|
|
|
|
According to McEwan (1998), “medical therapy is the most controversial component of the treatment plan for ADHD, and although it has certainly proven helpful to many students, there are dangers in believing that drugs are the ‘magic bullet’” (p. 78-79). Physicians who prescribe medications must make certain that a thorough examination and evaluation has been completed that includes both the home and the school. In support, Dendy (2000) offers that, it clearly stands to reason that medications can make or break a student’s success in school. It should come as no surprise that often one of the key reasons students don’t do well academically is because their medication regimen has not been adjusted to get maximum benefits at school (p. 205). Medications prescribed for ADHD generally look to keep the student focused and on task at school. Usually the school nurse and the parent review the medication dosage to be taken as per the family physician. Since most often medications are administered in school, it is imperative that the school nurse and the parent stay in close contact. One important factor not to be over looked is the role of the teacher. Teachers are often the best overseers and can provide valuable information regarding medication effectiveness. Administrators and school nurses should dialogue closely with teachers of ADHD students. If a student is struggling, then perhaps the medication and/or side effects are impacting on the student’s progress and success. According to Barkley (1998), the primary medications used to treat ADHD are central nervous system stimulants and antidepressants. Stimulant medications stimulate the central nervous system to increase activity and blood flow to the frontal lobe of the brain that controls thought, speech, and memory. The impact should increase attention and concentration and ultimately improve socialization and schoolwork. Dendy (2000) states that, when medications are working, teachers should see increases in attention, concentration, compliance, efforts on tasks, and amount and accuracy of schoolwork produced. Also when medications are working, teachers should see decreases in activity levels, impulsivity, negative behaviors in social interactions, and physical and verbal hostility (p. 211). Most stimulant medications have varied lengths of effectiveness. Most regular and sustained release medications last for only three to six hours, however there are a few exceptions. Traditionally Prescribed Stimulant Medications for ADHD depicts the various traditional and the 2000 - 2001 stimulant medications, pharmaceutical names, and lengths of effectiveness often prescribed to ADHD patients. Most educators understand Ritalin to be the commonly prescribed medication for ADHD. However, every student is different and for some Adderall and Dexedrine are far more effective medications. As varied as are the medications, so varied are the medication doses. Generally adolescents require higher doses than do younger children. Also for some adolescents, the prescribed medications do not last as long as they should due to the individual’s metabolism; thus more frequent doses during the school day. Teeter (1998) maintains that Ritalin is the most studied medication and is effective for approximately 75% of the individuals who take it daily. The side effects of both regular and sustained released stimulant medications (such as Ritalin) include loss of appetite, insomnia, nausea, vomiting, abdominal pain, thirst and headaches. One important misconception of taking stimulant medication is the concern that growth and physical development will be stunted. Teeter (1998) maintains that stimulant medications do not stunt growth or delay physical development. In addition to central nervous system stimulants, there are several secondary medications, such as antidepressants, prescribed to treat ADHD and coexisting conditions such as depression, anxiety, irritability, or aggression. Dendy (2000) points out that these medications do not significantly increase a student’s ability to pay attention in class. Antidepressants, the author maintains, “are prescribed to help with reducing moodiness, leveling off emotional highs or lows, improving frustration tolerance, reducing irritability and aggression, reducing impulsivity, and treating depression” (p. 208). Unlike Ritalin and Dexedrine, Dendy (2000) states, which last only three to six hours, antidepressants build up in the bloodstream and are effective all day. Similarly to central nervous system stimulant medications, there are a variety of Common Antidepressant Medications and Other Medications prescribed to adolescents diagnosed to have ADHD with or without coexisting conditions. One issue considered to be very serious for administrators, teachers, and school nurses is dealing with adolescents whose medications do not seem to be working. If administrators, teachers, and school nurses suspect this, they must communicate their observations to the parent(s)/guardian(s) and encourage them to speak with their family physician. Frequently medications that are stimulant-type with or without antidepressant supplements provide support for specific amounts of time and no more. For the student who needs a full day medication this can be problematic, especially when an important activity is determined to take place during that elapsed time period. Sometimes students are not on the correct medication doses and so go through trial and error. The family physician and the school must collaborate to find the correct medication(s) and dosage(s). Administrators must know that even when the medications are working properly, some inappropriate behaviors may not improve significantly or the student could become more unruly when the medication wears off. Dendy (2000) reports that researchers have found that, stimulant medication is slightly less effective for students with ADD (55 to 65 percent) when compared to ADHD (70 to 90 percent). Medication response for students with ADHD alone often seems miraculous, with grades jumping from Ds and Fs to As and Bs. However, when coexisting conditions are present, the medication response is not as dramatic. Sometimes a second medication is needed to treat coexisting conditions (p. 211). Even with medications that are in correct doses and extended time releases, ADHD adolescents will still wrestle with executive function deficits such as struggling with disorganization, impaired sense of time management, and forgetfulness. They will continue to lose things such as books and papers or forget to do homework, projects, and reports. They will continue to get into trouble for not staying after for extra help or even detentions. Managing the time they have in a school day and at home will continue to plague them for a long time to come. Administrators and their faculties and staff must look at Student Support Teams (SST) as vehicles for dialogue and collaboration. Inviting the parent(s)/guardian(s) to group discussions concerning medications and behavior management issues is imperative because only the parent can recommend changes to the family physician. Dialoging is especially important if the student is reticent to taking any kind of medications at all. Whether the dosage is one time or three times, regular or sustained release, fine-tuning is critical.
|
Medical
Treatments and Pending Issues