Ritalin

Karina212 · Nov 20, 2003

I am not a school nurse but I am a RN working in a pediatric neurology office where we prescribe many neurostimulants, such as as Ritalin. I know school nurses do administer these meds with a physician's order, but a lot of the time we prescribe the extended release so the parent only has to give it once in the AM.

I can not speak from experience as a school nurse about whether or not a particular child truly needs the medication, but I can say that I've seen dramatic responses from children with true ADHD who's life has been positively changed with these medications. Parents that are so skeptical about putting their kid on a stimulant have come back for follow up and can't get over how their child has responded so dramatically to the medication academically, socially, and emotionally.

I have also heard that neurostimulants are overused but the doctors I work for try alternative strategies, such as behavior modifications and accomodation plans in school prior to prescribing meds. We also see many teenagers who don't put any effort into helping themselves and have a careless attitude who are also on stimulants. In this case we won't renew the medication as there is no point in pushing pills on someone who doesn't want to help him or herself. There are many factors in dealing with children with ADHD, including family support, the child's willingness to succeed, school support and accomodations, and the pediatric neurologist following up with the patient on a regular basis (usually every 4-6 months depending on how the child responds to the meds.)

I personally don't believe that PCP's should initially be prescribing neurostimulants unless the child has been fully evaluated by the child neurologist, including neurobehavioral testing. A child study team evaluation would also be helpful, but it can be very difficult for the school to provide this if the child is not doing awful in school. I don't feel the doctors I work for overprescribe...if the med is not working for the child, in addition to all alternative strategies, we will refer the child to a child psychologist or psychiatrist to deal with any other underlying issues. The doctors I work for have a conservative approach to prescribing these meds - that is why I like working for them!

I hope you find this information helpful. Feel free to ask any other questions!

temptaker · Dec 1, 2003

I see less of these being given in school as well. My students on Ritalin are monitored for side effects, and I try to establish a good relationship with the parents. I have found out many of my students are on it at home, and the parents never told me.

memphispanda, RN · Dec 1, 2003

As a parent of a child who is on meds, and used to get them at school...

Please remember that the child you are seeing is a medicated child. You may not see behavior that you think indicates he needs meds, however that same child if NOT medicated may indeed show you behaviors that indicate he needs meds. I would be concerned if you were seeing negative effects of the med on the child--like sedation, hyperstimulation, etc, but not because you don't see the behaviors you expect.

schoolnurse/dr · Dec 3, 2003

I am a schoolnurse, and have had my own child on Ritalin as well as other psychotropic meds. These kids have to go through a lengthy process to get to the point of being put on meds. The teacher's have to document, document , document. They have to try all kinds of interventions in the classroom, and these all have to fail. They are tested by counselors, the nurse(hrg, vision) get extra help, and all kinds of programs to help them succeed. Most of this does not work for these kids, or is only a temporary change. Doctors are just realizing the last few years that diseases like depression, OCD,ODD, bipolar disorder are actually present in childhood. Schools can no longer suggest a child needs medication. They can only let the parent know to check with thier doctor. As far as seeing these kids at school, they won't be showing their true colors when you see them. Look at the kid that's in the office all the time for behavior problems, running out of class, can't get along with thier peers. These are the kids that need to be on medicine alot of the time, and thier parents won't even consider the possibility. My son has been on numerous different meds, to contain his ADHD, depression, and ODD.(oppositional defiant disorder) And yes he needs them, he's intolerable to live with without them. Feel lucky that some of the kids that are on meds that the parents didn't tell you about got the help they need.

SRobinson · Oct 28, 2004

This is my 7th year at a private school that has a large add/adhd population (. When I started this job, I wasn't very sure how I felt about add/adhd. After my first six months I was convinced that it is a valid disease! I have seen kids who take medication on a daily basis who miss their morning medication at home. They are totally different people when they come into my office.

As for physician's who haphazardly put children on medication....that is rare. The kids I see everyday go thru a ton of psychological testing and counseling before the prescription is written for stimulants.

I always am amazed at the arguments I hear about this not being a disease. The fact that this population takes a stimulant that has the opposite effect on them than the rest of us, that they are able to focus and LEARN, is enough to convince me that it is real.

SRobinson · Oct 28, 2004

This is my 7th year at a private school that has a large add/adhd population (. When I started this job, I wasn't very sure how I felt about add/adhd. After my first six months I was convinced that it is a valid disease! I have seen kids who take medication on a daily basis who miss their morning medication at home. They are totally different people when they come into my office.

As for physician's who haphazardly put children on medication....that is rare. The kids I see everyday go thru a ton of psychological testing and counseling before the prescription is written for stimulants.

I always am amazed at the arguments I hear about this not being a disease. The fact that this population takes a stimulant that has the opposite effect on them than the rest of us, that they are able to focus and LEARN, is enough to convince me that it is real.

Jeanine · Oct 28, 2004

I'm a school nurse who also has a son on Concerta. When I go to IEP (child study team) meetings on a student, many times the parent will say that the Neurologist has suggested a trial of ritalin or an equivalent medication. They are usually very skeptical because we've all been told that ADD is over-diagnosed and ritalin is over-prescribed. I try and reassure the parent that it is just that, a trial of the medication! If a stimulant works for their child, they will usually get positive feedback from the school and see less impulsive or undesireable behaviors themselves. If it doesn't work, there won't be any reported imporvements. We are constantly asking teachers to reevaluate classroom behaviors and relay them to the parents. The long acting medications are great as far as eliminating the undesireable side effects. There are no peaks and valleys as far as when the med wears off and before the next dose kicks in. There is no social stigma of having to visit the nurse for "your ADD medication", and we are seeing less effect on appetite. They are eating their lunch, and putting on weight. The only concern is growth delay for a student who is maybe small and immature already. They take a little longer to catch up height wise, and they don't fill out as early. I think that's a small price to pay to make your child less impulsive, more accepted by their peers, and hopefully more successful academically. We struggled with the decision of putting our son on medication, but it's the best decision we ever made for him!

akcarmean, LPN · Oct 28, 2004

I have 2 children with ADHD, son has adhd, depression, asthma, allergies, gerd, learning disabilities. without his medication he is violent and intolerable. My daughter has adhd, depression, and anxiety. We use counseling out of school and also the school counslor, we see a psychiatrist, use behavior modification, son is in LD classes. We keep in touch with teachers on a regular basis as well as the psychiatrist. We had all kinds of testing done before the kids were placed on medication. Myself I have depression, OCD, anxiety, hypothyrodism, currently 2 buldging disk on L4 and L5 with breaking, and deteriation, not to mention a spondilosis. I see a surgeon next week. I know I will be in surgery. I am barly able to care for my 16mth old all day long that is why I am going to go back to school on line so I can be doing something productive while I am laid up from surgery. I can already see things in my youngest son that I have seen in my older two children. psychiatrist said that he will most likely have adhd also. he is on the go all the time never slows down, very stubborn and mean at times. I don't know how many times I have been head butted today and hit in the head with his bottle. I am already starting with behavior measures. Never to early to start I hope. I agree that if the child doesn't have adhd the medication will not help. I have worked in the school system with the developmental disabled as well as physical. I have seen children at the school that you know they need medication but parents refuse and you would not believe the problems they cause in the class room, the time it takes away from other children's learning. I agree that not every child needs medication but there are a lot that do. I also believe that there is more than medication that needs to be done in order to help the child and the family.

Angelia

cjmmsn98, MSN, RN · Oct 29, 2004

As a schoool nurse, you are the one professional in a position to educate peers, parents, and children about ADHD and the treatment for it. First, look at the research about ADHD and all the treatment options. Several studies have been done that document the efficacy of stimulant medications as well as the co-morbid conditions that go with ADHD.

You would not have an issue about diabetes or asthma in a child or providing them with meds, right? ADHD (when properly diagnosed and treated) is an organic disorder and is improved with medications.

Unfortunately for those who have to live with ADHD, there is no blood test for it, which makes it more difficult to accept as a diagnosis.

It is the role of the school nurse to decrease the stigma of those with ADHD and support the treatment plan. You should be doing medication monitoring using some objective measurement (i.e. Connor's, Akhter, or Hawthorne) to provide feedback to parents and health care providers about the efficacy of the treatment in school.

The best way to help a child with ADHD is to base your practice on current research and knowledge of the standard of care for every health condition you encounter in the school setting.

Good luck to you in your role!