Introduction
ADHD is a complex disorder in which functional impairments occur both
at home and school as well as other contexts. To facilitate optimal
outcomes for students with ADHD, clear and frequent communication
between home and school is essential.1 Communication may involve initial concerns, school-based intervention strategies, and progress monitoring.
Communication is critical to building solid relationships between
home and school. For instance, to help a child with ADHD, parents and
teachers need to understand the unique demands and needs associated with
each context. Moreover, given the chronic and impairing nature of ADHD,
it is essential that this communication is positive and supportive and
that it encourages the planning and monitoring of interventions across
both settings. Parents are a great resource for teachers regarding the
student's interests and educational history. Likewise, teachers can
provide parents with clear descriptions of the actions that they are
taking to help the student succeed in the classroom (for example,
teaching the student how to use a homework planner) and how they will
monitor the students' progress.
There are a number of ways for teachers and parents to communicate
with each other, including phone calls, newsletters, log books, notes,
informal visits, conferences, and report cards.2
Parents may have preferences regarding the nature and frequency of the
communication. That is, some parents may prefer a structured
school-to-home notebook system in which communication occurs on a daily
basis, whereas others may prefer alternative forms of communication on a
less frequent basis. Moreover, given that ADHD is a highly heritable
condition (in other words, a child with ADHD may also have a parent with
the symptoms), the type and quality of communication between the two
settings may be affected
For students with ADHD, parents and teachers may find it useful to
set up a Daily Report Card (DRC). Evidence suggests that DRCs can help
the student, parents, and teacher monitor progress towards goals, and
goal attainment can be reinforced either at school and/or by parents.
However, it is important to consider several factors before using
school-to-home notes:2
- Teachers should discuss this method of communication with parents to determine whether they would find it useful.
- Communications should be clear and positive.
- Situations that require a problem-solving approach should be
handled by a different type of communication, such as an informal
meeting or a phone call.
Children with ADHD frequently experience difficulty with their homework.3
These troubles are important to address, as they can negatively affect a
child's academic achievement. Researchers have found that children with
ADHD frequently:
- forget to record the homework assignment
- forget to bring the materials that they need to complete homework
- put off starting homework at home
- tend not to persist or stay focused on the homework assignment
- may complete the homework in a careless manner
- forget to hand in assignments that are completed
These early homework problems may be the result of weaknesses in receptive language, memory, or organizational skills.4
However, as students get older, homework problems may become more
problematic as assignments increase in complexity and in the amount of
independent work required.
Research on homework practices
It is important for all students, but particularly for students who
are struggling academically, that homework is matched to the student's
abilities in terms of difficulty level and length of time to complete.5
That is, students should be able to complete homework assignments with a
high degree of accuracy. In addition, other strategies that have been
used successfully with students to improve homework completion are:
- graphing of homework completion
- cooperative study teams
- homework planners and teaching students how to use them
- real-life assignments
- family involvement
Students who struggle to complete homework, including students with
ADHD or learning disabilities, may require additional skills instruction
to help them complete assignments. For example, one study provided
explicit instruction to students with learning disabilities.4 In this study students were taught how to:
- accurately record an assignment
- plan how much time would be needed to complete an assignment
- organize their materials
- start and check their work
- keep track of assignments
In these explicit classes, the instructor first modelled each of the
strategies. Then the students orally rehearsed the tactics and used them
in guided practice under simulated conditions.
Students with learning disabilities may acquire and utilize
strategies that foster organization and homework completion, but only
when they are presented in a direct and supported manner. Likewise,
children with ADHD may require similar levels of explicitness and guided
practice in using homework planners. These students may also benefit
from graphing their homework completion, as this process helps
self-monitor performance.
In addition to the above strategies, students with ADHD may also need
enhanced reinforcement systems (such as token economies or behavioural
contracts) to address homework completion problems.5 Teachers may wish to refer to the book Homework Success for Children with ADHD: A Family-School Intervention Program5 for more ideas. In this program the following strategies are taught:
- how to setup a system for reporting homework assignments
- how to setup establish a homework routine
- how to give effective instructions
- how to implement positive reinforcement strategies
- time management and goal setting
- how to use punishment effectively
- how to maintain homework strategies and skills
In this program, collaboration between home and school is stressed as
well as the importance of monitoring progress to see if the program is
meeting the stated objectives.
Information is provided here about the medications that have been
officially approved for the treatment of ADHD by federal regulators of
drugs, such as:
- Health Canada
- FDA (Food and Drug Administration), U.S.A.
- EMEA (European Medicines Agency)
- MHRA (Medicines and Healthcare products Regulatory Agency), UK
There are two main types of medications used to treat children,
adolescents, and adults with ADHD: stimulant medication and
non-stimulant medication.
Stimulant medications
Stimulant medication, particularly methylphenidate (Ritalin®), has been the most widely used medication in the treatment of ADHD for the past four decades.6
Its beneficial effects on children's behaviour and school problems were
discovered serendipitously by Dr. Charles Bradley in 1950. He was using
one of the earliest types of neuroimaging techniques
(pneumo-encephalogram, which is no longer in use) to study the brains of
children with behaviour disorders. One problem was that this procedure
produced severe headaches in many of the children. So he used one type
of stimulant medication (an amphetamine) that was involved in regulating
pressure in the brain's ventricles, which he thought might alleviate
the headaches. To his surprise, most of the children showed marked
behavioural improvements and about half showed improved schoolwork.7
These children referred to the pills as "math pills" because they were
able for the first time to sit and complete their math sums! These
findings marked the start of the use of stimulant medication to treat
children with persistent and impairing symptoms of inattention,
hyperactivity, and impulsivity — what is now called ADHD.
Mechanism of action of stimulant medications (how they work)
There are two classes of stimulants:
- Methylphenidate-based drugs
Most of what is known about stimulant medication has come from
studies of methylphenidate. Over 1500 randomized controlled trials have
shown that methylphenidate is effective for the majority of children,
adolescents, and adults with ADHD. The most widely used form of
methylphenidate is Ritalin®; more recent forms include Concerta®, Metadate-CD®, and Focalin®.
- Amphetamine-based drugs
Amphetamine medications are considered equally effective as the
methylphenidate-based medications. Response to one type of stimulant
medication does not predict response to the other. However, some
individuals respond more favourably to one class of stimulant medication
than to the other. Commonly used forms of amphetamines for ADHD are
Adderall® and Dexedrine®.
Stimulant medications used in the treatment of ADHD work by
increasing the levels of brain chemicals (neurotransmitters, such as
dopamine and norepinephrine) that help transmit signals between nerves.
For example, methylphenidate has been shown to increase dopamine levels
in the brain, which enhances the ability to distinguish signal from
noise and increase the saliency of stimuli.8 9
These research findings are relevant for the classroom setting. For
example, many students with ADHD claim that most schoolwork is boring.
Treatment with methylphenidate increases their dopamine levels, which in
turn would increase the saliency of the task (suddenly it would appear
interesting) and improve their performance. This is exactly what has
been shown to happen in randomized controlled clinical trials;
children's academic productivity is far greater when being treated with
methylphenidate compared to when those same children are given placebo.10
Effects of stimulant medications
With these medications, individuals with ADHD are better able to
focus and ignore distraction. This can help them regulate their own
behaviour and thinking. In the classroom, students with ADHD may be less
fidgety, less emotional, and better able to concentrate when they are
being treated with stimulant medication. Also, they may be able to get
more work done and experience better relationships with others, so they
may get along better at school and at home.11
However, students with ADHD are likely to have missed out previously
on a lot of instruction and may also have learning problems. Medication
cannot solve these problems and so adaptive, tailored academic
instruction is essential for these students to succeed in school,
regardless of whether or not they are being treated with medication.
Also, it is unclear whether medication treatment for ADHD improves
academic achievement (as measured by standardized tests) over the longer
term in students with ADHD.
Duration of effects of stimulant medications
The two major classes of stimulants vary in how long the beneficial
effects last, and can be classified broadly as those with longer
duration versus those with shorter/intermediate duration of action (see
Tables 8-1 and 8-2). Stimulant medications for ADHD are usually given in
the form of pills or capsules that need to be swallowed and not chewed.
However, for children who have difficulty swallowing pills, some types
of stimulant medication come in capsules that can be opened and the
contents sprinkled on or mixed with food, such as apple sauce or
yoghurt.12
Table 8-1: Short-Acting Stimulants*
Trade Name |
Class of Stimulant |
Duration of Action |
Can Open Capsule and Sprinkle on Food |
Need for School Administration |
Adderall® |
amphetamine |
4 to 5 hours |
No |
Yes |
Dexedrine® |
amphetamine |
4 to 5 hours |
No |
Yes |
FocalinTM |
dexmethylphenidate |
3 to 4 hours |
No |
Yes |
Ritalin® |
methylphenidate |
3 to 4 hours |
No |
Yes |
* Stimulant medications have been listed in alphabetical
order. Note that not all of these forms of stimulants have been approved
in Canada or in countries other than the U.S.A.
These short-acting stimulants are taken at three- to four-hour
intervals, usually about 30 minutes before the previous dose wears off.
This means that students have to take the pills at school, either at
lunchtime or at another time during the day. Note that if the student
took the first dose at home upon waking or very early in the morning
(6:30 or 7:30 a.m.), the beneficial effects will start to wear off well
before the lunchtime recess, when it is common for schools to administer
the second dose. Likewise, the beneficial effects of a dose given at
noon will start to dissipate by around 3:00 to 4:00 p.m. — a time of
transition, coinciding with after-school daycare or activities,
transportation by school bus, and unsupervised time en route home. This
means that the student's behaviour and ability to concentrate may
deteriorate before the next dose can be given. If this situation arises,
it should be discussed with the parents, so that they can explain the
difficulty to the prescribing physician.
Notwithstanding the practical problem associated with the need for
multiple doses per day, short-acting drugs are useful in many ways.
First, they do help control many children's ADHD symptoms and the dose
can be adjusted easily, so medical treatment guidelines recommend that
doctors start with the short-acting stimulants before switching to a
longer-acting type.12
Also, doctors may prescribe a short-acting stimulant in the afternoon -
after the longer-acting stimulant wears off — so the child can
participate in after-school activities or have quieter evenings at home.
The past decade has witnessed the development and approval of
longer-acting preparations of methylphenidate and amphetamine for the
treatment of ADHD in children, adolescents, and adults. The main goals
of this drug development are:13
- to eliminate the need for multiple doses per day (particularly the
need for a mid-day dose, which often has to be given at school)
- to minimize the "roller-coaster" on-off effect of the short-acting stimulants
- to enhance the clinical utility of longer-acting forms
Table 8-2: Longer-Acting Stimulant Medications for ADHD*
Trade Name |
Class of Stimulant |
Duration of Action |
Can Open Capsule and Sprinkle on Food |
Need for School Administration |
Adderall XR® |
amphetamine |
10 to 12 hours |
Yes |
No |
Concerta® |
methylphenidate |
10 to 12 hours |
No |
No |
Dexedrine® Spansule |
amphetamine |
8 to 10 hours |
No |
Possibly |
Metadate CD® |
methylphenidate |
8 hours |
No |
Yes |
Metadate ER® |
methylphenidate |
3 to 8 hours |
No |
Possibly |
Methylin ER® |
methylphenidate |
3 to 8 hours |
No |
Possibly |
Ritalin-LA® |
methylphenidate |
10 hours |
Yes |
No |
Ritalin-SR® |
methylphenidate |
3 to 8 hours |
No |
Possibly |
* Stimulant medications have been listed in alphabetical
order. Note that not all of these forms of stimulants have been approved
in Canada or in countries other than the U.S.A.
Because the effects of some of these longer-acting stimulants can
last up to 10 or 12 hours, a student can take one pill in the morning
before coming to school and generally does not need to take another pill
at school. Longer-acting stimulants may also help children get through
after-school activities. Some children, however, may need a second dose
or a shorter-acting form of a different drug if the medication takes
longer than expected to take effect in the morning or the effects wear
off too quickly during the school day.
Side effects of stimulant medications
More than four decades of clinical application have demonstrated the
efficacy and safety of methylphenidate and amphetamine-based stimulants.
But like all medication, methylphenidate and amphetamine have some side
effects (unwanted effects). Not everyone will experience the side
effects, but it is not possible to predict who will and who will not. So
it is useful for teachers (as well as parents and the children with
ADHD themselves) to know what side effects stimulant medication may
cause, so that they can report observed side effects to the parent or
physician. Physicians have several strategies for reducing or
eliminating side effects of stimulant medication, including changing the
dose, adding or omitting a dose, switching to a different stimulant,
switching to another type of medication, or using an alternative or
adjunctive non-pharmacological treatment approach.12
The following common side effects may occur in up to 20% of children
with ADHD, but they are usually very mild and do not last long (they
start to decrease within 30 minutes to two hours and disappear
completely within 24 hours and when medication is stopped):
- stomach discomfort
- headache
- sadness
- irritability
- tendency to cry more
- rapid heart rate and increases in blood pressure
- difficulty falling asleep (so that the student may be very sleepy and cranky at school)
Effects of stimulant medication on children's growth are not fully
understood. Concerns about the effect of prolonged treatment with
stimulant medication on growth (that is, on height and weight gain) have
been raised repeatedly in the past three decades, but as yet there are
few firm conclusions.14
There is fairly consistent evidence that treatment with stimulant
medication in childhood and adolescence is associated with attenuated
weight gain.14 15
By contrast, findings regarding the effects of stimulants on height are
more complex and inconsistent. For example, some studies report an
attenuated growth in height of about 1 cm/year in the first one to three
years of treatment, whereas others do not.14
Moreover, it has been suggested that some children with ADHD may follow
a different growth trajectory, meaning that children with ADHD may not
grow quite as tall as children without ADHD, regardless of treatment
with stimulant medication.16
It has also been suggested that there is " growth rebound effect" (a
rapid increase in height and weight), when stimulant medication is
stopped.17 Although more recent studies do not find evidence of a rebound effect,15
this observation has lead many doctors to recommend "drug holidays"
during the weekend or summers. It is not known whether this practice
makes any difference for growth or weight gain in the long term.
Nonetheless, since children often use psychostimulants for several
years, periodic examination of growth in children using stimulants is
very important.
Serious but rare side effects of stimulant medication: More serious
but rare side effects include hypersensitivity or allergy, facial tics,
stereotypic movements, confusion, or hallucinations. Doctors generally
believe that the frequency and severity of side effects increase with
increasing dose.
Also, Health Canada suspended the market authorization of Adderall XR®
in February 2005 due to concerns about the risk of sudden deaths,
heart-related deaths, and strokes in children and adults taking regular
recommended doses of Adderall® and Adderall XR®.
There have been no Canadian reports of death in patients using this
medication. This decision has subsequently been re-assessed by Health
Canada following the recommendations of an independent Drug Committee
and this stimulant medication was reinstated in Canada in August 2005,
with a revision of the label to to include warnings against the use of
Adderall XR® in patients with structural heart abnormalities as well as the dangers of misusing amphetamines.18
Stimulant medication does not increase the risk for later drug abuse:
Stimulants are not considered to be habit-forming when used as
prescribed (that is, taken orally at the specified dose and frequency)
to treat ADHD in children and adolescents. Also, there is no evidence
that their use as prescribed leads to drug abuse. Convergent findings
from clinical studies suggest that children with ADHD who are medicated
appropriately with methylphenidate are at lower risk for developing
substance abuse problems than are children with ADHD who are not
medicated.19-21
However, there is a potential for abuse and addiction with any
stimulant medication — especially if that person has a history of
substance abuse. Also, when methylphenidate is abused, it is mostly
taken intravenously or snorted.8 22
The primary concern for schools is not that students with ADHD
themselves abuse their prescribed stimulant medication, but rather that
they misuse it, because they are frequently approached by other students
to sell, give, or trade their prescription drugs (particularly in high
school student populations).23
Non-stimulant medications
Atomoxetine hydrochloride is one of a new class of medications being
developed, known as "specific norepinephrine reuptake inhibitors."24 Atomoxetine is sold under the trade name Strattera®.
It is the first non-stimulant medication approved for the treatment of
ADHD. It was approved by the Food and Drug Administration (FDA) in the
U.S.A. in November 2002 and was subsequently approved by drug regulatory
agencies in Canada, the United Kingdom, Australia, Mexico, Argentina,
and several other countries.
Mechanism of action of atomoxetine
Unlike stimulants, which serve primarily to increase dopamine
neurotransmission, atomoxetine increases norepinephrine
neurotransmission, which is associated with better modulation of
attention. Data from numerous randomized controlled clinical trials have
shown it to be well tolerated and effective in the treatment of
children, adolescents and adults with ADHD.24 25
Like stimulant drugs, atomoxetine is effective in treating and
controlling ADHD symptoms at home and at school. Also, improvements have
been reported in broader social and family functioning.
Duration of effects of atomoxetine
Atomoxetine is generally given once a day either in the morning or
evening. If a second dose is needed, it is given in the late afternoon —
after the school day. Thus it is unlikely that students would need to
be given this medication during the school day.
Atomoxetine is a slower-acting medication compared to stimulants. The
beneficial effects of stimulant medication are evident within about 30
minutes of taking the medication (even after the very first dose). By
contrast, those of atomoxetine may not be discernible for almost a week
after the student starts taking the medication. Maximum benefits are
generally seen starting in the second to third weeks after starting
treatment and the beneficial on the behavioural symptoms may not appear
as dramatic as sometimes seen with stimulant medications.
However, once the beneficial effects emerge, there is some indication
that the effects of a single morning dose of atomoxetine last for about
24 hours. For example, parents' evaluations of their child's behaviour
during the evening and early morning activities (prior to the next
morning dose) indicate that the children have fewer problems with
homework completion, settling at bedtime, and falling asleep at night,
as well as getting up and getting ready for school the next morning.25
These routine household activities in the evening and morning typically
pose major problems for parents who have a child with ADHD.26
Side effects of atomoxetine
Overall, atomoxetine is well tolerated with minimal side effects.24 25 The most common side effects, which are generally mild, include:
- upset stomach
- decreased appetite
- nausea or vomiting
- tiredness or fatigue
- dizziness
- mood swings
As with stimulant medication, there have been a few concerns about
decreased growth in children and teens taking atomoxetine, so doctors
generally weigh and measure these youngsters periodically while on this
ADHD medication.
Atomoxetine is an eye irritant. Atomoxetine capsules are not meant to
be opened and should be swallowed whole. The drug is an eye irritant.
If the contents of the capsule come into contact with the eye, the
affected eye should be flushed immediately with water, and medical
advice should be obtained. Also, hands and any surfaces in contact with
the capsule contents should be washed with soap and water as soon as
possible.
Serious but rare side effects of atomoxetine
Allergic reactions are rare but do occur, usually as swelling or
hives. There have also been rare reports of episodes of paleness,
burning, prickling, or pain in hands or feet.
In 2004, atomoxetine began carrying a warning label that the drug
should be stopped if patients showed signs of jaundice (yellowing of the
skin or whites of the eyes, a sign of liver damage), but this is also a
very rare side effect.27
Patients and parents of children and adolescents taking atomoxetine are
advised to contact their doctor immediately if they develop itching,
dark urine, yellow skin or eyes, upper right-sided stomach area pain, or
unexplained "flu-like" symptoms.
In 2005, the US Food and Drug Administration (FDA) warned about an
increased risk of suicidal thinking in children and adolescents being
treated with atomoxetine.28
Specifically, like many other psychiatric medications, the FDA states
that atomoxetine "may increase thoughts of suicide or suicide attempts
in children and teens." The prescription bottle now carries a warning
label that advises parents should call their child's doctor if their
child has:
- new or increased thoughts of suicide
- changes in mood or behaviour including becoming irritable or anxious
Thus, teachers are strongly advised to notify parents of students
being treated with atomoxetine immediately if they observe any sudden
changes in aggression, mood, or behaviour or new or increased talk,
thoughts, or action related to suicide.
Atomoxetine does not increase the risk for later drug abuse: This
medication is not associated with abuse liability in humans at the usual
doses prescribed.29 Thus, unlike the stimulants, atomoxetine is not a controlled substance.
Antidepressants as ADHD medications
Various types of antidepressant medications have all been shown to
help children and adults with ADHD, but these medications are not
approved by federal drug regulation agencies to treat ADHD.
Response to medication does not confirm a diagnosis of ADHD
An individual's response to medication treatment for ADHD does not
rule in or rule out the diagnosis of ADHD. Individuals who do not have
ADHD, or who have another type of neurodevelopmental disorder or health
condition, may also show a favorable response to medication for ADHD.
Teachers and other school staff play several important roles
supporting and monitoring treatment programs for students with ADHD,
including when medication is part of the overall treatment approach.
Monitoring initial effects of medication treatment on classroom behaviour and performance
There is no way for doctors to predict in advance which of several
medications will be most helpful for a specific child, adolescent, or
adult with ADHD, or what the optimal dose will be. A student who does
not benefit from one type of stimulant medication may do very well on
another type, or on a non-stimulant medication. A student who does not
benefit from one dose may do very well on a higher or lower dose.
Similarly, side effects may occur with one type of medication but not on
another. Thus, the student's response to medication needs to be
monitored very carefully.
Teachers play an important role because they can observe and listen
to the student during the day, while the medication is active in the
student's brain, and report the duration and type of effects of the
medication. Without the teacher's input, the parents and physician would
not know whether the specific dose or type of medication is beneficial.
This is particularly so with younger students, who may not have the
capacity to evaluate, nor the vocabulary to describe the effects, or who
may not be able to remember them by the time they reach home at the end
of the school day.
Medication trial
One procedure for beginning medication that many physicians find
useful is to use a very careful trial in which a child is given placebo
and different doses of medication, or different types of medication.
Typically, in this procedure, neither the parent, the teacher, nor the
student are told what dose or medication is being given on any day or
when placebo is being given. This is important because no matter how
good one's intentions are, it is very difficult to be objective about a
child's behaviour when one knows an individual is on medication.
With parental consent, physicians may ask teachers to complete daily
or weekly ratings of the child's behaviour and academic performance, as
well as any side effects. The parent does likewise.
By comparing the teacher's ratings (and the parent's ratings) for the
different medication or dose conditions, the physician has a more
objective basis for deciding whether the medication really helped,
whether there were any adverse side effects, and what problems remain
even if the medication was helpful.
When completing the rating scales or description, it is important for
teachers to keep in mind both the improved times that the student has
experienced, as well as any periodic "melt-downs" that might occur as
the medication wears off. If the teacher's ratings are unduly influenced
by "melt-downs" (which might imply little or no improvement), the
physician may respond by increasing the dose, which may not help the
child and may make the "melt-downs" worse.
Ongoing monitoring of students with ADHD
Once the physician has determined the best dose for a particular
student with ADHD, it is very important to monitor how the student is
doing on a regular basis. Medical guidelines from bodies such as the
American Academy of Pediatrics and the American Academy of Child and
Adolescent Psychiatry recommend that follow-up information be obtained
from teachers to help ensure that the treatment is still helpful. The
regular, systematic feedback from teachers about how well the student's
behavioural symptoms are being managed, the amount and quality of work
being completed, and the quality of the student's relationships with
peers and adults in the school setting, are all essential for ensuring
success at school (as well as at home) for the student with ADHD.
Dispensing medication at school
Schools may be required to dispense ADHD medication at school. At
some schools, this is not always easy to coordinate. Often there is not a
school nurse on site to give the medication. Many school boards and
schools have developed systematic policies and procedures to ensure the
safe handling of all medication, and particularly stimulant medication
or any other controlled substance that can lead to tolerance and
dependence of misused or abused. Teachers are advised to check with
their school board to determine what policies and procedures are in
place.
Major recommendations by the U.S. Drug Enforcement Administration
(DEA) are listed in Table 8-3. For further information, please see this
web site: http://www.deadiversion.usdoj.gov/pubs/brochures/stimulant/stimulant_abuse.htm
Table 8-3: Recommended School Policies and Procedures for the Safe Handling of Medication
Delivery of Medication to School |
1. ADHD medication should be delivered to the school by a parent,
guardian or other responsible adult; students should be prohibited from
carrying ADHD medication to and from school. |
2. Medication delivered to school must be provided in a properly labelled container, indicating:
- Student's name
- Name of medication
- Dosage and time the medication is to be administered at school
|
Documentation of Medication Kept at School |
3. One person at school should maintain primary control and
responsibility for medication delivered to school and maintain a
Medication Inventory Log, which indicates:
- date that medication was received, along with its name and
amount received (number of pills), and signatures of the deliverer and
receiver
- name of student (grade and home-room) to whom the medication is to be dispensed
- signed permission for school staff to administer the
medication during school hours, along with written and signed medication
order from the prescribing physician
- name and telephone number of prescribing physician
- emergency contact telephone numbers for that student
- date and amount of medication destroyed or removed from school, along with name and signature of that person
|
Storage of Medication at School |
4. Medication should be stored in a secure and locked location
(room, drawer, or cabinet), with an inventory and accountability for the
keys or key-codes. |
Dispensing Medication at School |
5. Medication should be administered by the designated,
responsible school person. The student with ADHD should not be permitted
to self-administer medication outside the presence of school staff.
6. A log should be kept indicating the date, time, and amount of
medication dispensed, along with the initials of the person who
dispensed the medication.
|
Educating school staff and students about prescription drugs, street drugs, and drug abuse
An understanding of the use and risk for misuse and abuse of
prescription medication, particularly controlled substances such as
stimulant medication, is necessary for all school personnel, including
teachers, principals, school nurses, and school psychologists.
Establishing and adhering to written school policies and procedures
for ensuring safe handling of medication at school will decrease the
risk of misuse and diversion of prescription medication.
School personnel can play a helpful role in monitoring whether
students who take prescribed medication are being approached or
threatened to give or sell their medication, or whether their medication
has been taken or stolen by others.
We recommend instigating an effective, evidence-based, school-based
substance abuse prevention program (such as Life Skills Training or
Project ALERT), which should include information about the risks of use,
misuse, and diversion of stimulant medication.30 31
1 Bos, C.S., Nahmias, M.L., &
Urban, M.A. (1999). Targeting home-school collaboration for students
with ADHD. Teaching Exceptional Children, 31, 4-11.
2 Davern, L. (2004). School-to-home notebooks. Teaching Exceptional Children, 36, 22-27.
3 Power, T.J., Karustis, J.L., &
Habboushe, D.F. (2001). Homework Success for Children with ADHD: A
Family-School Intervention Program. New York: Guildford Press.
4 Hughes, C.A., Ruhl, K.L., Schumaker,
J.B., & Deshler, D.D. (2002). Effects of instruction in an
assignment completion strategy on the homework performance of students
with learning disabilities in general education classes. Learning
Disabilities Research & Practice, 17, 1-18.
5 Bryan, T., & Burstein, K.
(2004). Improving homework completion and academic performance: lessons
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