What do you do when medications just don't work.

Every once in a few years I come across a child whose disorder is so severe and treatment resistant. I am sure every child psychiatrist will at some point have such a patient. Even with today's medications sometimes hardware deficits can be so severe that no combination of medication can bring about reasonable change. This can be a difficult hurdle to cross for both the parent and psychiatrist. The parent might feel cheated that what was hopefully promised was not delivered and the psychiatrist put in a position of not being compitent. Under such circumstances I suggest the medications with the least side effects that have any minimal benefit be used. The child might need the highest level of care for long time. The parent should be supported in every which way and hope that nature takes a different course in neurobiological development.