What do you do when the teacher has a "bad" report?

[pastrygirl]

My 9yo/4th grader has been on ADHD meds for over a year now. It pretty much worked instantly, but we did switch to a different type several months ago to see if he would start eating more. After a few weeks, his behaviors/symptoms ramped up both at home and at school, so we decided (along with his psychiatrist) to increase the dosage. His symptoms include very loud vocal sounds, so that's usually the first tip that something is up. He was on a very low dose for his weight, but up until that point, it was working. Thankfully, the higher dose worked out right away.

It's been a couple of months since he started the higher dose (27mg Concerta). Last week, his teacher emailed me to say he'd had a tough week all week. He was distracted, distracting, couldn't get his work done, etc. He was annoying everyone in the class and making new vocal sounds that she hadn't heard before. Normally when she reports to me, I can say that I'm seeing the same at home (or, sometimes it turns out he didn't take his medication that morning, so I run over to give him a short-acting pill for the afternoon). But his behavior at home is as good as it gets for him; I haven't seen what she's been seeing in school.

I can only think of a couple of things that have changed in the past couple of weeks:
-- 3-day weekend over Easter
-- grandparents visited that weekend
-- we started giving him Nutella on bread for breakfast instead of cream cheese (too much chocolate now?)
-- he hasn't left enough time for his usual 15-20 minutes of Minecraft before school

I'm wondering if it's the Nutella or maybe the lack of Minecraft. Maybe the game helps focus him in the morning? He's started sleeping later, so he doesn't end up with any time to play after breakfast. He needs to gain weight, which is why we started the Nutella. Breakfast is the only big meal we can get into him, so we aim for 400-500 calories. He doesn't eat much after that. He finally gained 4 pounds since January, with the push to feed more fatty foods, after not gaining an ounce in a year.

I'm at a loss about what to do. He sees the psychiatrist once a month, but we had nothing new to report when we saw her two weeks ago. Everything was going well!

[egoldber]

Did you get a different generic at your last refill? There are known issues with some generic forms of Concerta NOT working like the name brand.

[pastrygirl]

Oh! I don't have the last 27mg bottle, but this bottle is the same mfr as the last 18mg bottle. I wonder if I should ask for the brand name.