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How to Manage ADHD Meds at School

Guidelines to follow if your child needs a dose of ADHD medication during the school day.

A doctor reviews a family's medication before school starts, a good way to start the year strong.
A doctor reviews a family's medication before school starts, a good way to start the year strong.

Most experts agree that children with attention deficit disorder should be on ADHD medication whenever hyperactivity, distractibility, and/or impulsivity interfere with success at school, home, and in social interactions. If your child takes medication to control his ADHD symptoms, make sure it’s administered on a schedule that works best for him.

If your child requires a mid-day dose to keep ADHD symptoms at bay during afternoon classes and homework time, use this step-by-step guide to set up an in-school ADHD treatment plan that will ensure your child receives the best treatment possible.

Step 1: Assess Your Child’s Needs

Determine a medication schedule that works. Is your child’s behavior consistent throughout the school day? How about her focus? Some children with ADHD do best with a short-acting tablet in the morning and another in the afternoon, ensuring they’ll have an appetite for lunch. For children on this treatment schedule, a midday trip to the nurse’s office at school is imperative.

Other children can take a morning dose that covers the entire school day. Most stimulant medications are available in a long-acting form that lasts for eight to 12 hours. However, keep in mind that, for some children, eight-hour tablets or capsules work for 10 hours – or six hours. The 12-hour forms may last anywhere from 10-14 hours.

Make sure your child’s symptoms are covered whenever necessary. Consider the possibility that your child with ADHD may need coverage beyond school hours – so that he can complete homework assignments and enjoy after-school activities and social relationships.

Ask the teacher to be your eyes and ears in the classroom. Along with your child’s teacher, observe when the medication wears off and base the timing of each dose on both of your observations. For example, your child might take an eight-hour capsule at 7:30 A.M., expecting it to last at least until 3:30 P.M. But the teacher notes that by 2 P.M. he is restless. So the next dose may be needed at 2 P.M.

Step 2: Paperwork & Prescriptions

Complete the paperwork. Go to the school’s front office and ask for a medication authorization form. Schools cannot give this form out without a request from a parent or guardian, because they aren’t permitted to recommend ADHD medication.

Most forms have three parts. Part one, to be filled out and signed by the parent, authorizes the school nurse or aide to give your child medication. Part two is completed and signed by the physician. It asks him to provide information on the diagnosis, medication, time, dosage to be dispensed, and possible side effects. Part three is the school’s approval of the form and it’s completed by an administrator.

Get a separate prescription bottle. Many schools require a separate bottle from the pharmacy. Your child’s prescription might look like this in order to accommodate both school and home administration:

Methylphenidate, 10 mg. tablets, #90
Label: School Use
Place 20 tablets in bottle
One tablet at noon

Label: Home Use
Place 70 tablets in bottle
One tablet three times a day

Step 3: Prep the Nurse

Talk with the school nurse. Take the form completed by you and your physician, plus the meds in the container labeled for school use, to the health room. The school nurse or assistant should let you know when meds are running low, but you should also monitor this yourself. Ask the nurse to alert you if your child misses a dose and if there are any questions or problems that need to be addressed.

Even if your child doesn’t take a dose at school, inform the nurse which ADHD treatment your child uses. In an emergency, she’ll know to avoid administering any drugs that might interact dangerously with it.

Prepare for when you forget. One of these days, your child will forget to take her morning dose, so plan ahead by having an extra supply of medication in the health room. Include instructions from the doctor saying that the nurse can give your child a dose if you call to report that you missed the morning dose at home.

Step 4: Prepare to Tweak Dosage

The teacher should know which medication your child takes and the ADHD symptoms it targets. Ask her to notify you if she notices the emergence of common ADHD medication side effects, such as headaches, stomachaches, tics, or “spaciness.” Some children also develop ticks, have negative “rebound” experiences, or can feel over-focused. If there’s a problem, your child’s medication may need to be adjusted.

Step 5: Address Problems

If the medication was missed, find out why. The person responsible for giving out the medication should alert you if your child doesn’t show up to get it. Did the teacher forget to remind him? Did he not want to leave class? Are the logistics in middle or high school such that there is no time to make the trip? If there is a problem, it needs to be addressed.

Respect your child’s desire for privacy. Work out an unobtrusive way for the teacher to let him know when it’s time to go to the nurse. She might catch his eye and tap her watch, or put a note on his desk. If you’d like your child to be responsible for keeping track of the time, get him a watch with a silent, vibrating alarm. (Check for kid-sized vibrating watches.) If leaving class to visit the school nurse makes your child feel embarrassed, talk with her doctor about taking medication that lasts through the day.

Building your child’s appetite. Appetite loss is a common side effect of stimulants. In many children, the problem subsides within a month. But if it is long-lasting or severe, kids may lose weight or miss out on essential nutrients. If appetite loss persists, talk with your doctor about alternative treatment plans or the types of food you can serve your child to keep him healthy.

Explore alternatives. One potential solution is to ask the doctor about prescribing a different stimulant-drugs affects individuals differently. Alternatively, your doctor may recommend a short-acting stimulant. Your child will need a lunchtime dose, but he should be able to enjoy a good meal before it kicks in. If neither strategy helps, he may fare better on a nonstimulant medication or on the Daytrana Patch which administers the stimulant through the skin throughout the day–allowing your child to skip taking a pill all together.

If long-acting meds work best for your child, make sure he gets a nutritious breakfast. Hold off on afternoon meds until 5 p.m.-his appetite may return before dinner. Keep healthful snacks, such as low-fat string cheese or carrots with hummus, on hand, and mix nutritional supplements, like Pediasure, into milkshakes.

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