A child in your class taking medication is bound to require more from you than your other students. This can mean a number of extra responsibilities:
- Monitoring the effects of medication–you see the medicated child, not his parents, or his doctor; therefore you are the best person for (a) seeing how much the medication is helping the child; (b) making sure it is not hurting the child; (c) noting changes in how the child or other children feel about him; and (d) providing this information to doctors, parents, and other school personnel. Many of the scales and observation techniques for identifying hyperactive and problem children can be used here as well.
Usually an update is recommended at least every three months, to discuss concerns or changes in the child’s feelings or behavior. This is also a good time to evaluate the child’s continued need for medication. Giving the child systematic drug holidays allow you and parents to see if he can function on his own without medication.
Another part of monitoring is making sure the child takes his pills when he’s supposed to. Some hyperactive children receive a noontime dose, either from the school nurse or, in some cases, you. The child should not be bringing pills in his lunchbox. This invites him either to forget about taking it, or other children to experiment with it.
You may run into the noncompliant parent, who fails to follow dosage directions: letting prescriptions run out for days or even weeks, forgetting to give their child his pills, giving their child more than the prescribed amount of pills. A child should not be given extra pills because he missed one, had a bad day, or needs it to get through a special event. Besides upsetting his body chemistry, being given extra pills may be seen by the child as a form of punishment, or a sign that his parents don’t feel confident he can control his own behavior. If you find parents who don’t follow their child’s prescription directions, first advise them it can be harmful to their child, and it is not recommended by doctors. If they continue, consult the child’s doctor.
- Communicating between doctors, parents, and teachers–although this is an essential part of the treatment process; it receives surprisingly little attention. Questions such as who should explain the effects of medication to the child, arrange update meetings, and take overall responsibility for the child’s treatment are often left unanswered.
Past research has shown parents, doctors, and teachers all having different ideas about what should be done, who should be doing it, and who the key figure should be. For instance, while parents and teachers agreed parents should take the most responsibility in their child’s treatment, doctors felt parents should not be involved. As well, teachers saw themselves as less involved than parents and doctors thought they should be.
These matters should be settled before a child starts taking medication. It requires a meeting with all three parties present, plus the child, if you think he would benefit from being there. If everybody knows what they’re supposed to do, and how to do it, as well as what everybody else is supposed to do, it saves time and prevents confusion later on.
We should not make light of the troubles of children. They are worse than ours, because we can see the end of our trouble and they can never see any end. William Middleton.
- Keeping the child normal–how you can explain hyperactivity and stimulant medication to hyperactive children, so they will understand and not think of themselves as weird.
It is the end of the day and all the kids have gone home except for Richie, who is still there, although you’re not sure why. You sense he may have something on his mind, so you ask him if everything’s all right. He doesn’t say anything right away, but after a long 30 seconds blurts out, “Do I have a wrecked brain because I’m hyperactive? Why do I have to be stupid hyperactive anyway?” What do you say?
Before you say anything, keep these four pointers in mind: (1) don’t try to hide anything from him, but then at the same time don’t tell him anything he doesn’t need to know; (2) explain his condition in words he can understand; (3) try to lead him into discovering his own answers; (4) listen carefully to what he says, show concern, and treat him and his problem with respect.
Below are some of the answers you could give:
- “No, your brain is not wrecked, but you do have some problems which other children don’t have. Do you know which ones I mean?” If the child needs prompting say, “Like sometimes you have trouble paying attention during class, or sitting still in your seat, or you blurt out answers before thinking them through.”
- Ask him what a person with a wrecked brain looks like. Does he look the same? Does he look remarkably different from anyone else in the class?
- Reassure him that he’s just like everybody else, except that some things are harder for him to do than the other children. Ask him about other kids in the class. Is it just as easy for Nancy, who is in the #3 reading group, to read as Diane, who is in the #1 reading group? Is it just as easy for you to climb the rope in the gymnasium as it is for him?
Is it Nancy’s fault she can’t read as quickly as Diane? Is it his fault he can’t sit still in his seat? Explain to him that these are traits we are born with, just like Tyler has red hair, and Jeffrey is taller than anybody else in the class.
Ask him if he has the worst problems of anybody in the world? Mention children who have far less than he does, children confined to wheelchairs or even hospital beds, who want more than anything else in the world one day to walk.
- Explain to him that everybody has things which they are better at or worse at than other people. Ask him what things he’s good at. If he has problems coming up with ideas, make positive comments like, “You can outlast most kids out on the soccer field,” or, “You have a funny sense of humor which makes people laugh.” Also bring up activities or tasks which you know the child enjoys doing or tries hard at.
- Assure the child that as he grows older he’ll learn to use his energy and abilities in ways that help him. For instance, firemen need a lot of energy to fight fires, professional athletes need stamina to run for a long time, and politicians need a sense of humor. He won’t always have to sit in a desk and pay attention to a teacher.
Also explain to him that as he gets older, people won’t care so much if he does things differently from them, because they will realize that how he does things doesn’t say anything about who he is as a person. Older people will value more his personality, and how he gets along with other people. Children in school tease him because they’re too young to understand this.
- Ask the child what he should do the next time kids make fun of him. Suggestions you can make are, “Ignore them and try not to let them get to you, because as soon as you do, they’ll be sure to bug you again”; and, “Look at their teasing as a way for you to become a stronger person inside.”
Finally, the best way for you to handle peer stigmatism in your classroom is by preventing it from happening in the first place. School-age children are particularly discriminating against anyone who looks different or behaves different from them. One way of breaking down this wall is by exposing your class more to exceptional people. You can do this in several ways: (a) making books available on various handicapping conditions; (b) showing films about exceptional people; (c) visiting schools or workshops for special people; (d) encouraging your students to tutor special needs children or help out with their activities; (e) asking students to introduce a make-believe or real special friend, explaining all his positive points and the things he has trouble doing; (f) inviting handicapped people to make guest appearances in your classroom; (g) using social skills programs such as Developing an Understanding of Self and Others (Dinkmeyer, 1970, 1973), and Human Development Program (Palomares and Ball, 1974); and (h) trying projective techniques such as role-playing and puppetry.
Ideally these activities should form an ongoing part of your curriculum. They will provide mutual benefit not only for exceptional children in your classroom, but also other students–both have a lot to learn from each other.
Following are some additional questions hyperactive children may ask you about taking medication, along with suggestions on how you can respond.
(a) “Why do I have to take pills?”
Answer: “Pills help you calm down and pay attention, so you can learn more and do the best you’re capable of doing at school.”
You can help the child understand this better with an analogy: “Say you enter a go-cart race. As you’re lining up at the starting line you notice that everybody else’s go-cart has four wheels, while yours only has three wheels. Do you think you will have the same chances of winning the race, with only three wheels? The same holds true for you in school: pills help you to have the same advantage in learning as everybody else, so you can have the same chances of doing your best.”
(b) “Will pills make me smarter?”
Answer: “No, pills will not make you smarter. They will help you do the best you can, and help you discover some of the neat things you have inside you, but they won’t give you something you don’t already have.”
You can also point out to the child the distinction between pills helping him do better and making him do better. If pills make him do better, then he no longer is responsible for what he does. Helping, however, means he is still in control of what he does.
An example of this is a boy putting together a model plane. He gets stuck on one piece and asks his dad for help. Ask the child if the boy should ask his dad to help him with just the one piece, or to do the whole thing for him. Talk about how the boy will feel in each situation. Ask the child if the boy will feel as proud of his plane, as responsible for making it, as likely to tell his friends he made it, if he lets his dad do it all.
In addition, you can help the child feel responsible for what he does by reinforcing his own efforts and accomplishments. Comments like, “You finished reading the story all on your own, good for you,” or, “I’m proud of you that you tried all the questions on your math sheet,” draw no link between effort and pill-taking, so the child is more likely to give himself the credit.
(c) “How long do I have to take pills for?”
Answer: “That depends on how hard you try to help yourself, and on how hard we try to help you. If we all try our best, the less you’ll need your pills, and the sooner you’ll be able to stop taking them.”
(d) “What can I say to my friends?”
Answer: “Tell your friends that you take pills to help you learn better in school. Ask them if they’ve ever taken a pill to help them get over a fever or a toothache. Ask them if they’re weird because they took an aspirin. Tell them you’re not weird either, because your case is no different from theirs.”