ADHD Ethics

[lavender]

How does your school handle approaching a parent about having their child tested for ADD/ADHD and medicated? Our administrator seems to be a little pushy with our parents for my tatse which puts me in a tough position sometimes. She used me to help get the child on Ritalin, etc. even if I know nothing about the child.

Also, what is your role in the referral/evaluation process? They just ask me to find doctors for the kids that will see them just for the eval and Rx. I feel bad for some of these parents because they are pushed pretty hard and then don't have the means to pay the $100/per month for the meds.

[wv_nurse 2003]

I don't really have an answer, but I am interested in what you will find out. A good friend of mine told me that the school called her to tell her she "had" to have her son evaluated for ADHD. She took him to the doctor, etc--Dr. stated "He's fine, just a kid". She reported back to the school--they insisted she get another opinion!!!

I know there are legitamate children with true disorders--but I do wonder if schools push the issue just to make children easier to handle in the classroom.

I worry about our "take a pill" method of dealing with everything these days--especially our children.

[Dave ARNP]

The school nurses in my area are just like this. They waste way too much of my time calling to get a consult (over the phone, no less) on a child with ADHD. I have even had requests to write the medication w/o seeing the child, simply going on their evaluation.

I think that schools have gone WAY to overboard with the whole ADHD deal. I have ADHD, and took medication for years. Honestly, I FEEL BETTER off of it. I still have issues, but I can deal with them myself. I never seemed to be able to deal with them ON the medication.

Medication is a GREAT thing for SOME children. However, a trained clinician, one who see's this FREQUENTLY needs to be eval'ing them. To me, school administrators are NOT this.

Dave

[LydiaNN]

This is why there are more states considering laws that wouldn't allow schools to "recommend" medications for ADHD. Teachers and administrators have no medical training and it is no more appropriate for them to "recommend" Ritalin than it is for to "suggest" an overweight child be put on phentermine, a child with seizures have a VNS implant in lieu of medication, etc. They certainly do have the right and responsibility to call a Student Study team meeting if they feel that the child does have ADHD or *any* disorder that is affecting their ability to learn; however, the legitimate purpose of these meetings would be to identify what problems the teachers are seeing to suggest that testing might be appropriate and to get the parents' input and approval. After assessments, if ADHD is identified, the school's role should be to determine what supports the child needs within the school- a child's doctor is the only one that has any business discussing medication with a parent. Schools may prefer meds because it makes educating the child much easier and less disruptive. My own son takes Adderall with very positive results, so I am NOT against meds. I am against pressuring parents to make a medical decision for their child based on what would be most convenient for the school! As far as the role of the nurse in the process, I think the school nurse can serve as a resource for parents by answering questions and helping them to locate information and assistance, but to encourage parents to follow one treatment or another based on the feelings of the administrator and not the needs of the child is unethical, and almost certainly illegal as well.

[jenac]

When my son was in 1st grade, his teacher asked me if I had ever considered medication. After a few deep breathes, I asked her why she felt he needed medication. He had never had any behavior problems- but she would report things like, when he was done with his classwork (usually before anyone else was)-he'd sit and tap a pencil on his desk. Things of that nature. My response to her was that instead of medication, she needed to find things to challange him more. I refused to get a Dr. consult based on her reasoning, and recommended she not suggest medications for any child. A year later- in a different school, in an excellerated program, his teacher asked me if I had ever noticed his "impulsive" behavior, or his fidgitiness? She never mentioned medications, but focused on the behaviors that caused her to be concerned. We sat down and talked about it-and I did eventually get a consult with his Dr. He has been taking meds now for almost 6 years- and it has made such a difference.

My advise-from a parents stand point- don't immediately jump on the medication bandwagon. Focus on the problems-what are you seeing, or what are the teachers saying? Every child a teacher thinks had ADHD should have a Multifactored eval to rule out other sources of a problem. The parents will be much more receptive to getting involved if the problem is addressed without the immediate suggestion of medication. Meds should always be a last resort, but if needed-great. But there are so many other interventions to try first.

[Jeanine]

In our school, the student is usually brought to the attention of the PAC/504/IRS team and we review the student's progress. The school psychologist or giudance counselor will distribute a Connor's Rating Scale to the teachers to fill out. We then review the student's results at a meeting, and the parents are invited to attend. It is unethical and I think illegal (at least in NJ) to even suggest that a student be placed on medication. The team usually requests that the parent take the results back to their pediatrician and hopefully, a pediatric neurologist for further eval. If you insist on an eval, the school can be required to pay, so we have to be very careful what we say.