Teacher Wants to Medicate Pre-Schooler

JustBeachyNurse, LPN · Sep 5, 2015

Teachers and other non prescribing providers cannot make recommendations to medicate a child. If a child is special education to imply a child needs medication violates federal regulations. I had a teacher tell me that when my son was in kindergarten. My response was "wow, I wasn't aware you went back to school to obtain diagnoses and prescriber rights". Magically they stopped pushing medication.

The school CAN recommend a psychoeducational evaluation for suspected disability which may include an evaluation by a psychologist, neurologist, psychiatrist and or developmental pediatrician.

However many professionals say things without thinking. Honestly its rare to medicate preschoolers for active behavior unless the behavior is harming (such as severely aggressive injuring other students or the child). Most often an engaging academic program, structured play, recess/PE and a class wide sensory program help the children develop the necessary sensory modulation to succeed in their academic career.

But yes, unless there was a severe disruption (unlikely) I'd definitely side with mom.

lifelearningrn, BSN, RN · Sep 5, 2015

I find him to be a typical 3-4 year old boy! lol Active and wants to do his own thing.

meanmaryjean, DNP, RN · Sep 5, 2015

Yet another good reason to home school. When my four year old got rowdy- I sent them outdoors to PLAY until they were tired.

JustBeachyNurse, LPN · Sep 5, 2015

I wasn't a fan of much of my son's daycare/preschool but as long as it was 32F or warmer they were outside. Obviously if very cold or very hot they were outside for a shorter period of time. It was more daycare than preschool so not so much pre-kindergarten prep (resulting in 8 or 9 of my son's classmates almost being retained in kindergarten ) but I thought activity & play was more important that multiplication and reading Chaucer.

lifelearningrn, BSN, RN · Sep 5, 2015

Pre-K is necessary at my school as this is a severely under-served population and they need the head start. It is very much and education setting rather than a day care setting, the kids don't get a lot of free play, unfortunately.

JustBeachyNurse, LPN · Sep 5, 2015

Pre-K is necessary at my school as this is a severely under-served population and they need the head start. It is very much and education setting rather than a day care setting, the kids don't get a lot of free play, unfortunately.

Too bad that goes against current evidenced based practice. Even taking a half day head start program and extending by an hour to allow for outside recess and free play increases academic success potential

ixchel · Sep 5, 2015

Lifelearningrn, please consider all I am about to say with an open mind, as I am a parent-turned-nurse who has walked down the ADHD path.

I have a brilliant boy. He's gifted in so many ways. His teachers have recognized this as well, so that's not just mama bias. As a baby, he was energetically curious about everything, struggled to sleep, and constantly explored. I struggled to take him places because this exploration need he had was borderline scary and dangerous at times. Taking him to a grocery store meant not leaving him in the cart's seat because he might fall out. He was, frankly, wild. We did finger foods on the run, because he couldn't sit to eat. He was terribly skinny, with circles under his eyes. But, he met his milestones (MONTHS early), slept soundly when he did sleep, and was a happy baby.

It wasn't until baby #2 was born, and I discovered "play dates" that I realized my boy was different. I'd never been around babies before, so I really didn't know. Babies weren't supposed to be that hard. And, what was most helpful to me was realizing it wasn't my failings as a parent, it was that my baby was simply different. Wild. Smart. Fun. And we could arrange our house and lives around him.

I was a crunchy all natural mama who was anti-vax and anti-med. I started my journey to BSN when my kids started their first year of pre-k. Every day, his teacher had struggles with him, and would pull me aside to talk. The teachers at that school were very careful to stay within their boundaries. Not one of them threw around acronyms like ADHD. They all made accommodations to help him, which I was thankful for. We tried so many things, too, but he still struggled. He would be impulsive, hyperactive, and invasive of the spaces of kids around him. Even still, I knew nothing about ADHD, and my boy was still in my mind, simply energetic. Exuberant.

Toward his last months at that school, I could tell his teacher was so worn out. I knew it was him. I knew she would never tell me that. I knew she tried everything. I knew something more was happening. I started to feel the weight of responsibility.

The following year we were at a new school. It was time for kindergarten. We had a teacher whose boundaries weren't as good. She had no problem telling me that he needed to get evaluated for ADHD. She suggested coffee, tea, but never medication. We developed a system of communication so that she could relay to me his behavior without needing a daily conference with me. I was glad for that. I was tired of her judgments and advice. The nagging wore me down. It offended me. The balance between my personal responsibility and her professional responsibility became blurred. I knew it was spite that caused it. Shouldn't she know how to handle a wild child in her classroom? Academically, he had no struggles. He was brilliant. I decided she wasn't holding his attention. He already knew so much of what they were doing. He started kindergarten already knowing how to read and understanding basic math and science concepts. He was bored. That's all.

He started upsetting his friends. Teacher notes coming home started reflecting social consequences more and more. I realized.... This is a problem. This is a really big problem. I had my first conversation with my pediatrician about it. He urged me to start learning about ADHD. He knew. He just knew I wasn't going to be a parent he could say, "your son has ADHD", to without me rejecting the idea outright. I had to come to this conclusion on my own.

At the end of kindergarten, we did behavioral questionnaires. I left out that this was the second time we were doing them. The first time, he was younger than the questionnaires usually looked at, so I was told outright, his "borderline" results may be inaccurate because my 4 year old was younger than the questionnaire was designed for. I was also told that due to his results, he most definitely was on his way to an ADHD diagnosis. At that time, the DSM-IV was not supportive of an ADHD diagnosis at that age.

But now, he was just about 6. We went to a new person. I was in the worst denial. This new person used more than questionnaires. This new person got to know my boy. And after all that, she agreed with what everyone was saying all along. He had ADHD. This time I was READY to hear it.

By this point, I was starting nursing school. I had access to academic journals. I researched. OMG I did so much research. I also decided to make my nursing elective an independent study on pediatric behavioral disorders, and best practice for treatment. Heck - if I was going to put in that much effort, I might as well get credit for it!

Research at this time pretty significantly points to medications being first line treatment. ADHD is an imbalance of neurotransmitters just like depression or bipolar. Stimulant medications assist in correction of that imbalance. I also learned that symptoms tend to get worse until 9-11 years old, and for some children, they do "grow out of it". For others, they continue into adulthood.

My point in sharing all of this is this..... When his kindergarten teacher started pushing for me to use caffeine, I was furious. When she relentlessly badgered me about getting him checked out for ADHD, she made me reject the diagnosis more, out of spite, but I never would have admitted that.

But..... She was right. And I needed her to keep pushing me. She's been teaching for nearly 40 years, and as far as childhood behavior goes, she really is an expert. No, she can't diagnose or recommend treatment. She violated boundaries terribly and was completely out of line. She could have gotten in a lot of trouble for it. But she was right.

This family has every right to be upset. Between us professionals here, I doubt this teacher would have stuck her neck out like that unless she felt strongly that this child needed advocating for. I'm sure she understands the consequences of what she said. Also remember you are hearing what the teacher said from the point of view of an upset family. It may very well be that the medication part of the conversation was just a tiny blip in a much longer conversation about behavior issues. The family may have heard the word "medication" and zeroed in on it because the idea of medicating children is truly offensive to mainstream society.

Approaching this family, I would be gentle and supportive. Let them know you are available to answer questions and point to resources if they need them. Tell them the teacher was inappropriate. They need to know others recognize that, because accurate or not, it WAS inappropriate.

If you do not know the latest research on ADHD and other neurobiological behavioral disorders, I encourage you to learn more. A good review of uptodate and the DSM-V might be helpful so that you're prepared to answer their questions when they are feeling ready to talk.

I'll be giving them hugs in my heart. This journey sucks. Once you find adequate treatment, though, a massive door opens to the child. They'll be more socially appropriate to peers, they'll be able to do well in school, and they'll have the ability to maintain control of their body and mind. Imagine constantly being out of control, unable to keep your thoughts still and your body from moving all the time. Some days it literally is painful.

Anyway, I hope my story is helpful, and you can get in touch with me anytime you need help/resources.

lifelearningrn, BSN, RN · Sep 5, 2015

Lifelearningrn, please consider all I am about to say with an open mind, as I am a parent-turned-nurse who has walked down the ADHD path.
I have a brilliant boy. He's gifted in so many ways. His teachers have recognized this as well, so that's not just mama bias. As a baby, he was energetically curious about everything, struggled to sleep, and constantly explored. I struggled to take him places because this exploration need he had was borderline scary and dangerous at times. Taking him to a grocery store meant not leaving him in the cart's seat because he might fall out. He was, frankly, wild. We did finger foods on the run, because he couldn't sit to eat. He was terribly skinny, with circles under his eyes. But, he met his milestones (MONTHS early), slept soundly when he did sleep, and was a happy baby.
It wasn't until baby #2 was born, and I discovered "play dates" that I realized my boy was different. I'd never been around babies before, so I really didn't know. Babies weren't supposed to be that hard. And, what was most helpful to me was realizing it wasn't my failings as a parent, it was that my baby was simply different. Wild. Smart. Fun. And we could arrange our house and lives around him.
I was a crunchy all natural mama who was anti-vax and anti-med. I started my journey to BSN when my kids started their first year of pre-k. Every day, his teacher had struggles with him, and would pull me aside to talk. The teachers at that school were very careful to stay within their boundaries. Not one of them threw around acronyms like ADHD. They all made accommodations to help him, which I was thankful for. We tried so many things, too, but he still struggled. He would be impulsive, hyperactive, and invasive of the spaces of kids around him. Even still, I knew nothing about ADHD, and my boy was still in my mind, simply energetic. Exuberant.
Toward his last months at that school, I could tell his teacher was so worn out. I knew it was him. I knew she would never tell me that. I knew she tried everything. I knew something more was happening. I started to feel the weight of responsibility.
The following year we were at a new school. It was time for kindergarten. We had a teacher whose boundaries weren't as good. She had no problem telling me that he needed to get evaluated for ADHD. She suggested coffee, tea, but never medication. We developed a system of communication so that she could relay to me his behavior without needing a daily conference with me. I was glad for that. I was tired of her judgments and advice. The nagging wore me down. It offended me. The balance between my personal responsibility and her professional responsibility became blurred. I knew it was spite that caused it. Shouldn't she know how to handle a wild child in her classroom? Academically, he had no struggles. He was brilliant. I decided she wasn't holding his attention. He already knew so much of what they were doing. He started kindergarten already knowing how to read and understanding basic math and science concepts. He was bored. That's all.
He started upsetting his friends. Teacher notes coming home started reflecting social consequences more and more. I realized.... This is a problem. This is a really big problem. I had my first conversation with my pediatrician about it. He urged me to start learning about ADHD. He knew. He just knew I wasn't going to be a parent he could say, "your son has ADHD", to without me rejecting the idea outright. I had to come to this conclusion on my own.
At the end of kindergarten, we did behavioral questionnaires. I left out that this was the second time we were doing them. The first time, he was younger than the questionnaires usually looked at, so I was told outright, his "borderline" results may be inaccurate because my 4 year old was younger than the questionnaire was designed for. I was also told that due to his results, he most definitely was on his way to an ADHD diagnosis. At that time, the DSM-IV was not supportive of an ADHD diagnosis at that age.
But now, he was just about 6. We went to a new person. I was in the worst denial. This new person used more than questionnaires. This new person got to know my boy. And after all that, she agreed with what everyone was saying all along. He had ADHD. This time I was READY to hear it.
By this point, I was starting nursing school. I had access to academic journals. I researched. OMG I did so much research. I also decided to make my nursing elective an independent study on pediatric behavioral disorders, and best practice for treatment. Heck - if I was going to put in that much effort, I might as well get credit for it!
Research at this time pretty significantly points to medications being first line treatment. ADHD is an imbalance of neurotransmitters just like depression or bipolar. Stimulant medications assist in correction of that imbalance. I also learned that symptoms tend to get worse until 9-11 years old, and for some children, they do "grow out of it". For others, they continue into adulthood.
My point in sharing all of this is this..... When his kindergarten teacher started pushing for me to use caffeine, I was furious. When she relentlessly badgered me about getting him checked out for ADHD, she made me reject the diagnosis more, out of spite, but I never would have admitted that.
But..... She was right. And I needed her to keep pushing me. She's been teaching for nearly 40 years, and as far as childhood behavior goes, she really is an expert. No, she can't diagnose or recommend treatment. She violated boundaries terribly and was completely out of line. She could have gotten in a lot of trouble for it. But she was right.
This family has every right to be upset. Between us professionals here, I doubt this teacher would have stuck her neck out like that unless she felt strongly that this child needed advocating for. I'm sure she understands the consequences of what she said. Also remember you are hearing what the teacher said from the point of view of an upset family. It may very well be that the medication part of the conversation was just a tiny blip in a much longer conversation about behavior issues. The family may have heard the word "medication" and zeroed in on it because the idea of medicating children is truly offensive to mainstream society.
Approaching this family, I would be gentle and supportive. Let them know you are available to answer questions and point to resources if they need them. Tell them the teacher was inappropriate. They need to know others recognize that, because accurate or not, it WAS inappropriate.
If you do not know the latest research on ADHD and other neurobiological behavioral disorders, I encourage you to learn more. A good review of uptodate and the DSM-V might be helpful so that you're prepared to answer their questions when they are feeling ready to talk.
I'll be giving them hugs in my heart. This journey sucks. Once you find adequate treatment, though, a massive door opens to the child. They'll be more socially appropriate to peers, they'll be able to do well in school, and they'll have the ability to maintain control of their body and mind. Imagine constantly being out of control, unable to keep your thoughts still and your body from moving all the time. Some days it literally is painful.
Anyway, I hope my story is helpful, and you can get in touch with me anytime you need help/resources.

Thank you so much for taking the time to share your story with me. I am going to be reading a lot more about ADHD, for sure.

JustBeachyNurse, LPN · Sep 5, 2015

There is a lot more research on early identification and diagnosis of ADHD. Sometimes a structured environment and sensory integration therapy from OT is enough to start.

ixchel · Sep 5, 2015

There is a lot more research on early identification and diagnosis of ADHD. Sometimes a structured environment and sensory integration therapy from OT is enough to start.

There is some research coming out lately regarding neurofeedback. It is so awesome! I looked up clinicaltrials.gov awhile back to see if anything was going on semi-locally but nothing was. It's basically brain training through a video game, strengthening the ability for patience, longevity and self control. Bummed this might not be accepted into wide-spread practice until my little guy is a big guy. The results look promising for those fortunate to receive early diagnosis and early intervention.

ixchel · Sep 5, 2015

Thank you so much for taking the time to share your story with me. I am going to be reading a lot more about ADHD, for sure.

I'm glad to share it! If in my lifetime, my research and experience can help even just one child find success, I'll consider my work complete. :) Because ADHD has struggled to achieve legitimacy in mainstream society, it takes those who do recognize it to break down barriers and dispel myths. These kids tend to be pretty awesome kids. They just need a little help, whether it be behavioral interventions or medications (or both).