How do clinicians assess tolerance versus disease progression in ADHD?

When medication seems less effective, clinicians look at several factors before assuming tolerance. They assess sleep, stress, workload, hormonal changes, and mental health, since all of these can worsen ADHD symptoms without any change in the underlying condition. They also look at whether life demands have increased. A dose that worked well during a quieter period may feel insufficient when responsibilities grow. This is not failure or tolerance. It is a mismatch between support and demand. True medication tolerance does happen, but it is less common than people think. Careful assessment helps determine whether adjustments, additional supports, or addressing external factors is the most appropriate next step.