In a time when Attention-Deficit/Hyperactivity Disorder (ADHD) diagnoses are on the rise and the demands on the education system are increasing, the role of the school nurse in navigating the complex interplay of medication management, behavioral interventions, necessary accommodations, and care coordination for students with this complex neurodevelopmental disorder has never been more pivotal.
Definition & Reach
ADHD is a chronic brain condition marked by persistent and debilitating symptoms of inattention, hyperactivity, and impulsivity. Students with ADHD may be affected across various domains, including academics, social connections, and daily activities. According to the Centers for Disease Control and Prevention (CDC), about 1 in 9 children in the United States between the ages of 3 and 17 have been diagnosed with ADHD. The majority of children diagnosed with ADHD also have at least one additional related condition, and approximately 18 percent have three or more. ADHD that is poorly managed or remains untreated, has also been found to significantly elevate the likelihood of experiencing severe health issues in adulthood.
Medication Management
ADHD is commonly treated using three main categories of medications: stimulants, alpha-2-agonists, and norepinephrine dopamine reuptake inhibitors (NRIs and NDRIs). These drugs share a common feature in that they all work to enhance the executive function of the brain, and by doing so, they can improve memory and concentration while also reducing impulsivity and hyperactivity. Key considerations for school nurses supporting students prescribed medication for ADHD include:
- Monitoring for side effects such as abdominal pain, nausea, dizziness, tics, irritability, and rebound, as well as behaviors associated with insomnia.
- Coordinating with families and healthcare providers on medication schedules and compliance with medication protocols, especially around controlled substances.
- Educating school staff on the effects and limitations of ADHD medications.
Assessing the efficacy of ADHD medication involves monitoring changes in behavior and the emergence of any new or heightened side effects. The input of school staff is crucial in this evaluation process, and teachers should be urged to communicate their observations to the school nurse.
Behavioral Interventions & Academic Accommodations
Students with ADHD may qualify for either an Individualized Education Program (IEP) or a 504 Plan, depending on how their ADHD impacts their education. The school nurse's responsibility is developing an Individualized Healthcare Plan (IHP) for students with ADHD. The IHP should include pharmacological interventions as well as behavioral and academic supports. Research consistently shows that behavioral interventions are highly effective for managing ADHD symptoms at school. These may include:
- Extended time on tests
- Preferential seating
- Breaks for physical activity
- Use of technology for task completion
- Systems for organizing school materials
- Positive reinforcement techniques
Care Coordination & Education
Strong partnerships between families and schools are essential for managing ADHD, and the school nurse plays a vital role in the coordination of care. Behaviors associated with ADHD are frequently misunderstood, which can lead to psychosocial implications and disciplinary issues. Having a child with ADHD also significantly impacts family dynamics, resulting in higher levels of parental stress and increased tension within the home. Through active advocacy and facilitation of parental involvement in a student's ongoing ADHD management plan and by working closely with teachers, administration, and other school support staff to help identify and implement accommodations and services that support the needs of students with ADHD, school nurses can ensure that students receive comprehensive support for their overall well-being and academic success.
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