We got this student who has ADHD and maybe something else, he used to be worse in behavior but after his parents got him his medication approved to be given twice a day instead of once a day, he has been getting better in behavior. He's a very sweet Kinder student and he's extremely lovable.
But we had an issue last Friday, he was not wanting to cooperate in taking his medication. Usually he's a champ about it and does it, no questions asked. But that day, he was clearly upset and wouldn't listen. I kept asking him what's going on, but he kept just moaning and acting like a little animal (And I mean literally, when he's off his medications, he's speech and all his normal behavior disappears and acts like a small little animal, not speaking and gets into a small ball and refuses to come out.) I thought maybe his mother forgot to give his morning dose, but not that day, he did get his first dose, but he was upset about a situation before I came in. He got a stamp and he was stamping all his classmates and it got taken up. He got mad and that's why he was acting like this.
We kept trying to cohort him out and to listen to me. But he kept just saying "No!" and this kept going to an HOUR. At one point, the elementary coach came and grabbed his hands and was playing it off as she was hugging him, so I took the opportunity to give the medication, but he turned as I pushed the syringe and spit the medication back at my face. I was livid, but I tried to play it off so he can come with me, but he still refused. As I said, this took an HOUR and I was suppose to do my last group of Kinder of Hearing and I wasn't able to.
I'm just at a loss right now, what we should do? The medication has a 4 hour lifespan, (Procentra 5mL solution), and when he gets the medication, he's a good kid, but now I'm not so sure if it's working at all. And not only that, I'm not sure what I should be doing myself, because I'm pretty sure I can't handle him and only a few teachers have the training to handle the children, so I'm not sure what I can do if this happens again.
I always clear it with the parent, but seriously, 2 M&Ms are not going to send a kid over the edge! Plus, if it gets him to take the medication, then everyone will be happy!
I am one of the few people in the school that is core team trained to restrain a child. And like OD said - I do it judiciously and in situations that need it. Child is a danger to self, others. But the situation is really dependent on what the child needs and the other children need. You may have a child that needs to be taken out of that room when their behaviors begin to escalate. Or it may be impossible to remove the child and it may be necessary to remove the other students for their safety.
One of my first questions always is how is the student at home? Does he medicate well at home? (I am sort of thinking no since the parents are pushing for two dispenses at school) And the fact that the parents want the second admin also tells me that he has the behavior issues at home as well.
Now on to your issues with actually dispensing the meds - you can't force the child - but is the child amenable to reinforcers (remember, in a school setting under a behavior plan we don't bribe, we use reinforcers!! take your meds and earn 3 minutes on the ipad or whatever!) or if it's an issue of flavor as procentra isn't exactly gourmet flavoured perhaps the child will take it better if it's mixed with some juice (not apple) or pudding or what have you. There may even be a compounding pharmacy that can make it into a gummy. I have several by me. But these things do take some consistency and cooperation from the parents too.
I am one of the few people in the school that is core team trained to restrain a child. And like OD said - I do it judiciously and in situations that need it. Child is a danger to self, others. But the situation is really dependent on what the child needs and the other children need. You may have a child that needs to be taken out of that room when their behaviors begin to escalate. Or it may be impossible to remove the child and it may be necessary to remove the other students for their safety.
One of my first questions always is how is the student at home? Does he medicate well at home? (I am sort of thinking no since the parents are pushing for two dispenses at school) And the fact that the parents want the second admin also tells me that he has the behavior issues at home as well.
Now on to your issues with actually dispensing the meds - you can't force the child - but is the child amenable to reinforcers (remember, in a school setting under a behavior plan we don't bribe, we use reinforcers!! take your meds and earn 3 minutes on the ipad or whatever!) or if it's an issue of flavor as procentra isn't exactly gourmet flavoured perhaps the child will take it better if it's mixed with some juice (not apple) or pudding or what have you. There may even be a compounding pharmacy that can make it into a gummy. I have several by me. But these things do take some consistency and cooperation from the parents too.
:inlove:
Compounding pharmacy sounds like a idea that could be worth perusing if refusal is regular. What works with child at home that might work at school as well? Working towards a reward is a good goal.
I also have to step back for a moment and think is it the medication? I feel like it the first thing people jump to; I've had teachers say "x student must like this today because they didn't take their morning med" when in fact they did and there is another factor going on. This is very, very frustrating to work with sometimes.
Is there a safe place for this student when he gets like this? I've worked with a student like this and we set up a padded area so that if the student did want to bang their head, they could do it in a way with reduced harm. Either way, I would not force a child to take their medication - if they refuse and the parent wants them to take it that badly, I will call them to come and do so.
I am also one of people that has been training to restrain a child, but need the factors like Flare has above. It is really a very last resort and I would not medicate a restrained child in a school setting unless I had very, very specific doctor's orders (and a very, very detailed plan set up in agreement with the parents and the school that was very much signed). But even then, I would be wary.
Specializes in Cardiology, School Nursing, General.
I have accidentally tasted his medication one time when it splashed in my mouth that day, it doesn't taste bad (tasted like strawberry.) He does take it happily, no questions asked if in a good mood (Like today, I was in love with him when he took it with a smile and a hug.) and he never complains of the taste. I just think it's more behavioral, that if "They aren't giving me what I want, I won't give them what they want."
Specializes in Cardiology, School Nursing, General.
:inlove:
Compounding pharmacy sounds like a idea that could be worth perusing if refusal is regular. What works with child at home that might work at school as well? Working towards a reward is a good goal.
I also have to step back for a moment and think is it the medication? I feel like it the first thing people jump to; I've had teachers say "x student must like this today because they didn't take their morning med" when in fact they did and there is another factor going on. This is very, very frustrating to work with sometimes.
Is there a safe place for this student when he gets like this? I've worked with a student like this and we set up a padded area so that if the student did want to bang their head, they could do it in a way with reduced harm. Either way, I would not force a child to take their medication - if they refuse and the parent wants them to take it that badly, I will call them to come and do so.
I am also one of people that has been training to restrain a child, but need the factors like Flare has above. It is really a very last resort and I would not medicate a restrained child in a school setting unless I had very, very specific doctor's orders (and a very, very detailed plan set up in agreement with the parents and the school that was very much signed). But even then, I would be wary.
There's not a place for him to be safe in, he's rarely like this. So what happens is we don't restrain him but we talk to him and we try to keep him safe by watch him.
We didn't restrain him for his medication that time, we were trying to get him to come out so he could come with us to the office because he spit the medication and his mother was coming, but I guess he's scared of the consequences so he was crying and not answering us. So he would wedge himself in the back of the door and bang his head. So we had to put our hands in front of him and stop him from self-harming.
There's not a place for him to be safe in, he's rarely like this. So what happens is we don't restrain him but we talk to him and we try to keep him safe by watch him.
We didn't restrain him for his medication that time, we were trying to get him to come out so he could come with us to the office because he spit the medication and his mother was coming, but I guess he's scared of the consequences so he was crying and not answering us. So he would wedge himself in the back of the door and bang his head. So we had to put our hands in front of him and stop him from self-harming.
Time to find a safe place, even if he's rarely like this. Easier said than done, I know. But, if you're putting your hands in front of his head, that can inadvertently harm you both.
Sometimes children on ADHD meds have worsening of behavior when the med is wearing off. This behavior can be worse than if he had no medication at all. Sometimes children with another psychiatric diagnosis can have worsening of behavior on ADHD medications.
Specializes in Cardiology, School Nursing, General.
I'm not sure, but I don't think so.
I do believe he has something else because of his sister who is a year older than him. She is autistic and the same behaviors she displays when she's going off the edge is the same as he is, but it's only when he's off his medication.
We don't have much space here at our school, like at all, so I'm not exactly sure what do you mean by "safe space".
I would call the parents and tell them to come get their kid. I would not be giving any medication to a child in school with force, that is assault and you can be charged for it or potentially have your license affected. Call the parents and let them sort their kid out. Public school does not seem like the right environment for this kid.
I would ask for more training so you can deal with this child appropriately.
The current plan sucks.
I am a bit upset that you tried to force the kid to take the medication. That never works. It just escalates the behavior.
It sounds like this child has some behavioral issues on top of his ADHD. My younger brother used to act like that, but he was abused before we adopted him. I don't know what's going on with your student, obviously, but he may need further evaluation.
The best thing you can do in an intense situation like that is to remain calm. Getting agitated only inflames the child's behavior. If his behavior escalates secondary to stimuli, then the next thing to do is stop doing whatever is bothering him. Back away and leave him alone until he settles down. If he is unable to calm himself, then it's time to call the parents.
Forcing meds on a child in the midst of a meltdown is a good way for someone to get hurt.
If your school system has a special needs teacher or program, I would suggest that you get in touch for immediate solutions. For long term solutions, you'll need to get the whole team involved and get plans in place.
:inlove:
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Amethya
1,821 Posts
Can you give candy to a ADHD child or will it make them more hyper? I was thinking of doing what one post said bribe him candy.