How do you know when an adolescent with adhd needs his meds raised?

My brother moved in with me back in October, due to family problems.
I have guardianship of him, and he's been doing a lot better, except maintaining his adhd. He was taking adderall xr 10 mg. once daily.
But about a few weeks ago, I started noticing that he was acting the way he usually does without medicine. ( He was taking the adderall xr for a year and four months)
He started getting very short with me, destructive,angry,figits,hard to remember things,not communicating. It was like walking on egg shells.
I have a 17 month old at home with us, and I am seven months pregnant, and I am high risk during this pregnancy. I was told not to be working and not to be in stressful situations. So I spoke to my brother about it, and he said he was fine. Well one night he didn't get what he wanted and the way he wanted. So he freaked out on me, throwing things,slamming his door. Just being a ***. Then an hour or two later he came out and acted like nothing happened. The next week I brought him to go get his permitt and I even helped him study a little. He told me he has been studying so I was like great you should be fine. We went to the DMV and he had such a hard time reading,following directions, and even paying attention. He failed, he got one over the limit you could get wrong. And he came out and started flipping out on me and it went to a level I should've not been in. When I got home I got his report card and the A's went to F's. The teacher put some comments down and asked if i would call her. I did and she explained that jacob is lacking in social skills, reading, writing, effort, can't stay still, argues,rude, blurts things out. So,
I told her i would find out what was going on. I called around to everyone that works with him, and spoke to his old highschools nurse who use to dispense his meds to him. And got an idea of what adhd is all about and what meds he's been on in the past. His counceler told me that it might not be the medicine, it could be something going on in his life, or it could be he's just being an normal teenager. So he advised me to talk with him and maybe leave and go do something for the weekend. So we went fishing and he was a little better but not much. Then when we were there our second day we got a call our mother was on life support. And Jacob acted like he didn't care, he wanted to go hang out for easter vacation with our father. When I got home I called his doc and they got me in this past monday. So we met with the doc, and he asked Jake a few questions and asked him how he felt, and etc. And he believed he needed a med change and a raise. So he started him out with 18 mg of concerta in the morning and then a ridilin 10 mg in the afteroon. The doc told me it was a low dose but see how it does and then call him in a week or two and we can raise it. So he's been taking it since monday and theres no change.

It kind of sounds like you're doing what you need to do, which is talk to his doctor. Sometimes medications can take a full week or longer to kick in. Is this medication being prescribed by a general practitioner or a psychiatrist? Psychiatrists are more knowledgeable about these types of med so I would suggest you see one if you haven't.

you need to take him to the er the next time he freaks out. You r pregnant hi-risk-you don't need to stress. Birth defects are directly related to this. I know he doesn't mean it, but tell the doctor. At least take him to his doctor and demand a raise in his medication.

I promise you from experience and as someone who takes all the medications my doctor tells me to: medications don't work very well! More medications. It seems to be the answer way too much. Everything that's going on with him is not from ADHD. I understand that it can be hard to know what to do, so who do you trust, the doctor with the degree. But really, they don't understand everything about the mind. I take my medications because I want to see if they will prevent me from having a manic episode but so far, after taking meds the doctor has prescribed for 8 years, I haven't seen that the meds have helped me. A therapy session with both of you there talking about the issues and your relationship would probably help the most.