Medication Opens the Door — But the Teacher Is the One Who Teaches
Medication Opens the Door — But the Teacher Is the One Who Teaches
Why your child’s ADHD medication isn’t improving their marks — and what actually will.
Here’s a conversation I have in my consulting room almost every week.
A parent sits across from me, frustrated. Sometimes tearful. Sometimes angry. They say something like this: “Doctor, we’re doing everything right. He’s on medication. It’s working — his teacher says he’s calmer, he’s sitting still, he’s not disrupting the class anymore. But his marks haven’t changed. His reading is still behind. His maths is still a disaster. What’s the point of all this if his grades don’t improve?”
I understand that frustration completely. You’ve fought through the guilt of starting medication. You’ve managed the side effects. You’ve adjusted doses. And now your child is calmer, more focused, less fidgety — but their report card looks exactly the same.
Nothing is going wrong. Medication is doing exactly what it was designed to do. The problem is that everyone — parents, teachers, sometimes even doctors — expected it to do something it was never designed to do.
The Finding That Changes Everything
Research from Florida International University studied 173 children with ADHD in a controlled classroom. On medication, children completed 37 percent more work and committed 53 percent fewer rule violations. They looked like model students.
But when researchers measured how much those children actually learned — how much new content they absorbed and retained — there was no detectable difference between children on medication and children on placebo.
Medication dramatically improved how children behaved. It did not improve how much they learned. This pattern has been confirmed across multiple large studies.
Productivity and behaviour improved. Actual learning — the acquisition of knowledge and skills — requires something else entirely. It requires teaching. Specifically, teaching that understands how the ADHD brain works.
What Medication Actually Does
🖥️ The Computer Analogy
Think of your child’s ADHD brain as a brilliant computer with infrastructure problems. The Wi-Fi drops out. The RAM fills up too quickly. Pop-ups constantly interrupt whatever’s running.
Medication upgrades that infrastructure. It strengthens the Wi-Fi. It expands the working memory. It installs a pop-up blocker.
But someone still has to type.
Or think of it as eyeglasses for the brain. Before medication, the words on the board were blurry. Now your child can see clearly. But seeing the board doesn’t mean they understand what’s written on it. A teacher still needs to teach them.
Medication opens the door. Education walks through it.
The Four-Legged Table
I ask every family to imagine a sturdy table with four legs. Remove one leg and the table wobbles. Remove two and it collapses. Your child’s success rests on all four.
Medication carries the biggest single load. It addresses core brain chemistry. But 40% is not 100%. This is where the misunderstanding lives.
Structure. Routine. Emotional regulation. Consistent boundaries delivered with warmth. Being the co-pilot while they learn to navigate.
Classroom accommodations. Modified instruction. A teacher who understands how this brain processes information. Often the wobbliest leg.
Remedial teaching. OT. Speech therapy. Psychology. The specialists who address conditions sitting alongside ADHD.
Sixty percent of your child’s support sits outside my prescription pad.
To Every Teacher With an ADHD Child in Their Classroom
This isn’t about blame. Most teachers I work with are dedicated and genuinely want to help. The problem isn’t willingness — it’s understanding. You carry 20 percent of this child’s entire support structure. Here’s how to make your 20 percent count.
Available to Learn ≠ Actually Learning
The child is calmer now. Less fidgety. Less disruptive. They seem like they’re paying attention. And they probably are — more than before.
But paying attention and learning are different things. A child watching television is paying attention. They’re focused and engaged. But how much are they learning?
Medication means this child can now receive instruction. Whether they understand what you’re teaching depends entirely on how you teach it. This is the window medication creates. What you teach during that window — and how you teach it — is what determines whether their marks improve.
Check for Understanding, Not Just Completion
When a medicated child completes more worksheets, it’s tempting to think they’re learning more. They’re not — they’re just completing more. That’s medication working on behaviour, not on knowledge.
Ask them to explain what they’ve done in their own words. Look at accuracy, not volume. A child who completes ten problems and genuinely understands them has learned more than one who rushes through twenty and can’t explain any of them.
Pack the Bag Differently
Medication improves focus and impulse control. But working memory — the brain’s ability to hold information while using it — is still smaller than their peers’. This isn’t about intelligence. It’s about capacity.
Think of working memory like a school bag. Most children’s bags can hold a laptop, books, lunch, and a PE kit and still zip up. This child’s bag is much smaller. It fills up fast. When you stuff too many instructions inside, things fall out.
Don’t shout at the bag. Help pack it differently.
One step. Check-in. Next step. Check-in. Written instructions alongside verbal ones. Visual reminders on the desk.
Build the Road
Medication turns on the engine. But an engine needs a road. Structure is that road.
Give advance warning before transitions: “In five minutes, we’re moving to maths. Start finishing up.” The ADHD brain struggles to shift gears. When they don’t immediately switch tasks, it’s not defiance — their brain is still processing the gear change.
Predictable routines. Visual timetables. Consistent expectations. These reduce the cognitive load on a brain that’s already working harder than everyone else’s.
Use Accommodations — They’re Not Advantages
A wheelchair ramp doesn’t give someone an advantage. It allows them to access the building like everyone else. Accommodations work the same way.
Here are the ones that make a real, evidence-based difference:
📍 Seating
Front of class, away from windows and doors, near you for easy prompting. Near focused peers — not near distracting ones.
📋 Instructions
Written AND verbal, provided together. One step at a time. After giving the instruction, ask: “What did I just ask you to do?”
🧩 Work Structure
Break tasks into smaller, visible chunks with a clear end point. They need to see the finish line to get started.
🏃 Movement
Build breaks into the day — not as rewards, but as neurological necessities. Allow fidget tools. Movement helps this brain think.
⏱️ Time
Extended time on assessments. Their brain processes at a different speed. The knowledge is there — the processing just takes longer.
📂 Organisation
Check homework diary daily. Provide written copies. Allow photos of notes. Colour-coded folders. Two sets of textbooks if feasible.
📝 Assessment
Reduced visual clutter on papers. Fewer items per page. Allow oral or typed answers. Reduce quantity while covering the same content.
💬 Feedback
Frequent, immediate, and specific. Not “good job” but “You stayed focused through all five problems — that took real effort.”
These aren’t special favours. They’re how this brain accesses the same curriculum as everyone else.
Watch Your Language — It Shapes Their Self-Belief
Children with ADHD have typically absorbed years of negative messaging by the time they reach your classroom. Your words carry enormous weight.
A child who feels safe in your classroom will take risks with learning. A child who feels judged will shut down — no matter how good their medication is.
Know What You Can’t Fix — and Who Can
Up to 80 percent of children with ADHD have at least one co-existing condition. Medication doesn’t touch these. Think of it like apps running in the background on a phone. ADHD is one app. But anxiety.app, dyslexia.app, and sensory_processing.app might all be draining the battery too.
Watch for these signals:
Your role isn’t to diagnose these. Your role is to notice them, communicate what you’re seeing to the parents and learning support team, and reinforce in the classroom what the specialists are building in their sessions.
When the Table Has All Four Legs
I’ve seen it hundreds of times. A child on the right medication, with parents who provide consistent structure, a teacher who understands and accommodates, and the right therapeutic support in place — that child doesn’t just cope. They surprise everyone. Including themselves.
Their marks improve — not because medication made them smarter, but because the entire system is working together. The medication made them available. The teacher taught them. The parents supported them. The therapists addressed what was hidden beneath the surface.
And I see the opposite just as often. Excellent medication. Supportive parents. But a classroom where the teacher doesn’t provide accommodations and interprets the child’s difficulties as laziness. No remedial support for reading. No OT for handwriting. No one addressing the anxiety.
That child’s marks don’t change. Their anxiety grows. Their self-esteem erodes. And someone says: “Maybe the medication isn’t working.”
The medication is working. It’s carrying its 40 percent. But 40 percent can’t hold a table on its own.
A Message to Parents
If your child is on medication and their marks haven’t improved, don’t panic. Don’t assume the medication has failed. And don’t increase the dose hoping more medication will produce better grades — it won’t. Instead, check each leg of the table.
- Leg One — Medical. Is the medication right? Is the dose optimised? Have comorbidities been assessed? Ask your paediatrician.
- Leg Two — Home. Are you providing structure and routine? Breaking homework into chunks? Responding with patience? You’re probably doing more than you realise.
- Leg Three — Educational. Does the teacher understand ADHD and how it affects learning, not just behaviour? Are accommodations actually in place? This is often where the gap is.
- Leg Four — Therapeutic. Have learning differences been assessed? Is OT, speech therapy, or psychological support needed? Are these professionals communicating with the school?
If any leg is wobbly or missing, that’s where progress is getting stuck. Not in the medication. In the missing support.
Quick Win This Week
Have a conversation with your child’s teacher. Not about marks. Not about behaviour. About understanding.
- Open with partnership: “My child’s medication is helping them be calmer and more focused. But I want to make sure we’re also giving them the classroom support they need to actually learn and progress. Can we talk about what accommodations might help?”
- Ask specifically: “Are instructions being given one step at a time? Is there a visual schedule? Does my child have extra time? Is their seating helping them focus?”
- Be specific about your child: Not “she has ADHD” but “she can focus now with medication, but she still needs instructions broken into single steps because her working memory fills up quickly.”
- Offer to share resources: If the teacher seems unsure, offer information from your paediatrician or psychologist. Suggest a meeting with the learning support coordinator.
That single conversation — positioning yourself as a partner, not an adversary — can strengthen the wobbliest leg of the table overnight.
Remember This
Your child’s success doesn’t rest on medication alone. It never did.
Medication is the most powerful single leg — roughly 40 percent of the load. But a table cannot stand on one leg, no matter how strong.
When all four legs are solid — the right medication, consistent home support, a teacher who understands and adapts, and specialist intervention for the conditions alongside ADHD — children don’t just manage. They thrive.
Your child’s brain isn’t broken. It’s wired differently. The medication has opened the door. Now let’s make sure someone is teaching on the other side.
Forty percent is done. Let’s build the other sixty.
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