

Attention Point cannot be used without clinician support. Parents cannot access the data. Through a partnership with CHADD, the clinician can monitor your child's treatment free of charge for a full year.

Stethoscope on a medication monitoring form
A stethoscope. Blue-toned, shallow DOF with selective focus on the head
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Interpreting Feedback

If everything is going well, don't change your child's treatment plan. But if symptoms are uncontrolled, behavior problems are evident, and academic performance is suffering, changes and adjustments may follow. If there are no behavioral or academic issues, but ADHD symptoms are high, pay attention to how your child is doing in the morning and afternoon. If behavior is inconsistent, an adjustment may be necessary. If symptoms are high, but behavior and academic performance is fine, no change may be required.

Speak with your child and her teacher to determine the source of problems during hard weeks. If problems persist, consult with your
child’s healthcare provider to determine the appropriate next steps. In middle and high school, ADHD symptoms may appear to be well-controlled, and the issues to come out as behavioral, social, emotional, or academic difficulties.

How to Treat ADHD in Children: Next Steps

  1. What ADHD medications are used to treat children?
  2. Is ADHD medication right for my child?
  3. What are common side effects associated with ADHD medication?
  4. What natural treatments help kids with ADHD?
  5. What if the medication stops working?
  6. How can I find an ADHD specialist near me?