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 can say that I've worn my fair share of medication from difficult patients and students. And I totally get what you're saying -you think you've got a calm moment and nope - nice pink syrup spit all down your favorite lab coat. Now you get to spend the rest of the day sticky. Or was it worse when i was holding the student in a full restraint because he was trying to headbutt, kick, punch, etc and he urinated all over the floor and me - yeah - definitely worse. But we roll it off and just want what's best for these kids. It's most rewarding when a child who was a regular issue becomes a non issue. It feels like a victory.
It sounds like this child needs the interventions of a behaviorist if they are not already in place. If they are, it may be time to go back to review the plan. It's hard to say exactly what a child like this needs without knowing the child and being there to observe what works and what doesn't.
ETA: The medication is not necessarily an end all be all - do the behaviors start at the stroke of the last dose "wearing off"? Does he have bad mornings? Teachers are quick to believe that every poor behavior is a result of a medication not being given at the stroke of - but we all know that given out administration windows that medications don't just "shut off" like that. i mean isn't it remarkable how many of us have students that don't take their ADHD medications on weekends, holidays, summers, etc yet can still function... but when you give it on monday morning it was like giving the magic elixr - that's it, no need for that blood level to rebuild the same way it needed to the original way it needed to when they were first rx'd the med...just a little nibble for thought.
Specializes in Cardiology, School Nursing, General.
I can say that I've worn my fair share of medication from difficult patients and students. And I totally get what you're saying -you think you've got a calm moment and nope - nice pink syrup spit all down your favorite lab coat. Now you get to spend the rest of the day sticky. Or was it worse when i was holding the student in a full restraint because he was trying to headbutt, kick, punch, etc and he urinated all over the floor and me - yeah - definitely worse. But we roll it off and just want what's best for these kids. It's most rewarding when a child who was a regular issue becomes a non issue. It feels like a victory.
It sounds like this child needs the interventions of a behaviorist if they are not already in place. If they are, it may be time to go back to review the plan. It's hard to say exactly what a child like this needs without knowing the child and being there to observe what works and what doesn't.
ETA: The medication is not necessarily an end all be all - do the behaviors start at the stroke of the last dose "wearing off"? Does he have bad mornings? Teachers are quick to believe that every poor behavior is a result of a medication not being given at the stroke of - but we all know that given out administration windows that medications don't just "shut off" like that. i mean isn't it remarkable how many of us have students that don't take their ADHD medications on weekends, holidays, summers, etc yet can still function... but when you give it on monday morning it was like giving the magic elixr - that's it, no need for that blood level to rebuild the same way it needed to the original way it needed to when they were first rx'd the med...just a little nibble for thought.
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That's a good question. What I observed is he's fine in the mornings. He gets his dose in the AM, and he's okay. I think it's mostly the medicine effects wear off after a while. I'm suppose to give his dose at 11, if I do it at the right time, he's okay and he takes it like a champ because the last dose is still in effect. So it degrades as time goes on. Today I gave it 30 minutes later, he was still sitting down and listening doing his work, so the medicine was working, and he wasn't resisting much because he said no and got moody, but he still took the medication. So yeah it's mostly because the medication is wearing off, without it he acts out. Even if I'm like 15 minutes late, he still gets his medicine but later than that and the behavior gets worse. He gets moody and says no to everything and eventually shuts down and doesn't want to speak.
But the problem is that the last meltdown, he was on his AM dose but he got mad at the teachers and gave this mentality "If you don't give me what I want, I won't give you what you want." and starts to act out. So this behavior I'm worried about, because if he can meltdown with medication, then how can we fix this behavior?
I can say that I've worn my fair share of medication from difficult patients and students. And I totally get what you're saying -you think you've got a calm moment and nope - nice pink syrup spit all down your favorite lab coat. Now you get to spend the rest of the day sticky. Or was it worse when i was holding the student in a full restraint because he was trying to headbutt, kick, punch, etc and he urinated all over the floor and me - yeah - definitely worse. But we roll it off and just want what's best for these kids. It's most rewarding when a child who was a regular issue becomes a non issue. It feels like a victory.
It sounds like this child needs the interventions of a behaviorist if they are not already in place. If they are, it may be time to go back to review the plan. It's hard to say exactly what a child like this needs without knowing the child and being there to observe what works and what doesn't.
ETA: The medication is not necessarily an end all be all - do the behaviors start at the stroke of the last dose "wearing off"? Does he have bad mornings? Teachers are quick to believe that every poor behavior is a result of a medication not being given at the stroke of - but we all know that given out administration windows that medications don't just "shut off" like that. i mean isn't it remarkable how many of us have students that don't take their ADHD medications on weekends, holidays, summers, etc yet can still function... but when you give it on monday morning it was like giving the magic elixr - that's it, no need for that blood level to rebuild the same way it needed to the original way it needed to when they were first rx'd the med...just a little nibble for thought.
But the problem is that the last meltdown, he was on his AM dose but he got mad at the teachers and gave this mentality "If you don't give me what I want, I won't give you what you want." and starts to act out. So this behavior I'm worried about, because if he can meltdown with medication, then how can we fix this behavior?
So given that piece of info - the simple answer is no - the meltdowns are not related to him timing out of his meds. The teachers and staff would like it to be that simple - he melts down and all they need to do is call you for a dose of calm me down juice - but there are two problems with that - one is that it's probably not time for med admin and two - that does not necessarily seem to be the underlying issue. Too often we think that the right answer is to throw a boatload of pharmaceuticals a these kids. In a lot of cases, the medications help, but so often it's a matter of finding behavioral support and the two biggies: follow through and consistency. In school we can implement behavior plans and track what is going on, report who the day went, but it's oh so rare that we get that level of a report and tracking back from the home. Usually the parent is just too tired and trying to get dinner off and the other kids to bed that we may end up with a communication log that gets filled out with a few lines - good night, bad night, maybe a detail or two if we're lucky.
Don't let the staff guilt you. His behaviors have nothing to do with your practice.
So given that piece of info - the simple answer is no - the meltdowns are not related to him timing out of his meds. The teachers and staff would like it to be that simple - he melts down and all they need to do is call you for a dose of calm me down juice - but there are two problems with that - one is that it's probably not time for med admin and two - that does not necessarily seem to be the underlying issue. Too often we think that the right answer is to throw a boatload of pharmaceuticals a these kids. In a lot of cases, the medications help, but so often it's a matter of finding behavioral support and the two biggies: follow through and consistency. In school we can implement behavior plans and track what is going on, report who the day went, but it's oh so rare that we get that level of a report and tracking back from the home. Usually the parent is just too tired and trying to get dinner off and the other kids to bed that we may end up with a communication log that gets filled out with a few lines - good night, bad night, maybe a detail or two if we're lucky.
Don't let the staff guilt you. His behaviors have nothing to do with your practice.
Again, .
Also, we are never sure if parents follow through with a behavior plan at home. As Flare mentioned, long day at work, fatigue, etc can definitely play a role in sticking to a routine and plan. A child like this (plus a sibling which similar patterns, you mentioned) is exhausting! I cannot begin to imagine what it must be like to manage at home.
However, if a behavior plan is implemented and there is no follow-up at home, typically that is seen at school when the plan is put in place. A student like the one above can really need everyone on the same page, same plan, 24/7. Meds, sure, they may be part of the plan - but if the rest of structure is off in anyway, meds are not going to be the issue. And more often than not, most people go straight to thinking they are because they are the easy answer.
I second that this student - if he does not have access to one already - needs a behavior specialist. If he does not have an IEP, you can talk with your special education team.
Specializes in Cardiology, School Nursing, General.
So I asked the SPED person at our school, basically this kid is NOT under a 504 and she can't set him up on one until his mother approves that he needs a behavior specialists. So it all pin points to his mother, and I'm livid this isn't fixed. This kid is being medicated but not under a 504 plan? Really? No wonder the teachers are acting like this and throwing this all on me. I seriously think we need to get this settled before that poor baby gets injured.
OK, sounds like administration is ***** there. First of all, Special Ed has nothing to do with 504 and vice versa. This child may ultimately end up in special ed but you don't need special input to convene the 504 committee to decide if the child qualifies for 504. Second, you don't need mom's approval for a behavioral specialist. All you need is mom's approval to be in 504. The 504 committee can make a decision if the child qualifies for 504 WITHOUT a medical diagnosis. Box 1 of the 504 evaluation form states, "Does the student have a physical or mental impairment? Note #1 of that box states, "This is an educational determination only, and not a medical diagnosis for purposes of treatment." That statement alone would qualify this child for 504. So, leave special ed out of it, find out who the 504 committee members are, get them to read the 504 evaluation form, get mom's approval, convene the committee, and get this kid some help.
OK, sounds like administration is ***** there. First of all, Special Ed has nothing to do with 504 and vice versa. This child may ultimately end up in special ed but you don't need special input to convene the 504 committee to decide if the child qualifies for 504. Second, you don't need mom's approval for a behavioral specialist. All you need is mom's approval to be in 504. The 504 committee can make a decision if the child qualifies for 504 WITHOUT a medical diagnosis. Box 1 of the 504 evaluation form states, "Does the student have a physical or mental impairment? Note #1 of that box states, "This is an educational determination only, and not a medical diagnosis for purposes of treatment." That statement alone would qualify this child for 504. So, leave special ed out of it, find out who the 504 committee members are, get them to read the 504 evaluation form, get mom's approval, convene the committee, and get this kid some help.
This.
However, if Mom is not on board, it can be so very hard to get anything signed even after a behavioral specialist comes in and supports accommodations for this student. I have worked with a few parents that feel there is a stigma attached to IEPs/504s and refuse to have one implemented for their child, despite documented need for one for the best interest of the student. I mean, seriously, gone through all the steps, had the meeting, agreed to plan at the meeting, IEP or 504 written, and then parent flat out refuses to sign in. My school has still put forth some techniques/accommodations and behavior plans, but certain things like testing/work modifications can't be official. It just stinks when parents are not on board.
I have advocated for 504 plans for students, going straight to the source in my school, which is the principal, involved the parent, and than worked with Sped.
Also, even if the kiddo doesn't have a 504/IEP doesn't mean that you can't have an informal consult from a SPED teacher/behavior interventionist. I'm a former SPED teacher, and I've observed/consulted with many students not on my former caseload and provided strategies to get the team started (antecedent - behavior - consequence; consistency is key).
I'm so sorry -- you sound like the child's one true advocate in this situation. The teachers are blaming meds and the mother may not be fully on board (yet). Keep fighting for this one, I'm rooting for you!
you, Flare!
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Flare, ASN, BSN
4,431 Posts
I can say that I've worn my fair share of medication from difficult patients and students. And I totally get what you're saying -you think you've got a calm moment and nope - nice pink syrup spit all down your favorite lab coat. Now you get to spend the rest of the day sticky. Or was it worse when i was holding the student in a full restraint because he was trying to headbutt, kick, punch, etc and he urinated all over the floor and me - yeah - definitely worse. But we roll it off and just want what's best for these kids. It's most rewarding when a child who was a regular issue becomes a non issue. It feels like a victory.
It sounds like this child needs the interventions of a behaviorist if they are not already in place. If they are, it may be time to go back to review the plan. It's hard to say exactly what a child like this needs without knowing the child and being there to observe what works and what doesn't.
ETA: The medication is not necessarily an end all be all - do the behaviors start at the stroke of the last dose "wearing off"? Does he have bad mornings? Teachers are quick to believe that every poor behavior is a result of a medication not being given at the stroke of - but we all know that given out administration windows that medications don't just "shut off" like that. i mean isn't it remarkable how many of us have students that don't take their ADHD medications on weekends, holidays, summers, etc yet can still function... but when you give it on monday morning it was like giving the magic elixr - that's it, no need for that blood level to rebuild the same way it needed to the original way it needed to when they were first rx'd the med...just a little nibble for thought.