Most adults concede it is harder being a kid these days. The complexity of society and all its dysfunctions seems to be affecting children in ways we are just beginning to understand. Twenty-five years ago most prescription medications taken in schools were pills for head colds. There was the occasional student with asthma, diabetes, or seizures, but there were few students who took prescription medications at school. Most schools had no policies. Children had their meds on their person and took them at the drinking fountain near the prescribed time. Many times teachers didn't know a student was taking any meds. 

When I began researching this area, I thought this type of information could be gathered from a single source, such as a local pharmacist, the marketing department of a drug company such as Eli Lilly, or from the FDA, which must keep track of all controlled drugs. After several days of phone calls and face to face questioning, I found there is no "authentic" document that gives this information. Therefore, I had to piece information together from all of these sources to better make sense of this elusive data. Many were surprised I would ask such a question. One pharmacist didn't understand why teachers would want to know this information. (It would seem that those developing and dispensing medications need more information about school instruction and school cultures in general.) Therefore, after talking and listening to many sources, the top four conditions and classes of medications are in no particular order, since no one really seems to know. But, there is general agreement that many prescriptions are written for children for the following: ear and throat infections - antibiotics with the most popular being Amoxicillin and other drugs in this class of broad-spectrum antibiotics; asthma - inhalers, chromolyns, and steroid-based drugs; ADHD - stimulants, with Ritalin being the most common prescription; epilepsy - seizure-controlling medications, of which there are several new ones on the market.

• Antibiotics: You can generally guess a child may have an ear infection (or chronic ear infections) when you need to speak louder because the child cannot hear you, when you see a child cradle the head in a hand in order to place pressure on the ear and relieve the pain, when the ear may be seeping a yellowish or slight greenish liquid, when a child complains of ears that hurt or throb. Ear infections are very common, especially in very young children. (Learn more about ear infections and how they affect health and hearing by going to Kidsource Online, sponsored by the American Speech-Language-Hearing Association.) If they become chronic, some children have small tubes placed in their ears in order to promote appropriate fluid drainage. Untreated chronic ear infections can result in permanent hearing loss; yet, we also know that frequent antibiotic treatments can create tolerance to the drug and make a child more highly susceptible to more serious infections. Side effects may include some nausea, diarrhea, and a slight skin rash. It is important that a child finish the regimen of dosage, even if they "feel all well now." This magic bullet drug usually gives a child relief in two or three days, but if the medication is stopped before the full dosage course, the infection will return. Amoxicillin is commonly prescribed either in capsules, liquid, or chewable because it is effective and relatively inexpensive. However, there are numerous other antibiotics with registered names which are more "designer" for specific types of infections and, of course, more expensive. Doctors will rely on them if a child is not responding as expected the more common antibiotics, such as Amoxicillin. We now know that doctors are more hesitant to prescribe antibiotics for fear of the child developing a resistance to their power.
  Parents, however, still pressure doctors to give them to their children. Doctors are now prevailing. Therefore, many of these children require observation as to their condition, so if they do get worse, doctors may have to become involved. Therefore, teachers must now not only understand what children may be like in the classroom when taking antibiotics, but they must more closely monitor children who are not receiving antibiotics for signs of symptoms worsening and requiring swift medical intervention.
  
   
• Inhalers, Chromolyn, and Steroids: There has been a rapid jump in the number of children and adults who have developed asthma in the last ten years. There is still no clear reason for this quick increase, but medical researchers suspect it is a combination of increased irritants (e.g., pollution, use of chemicals, and lifestyle changes, such as increased stress). Infants are now commonly diagnosed with asthma. We believe that 80% of those who have asthma also have a history of allergies. Many have a history of food allergies as a child, a common one being milk. Virtually all asthmatics report having hay fever as a precursor to asthma. How this is all intertwined is not clear, but we do know that more children are being treated for asthma, and the chance of a child having an asthma attack in school is very real. The two courses of treatment for asthma involve inhalers , medications by mouth, or a combination of both. Some children are still taking desensitizing treatments which is a diluted mixture of those molds and pollens to which a child is sensitive and given as weekly injections. Inhalers are small vials of medication that children can inhale. They are largely used as a preventative and children have a regimen in making sure they have taken their meds a prescribed number of times per day. However, sometimes environmental influences are too much, and an asthma attack can happen. Such symptoms include coughing a lot while exercising and then after exercising, shortness of breath, wheezing and hearing a "rattle" in the lungs that sounds like an accordion being squeezed in and out, and a general tightness in the chest. Critical attacks may include blueness around the mouth. Seek help immediately. An asthmatic child should never be away from medicine. Some children have epinephrine pens in case there is a sudden, severe attack. Steroids and chromolyn are are used in inhalers and have proved to be safe and effective. Athletes find it particularly helpful as a part of their medical control of asthma.  However, oral steroids, such as prednisone, can have severe permanent side effects if not carefully monitored. Children who take oral steroids may be sleepy or jittery about 30 minutes after dosage. They may have increased appetite and need food more often than other children.
   
• Ritalin:    Ritalin is in a controlled class of stimulant drugs and is most often prescribed for ADD and ADHD.  There is a great deal of information available about ADD and ADHD, mostly written by professionals in education, psychology, and medicine.  Educators might benefit from understanding ADHD and drug therapy by reading what Paul Perry and Sam Kuperman have discovered.  This research team (educator and medical doctor) revised their original overview of pharmacotherapy, and it remains the standard concerning the examination of double-blind studies of stimulant medication.  Teachers will find surprising information in this well-written, readable research article.  This information can be very helpful to teachers, especially the section concerning drug interactions with stimulant medication.  Since many children are taking more than one medication, either prescribed or over-the-counter, any potential drug interactions are critical to know for today’s inclusive classrooms. 

The controversy surrounding Ritalin will not soon go away, but as schools become more accountable for children's learning as measured by standardized state test scores, more parents will be "encouraged" to place their children on this drug by teachers and principals. Information about the use of Ritalin is discussed is quite useful for all teachers to know.

 This site http://www.chadd.org will tell you more about Ritalin and other stimulant drugs as well as give you a overview of a national parent support group active in most states. Click on the "Chapter Locater" to see if there is a local chapter for additional information or to attend a meeting. The FAQ pages on ADHD and recent research gives you a better idea of areas of greatest interest to parents.

• Anticonvulsant drugs for epilepsy: There are many types of epilepsy as well as severity and frequency of seizures. To get a better understanding of the available medications, this epilepsy site helps families with children. Thanks to the broad array of medications, many children have their seizures under control. However there are some children, especially children with disabilities, who seem to become tolerant to medications more quickly than other children and will have frequent drug changes, dosage changes, or mixes of medications in order to gain better control of seizuring. There are numerous side effects with these medications, the most common being drowsiness, stomachaches, and headaches. Some children become more hyperactive-like while taking certain medications. Overdosing is dangerous and children must be closely monitored, since stress is a factor in triggering seizures. Epilepsy can occur in all children and, most generally, the cause is unknown; however, it is especially common in children who have head injuries, cerebral palsy, and classic autism.

Instructional Modifications

When planning lessons for children who are taking medications, the best instructional modification all teachers can make is a healthy dose of patience. Know the windows of time when the child will get the best results from any medication. For example, a child taking Ritalin will need about 20-30 minutes for the drug to "kick in" - however, after about two hours the drug begins to wear off. Therefore, a teacher may wish to consider tasks that require more attention, such as new material or giving a test, to be done in that optimal window of time. Children who are taking drugs for asthma may not feel very well during high pollen times of the year or on very cold days. High-stakes testing should take this into consideration and children who are sensitive to seasonal stress should have special accommodation of rooms with air filters or extra time. Some meds need to be taken with food. Teachers and school health staff should have appropriate food items on hand so that children can take their meds appropriately. This will help avoid having children who have tummys that hurt or just plain get sick. The best rule of thumb is this. When you have a child who is taking medication and is not doing well either academically or behaviorally, closely observe all the parameters of the environment and the task and see what adjustments can be made to increase success for the child. Instructional modification can be just changing your schedule or tasks, providing extra time, providing a little snack, or allowing a child to move around. Common sense is the best guide.

Behavioral Interventions for Attention to Task

We actually know a great deal in how to keep ADHD children on task. The problem with the most of us is we just don't structure the intervention as well as ADHD children demand in order for an intervention to be successful. The University of Virginia's website features several interventions for attending to task. Note how well-structured each intervention is and how results for improvement can be measured. Similar interventions can be planned for both home and classroom. Satterfield's research suggests that medication alone is not enough to permanently change the behavior of ADHD children. There are two other components: one is using consistent behavior management techniques and the other psychological counseling. ADHD children are more visual learners than auditory learners. The more successful interventions use many visual cues for success.

School Policies in Dispensing Medications

Teachers of disabled children face many challenges, but none is so frustrating and heartbreaking as having a child with a disorder or syndrome where there is no cure or no medication to control symptoms. These children have what are called low-incidence disabilities, meaning there are few children who have such a disorder. Many of these children will die before they reach adulthood. The National Organization for Rare Disorders, Inc. provides information through education about rare diseases, advocacy for research and right to privacy on medical matters, and maintains a rare disease database.

Once you are into this WWW site, click on the two areas dealing with drugs and medications. This will give you an overview in how drugs are developed for rare diseases and how those who need to have these drugs can be connected. The Orphan Drug Law encourages pharmaceutical companies to do research and develop drugs to treat low-incidence disorders. Before this law was enacted, drug companies were reluctant to place resources into low-incidence diseases, since the cost of the development would make the drug either cost prohibitive to the patient or the company would lose a considerable amount of money for lack of market. This Orphan Drug Law of 1983 has helped to remediate these problems and already several promising treatments have been developed, with the most recent medications are listed in their online newsletter.    If you have a child taking an experimental medication, you will need to collect observational data in the cognitive, behavioral, social/emotional, and physical parameters. Good, objective data will be helpful to the child, the family, and the care physicians as new treatments are explored and perfected.

If you have a child in your class or your school with an "orphan disease," this is an excellent site to learn more about the disease or syndrome, what is being done through the development of new medications and therapies, and how to use their parent connections area to support your parents who have similar children

Concluding Remarks

Educators will need to be better prepared about medical issues for all their children, especially those with disabilities. Parents will especially need support and encouragement as well as sources for information. Teachers can play a pivotal role as a communication link between parents and the medical profession. Careful administration of medications and objective data are helpful for all involved, and educators must be proactive in this critical (and often neglected) area of concern school communities.