### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I have a 14 yr old daughter who has been diagnosed as Borderline Intellectual Functioning by a local Psychologist. She was diagnosed as ADHD at about 7 yrs old. She struggles in school and social environments (common, I know). She is very impulsive and has a tense relationship with her siblings. She is currently being treated by a Psychiatrist and we have previously had her in counseling for her behavior. She has been on numerous medications (stimulants) and is now using a non-stimulant Strattera. We don t really see any change. Methylphenidate seemed to work best for the longest period of time in her life, but through puberty, it seems to have little affect now. We feel as if we are running out of options and we want her to be happy in her life. We re also afraid that her siblings will end up resenting or disliking her, due to her behavior. She has a 16 yr old sister and 3 x 11 yr old siblings (2 brothers and 1 sister--triplets). So there is plenty in our house to lose focus on. I also (Dad) have been diagnosed as ADHD, so I fully understand where that came from. I would like your opinion on other potential treatment options: medication (stimulant, non-stimulant, combination; non-medication, etc.)? Thank you.

### output:

Hi, thanks for the query. It seems that you are having a lot of trouble with daughter right now. If ADHD remains incompletely treated, it does a toll on children self-esteem also & too many times, in a desire to get noticed, get some appreciation, child engages into undesirable behaviors which are at present your main concern. We need to formulate a multimodal treatment plan for her consisting of medications+ parent teacher management training (PTMT). If methylphenidate has worked for her & if there are no contraindications for methylphenidate, we can shift from atomoxetine (strategy) back to methylphenidate & hike the dose to maximum 60 mg/day. As a part of parent teacher management, we can engage into token economy, contingency management, role plays, time out etc. which are taught by Psychologist to both the parents & teachers in school. Hence, do contact your Psychologist for PTMT; if you need further help do revert to me. Good Luck