Who should be responsible for administering medications in school?
This seemingly innocent question has touched off a lot of controversy recently, with some teachers, administrators, and even school nurses expressing reluctance to administer medications for ADHD.
In my view, there's no medical or scientific reason for concern, provided they're administering the medication in accordance with a doctor's prescription. Ritalin, Dexedrine, and other ADHD medications have an outstanding safety record in the treatment of ADHD. And occasional errors in administering the drugs aren't likely to cause any long-term harm.
The most common error is likely to be a missed dose. But since most of these drugs don't accumulate in the body, an occasional missed dose won't make a difference in the long run. If a child misses his midday dose, he'll probably have a difficult time in the afternoon, but once he takes his next scheduled dose he'll be back where he should be.
Potentially more serious is a case in which a child receives an incorrect dose--either because she inadvertently is given a second dose or because she gets someone else's prescription by accident. But here, too, the physical risks aren't that great if a child receives, say, a double dose on a single occasion. (Of course, it's still important to know that the mixup occurred, so that you don't think your child is having trouble tolerating her usual dosage. And if medication errors are occurring frequently, you need to find out why and ensure that the school promptly takes steps to fix the problem.)
Despite the relative safety of ADHD medications, however, a growing number of schools are refusing to get involved in administering them. Many cite the administrative burden; some also say they don't want to be responsible for making sure the child complies with his medication regimen.
We can debate whether these concerns are justified, but the bottom line is that if your school won't administer medication during school hours, you have a number of choices:
- You can come to the school yourself every day to give your child his midday dose--which isn't a practical option for many parents.
- You can make your child responsible for taking his own medication every day. This is a good choice for older children and younger ones who are motivated. But it may be an uphill battle for many children. Few of them like to take a pill in the first place, and the problem is compounded by the ADHD itself. If your child has trouble remembering to bring her schoolbag at the end of the day, will she remember to take her medication at lunchtime?
- You can help by giving the child reminders--for example, packing the medications right in her lunchbox. And even if the school has a policy against administering medications, you can certainly ask for its help in reminding your child to take them.
- An alarm watch--some come with as many as five alarms--is a great way to remind the child to take his medication. Similarly, some pill cases have programmable alarms.
- You can ask your doctor to consider a longer-acting stimulant such as Adderral, Dexedrine spansules, or sustained-release Ritalin, which may allow you to skip the midday dosage altogether.