When Treatment Isn’t Working

Like all other kinds of medicine, some mental health and learning disorders are harder to diagnose, and harder to treat, than others.  

Since there are no blood tests to determine if a child has ADHD or OCD, clinicians depend on measures of behavior. And many behaviors can point to several different underlying disorders.  

If a child is having trouble concentrating in school, for instance, he could have ADHD. But he could also be very anxious. Add to this the fact that some children have multiple disorders — autism and ADHD for instance, or anxiety and depression. All of this contributes to the fact that sometimes the first diagnosis you get is not accurate. And the first treatment is not always effective. 

How do you know when it’s time to look for a second opinion, or different treatment options? 

• If you have poor communication with your clinician. If you feel that you don’t understand the diagnosis or the treatment, or that they don’t listen to your concerns or answer your questions, you need to find an alternative. It’s important for your child that you and the professionals you work with are all on the same team. 

• If your child — especially your teenager — doesn’t have a comfortable relationship with his clinician. For successful treatment, your child needs to bond the therapist trying to help them. If they’re not willing or able to talk about their feelings and experiences, the clinician can’t effectively tailor the response. 

• If the clinician doesn’t seem to have enough training or experience with the diagnosis or the treatment.  Specialized behavioral therapies like exposure and response prevention (for OCD) or habit reversal (for Tourette’s) have been shown in studies to work in a specific sequence. Vague approximations are likely to be less effective. Similarly, medications are best prescribed by a clinician who has a lot of experience with getting the right dose, managing side effects, and adjusting over the long term. 

• If the clinician proposes medication for your child without giving you a clear diagnosis. Trying medications to see if they work, without understanding what the problem is, can lead to ineffective treatment.  

• If your child is struggling and your clinician is adding one medication after another. When kids are on multiple medications, it’s easy to lose track of what’s working and what’s not. When kids are given medications to alleviate side effects of other medications, it may be time to get a second opinion. 

• If your child isn’t responding to treatment. This may mean that the diagnosis was wrong, and you need to seek a new, broader evaluation. It could also mean that there are several disorders involved, and they need to be identified and treated separately. 

• If the medication your child is on is not alleviating his symptoms, the first step is to make sure that you’ve given it enough time to work—some kick in more quickly than others. You also want to make sure that your clinician has tried adjusting the dosage. Sometimes it takes time to get the dosage up to an effective level. If you’ve done those things and you’re not seeing results, it may be time to explore alternatives. 

• If the medication your child is taking has problematic side effects, the first thing to do is to make sure the dosage isn’t too high. If that doesn’t solve the problem, you should look into other options. 

• Adding medications is something clinicians should do with great care. It’s not unusual for children to take two or more medications, because it’s common for children to have several disorders: for instance, kids with ADHD may have anxiety or depression. You want an experienced clinician if you are combining medications, and it’s generally not a good idea to add medications to counter side effects of the first one. 

Return to Connect to Care for more information about getting kids help.