Dear Community,
This past year, after DS13 had a challenging year in 8th grade, we looked at what had been going on with him for the last couple of years academically and for a few years socially. We realized that ADHD had been staring at us in the face. I suppose his 144 FSIQ/151 GAI got him through to a point where he finished MS with 3Bs and the rest As but the classes, for the most part were not difficult, even Honors Core. He really started tanking in Algebra this year even with scaffolding at home and a grading system that was set up for success for most students. Basically, he was learning nothing in class because he could not focus. Really it's a miracle he cranked out a B.
We took him to a pediatric psychiatrist because that we could not get into a neuropsych quickly and we wanted to get a plan in place. since he starts high school with an all Honors course load in mid-Aug. Psychiatrist was equivocal but said based on what DS told him, it seemed like a good idea to start meds. So, he started about 14 days ago on the lowest dose of Concerta (generic). )(NSERT PART WHERE I STEW, CRY, AND PULL MY HAIR OUT TRYING TO DECIDE WHETHER TO GIVE HIM MEDS-WE DECIDED YES) We figured he was mostly inattentive type but seeing him on meds made us realize he was combined. He's had a number of summer enrichment classes as well as an online high school class he takes ahead of time. He has shown a marked improvement in his ability to self-direct, focus, and self-regulate with his work and socially.

He decided on a small private high school rather than the hugemongous highly rated pressure-cooker public school that all his friends are going to that boasts 35 kids+ in most AP classes. The small high school he chose has class sizes of about 21. So I feel good about his ability to have a good classroom experience given the better ratio.

So, he is starting this high school in a month. How will I know if he is floundering and needs a higher dose as opposed to just more help? Or is the point for him to improve his EF on his own with the meds? Will he know he needs a higher dose?
Should I resign myself to keeping him on the lowest dose and just scaffolding him with tutors and other help if needed? Are there signs I can look for?

We really want to keep him on the lowest dose because he is a 6 ft tall 112 lb 13 year old. He has lost what was a voracious appetite. I've read all the advice and feed him well in the morning and evening when his appetite returns. He needs to keep his weight on if at all possible.
Insight? BTDT?
Thank you in advance. I truly appreciate it.

My understanding is that the lowest dose often is not enough. You probably did a number of questionnaires before his diagnosis that output a score. There are also follow up forms that help decide if the med is working or not. Also, I would think at 13, DS should be able to have an idea of whether they are working (combined with what you see behaviorally, grades, etc.)

You may be able to call and ask for a higher dose on a trial basis. In addition, if his weight becomes an issue, there are other types of drugs that may work without affecting hunger as much. I have been told that these can work differently on different individuals. You also may want to ask if you can skip pills on weekends.

That all being said, I would address your concerns with the prescriber, or whoever is in charge of doing the refills.

You are very kind to respond. I great appreciate it.

I think all you can do is try the next higher dose and try to get input from him about how much more it helps. If it doesn't help much more, go back to the lower dose. In terms of the appetite issue, you might want to ask about going to a short-acting dose of ritalin. That way it would wear off around lunch time. He could take the second dose around lunch time, and then it would wear off before supper. But then you have the issue of either needing a third dose or him not being medicated for homework. The long acting doses are terrible in terms of sleep/appetite. But short acting are a pain because then he would need to go to the nurse, remember to take a pill multiple times per day, etc.

I have been off for a while. Thank you blackcat for your kind response.

Anecdata: DS14 has gone back and forth a couple of times over the last 4 months trying to figure out if the double dose of Concerta works better than single. It's had some negative effect on eating, more on sleeping. However, for what it's worth, his side effects don't seem to increase with the double dose.