MEDICATION SIDE EFFECTS

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PREFACE

In this section, I've tried to compile some tips for how to manage some of the more common problems associated with medication side effects in the classroom, although many of the accommodations listed below are equally applicable to adults who are on these medications.

Dealing with medication side effects seems to be a bit more straightforward than dealing with other kinds of problems, as some accommodations are essentially required and there's not much point in debating or questioning when you're told something like "He's on lithium and has to keep a water bottle with him so he can drink frequently." Other side effects will be harder to deal with and may require some collaborative experimenting to determine what works.

If the student is first going on medication for a neurobehavioral condition, expect that there may well be number of medication adjustments as medications need to be fine-tuned. Ask the prescribing physician to provide the school with a list of common, expected, or known side effects for the student.

The tips below are organized by type of side effect and not by diagnosis or class or medication. Keep in mind that the student should be consulted as to what may be needed and/or helpful. Additionally, although it is not specifically repeated as an accommodation under each problem, educating the school personnel about the child's medications and their side effects may be one of the most important accommodations you can provide so that school personnel understand and can be supportive.

INCREASED THIRST

If the student is experiencing increased thirst, allow the student to have unlimited access to water, juice, or whatever fluids their physician or they request. Many students may want to keep a water bottle on them at all times.

VISUAL BLURRING

If the student is experiencing visual blurring as a side effect, reduce the amount to be read, provide a reader, and use books on tape if the student will be remaining on that medication.

FREQUENT URINATION, NAUSEA, VOMITING, DIARRHEA, FLATULENCE

If the student is experiencing gastrointestinal or urologic side effects ( increased urinary frequency or urinary urgency, nausea, vomiting, diarrhea, or flatulence), allow the student to have a permanent pass that they can use to just leave the room without having to ask. Note: if a student has these problems, inform all teachers that the student does not have to ask permission to leave the room and will just be leaving as needed. In conjunction with this, the student should be asked if they prefer to sit near the door or elsewhere in the room.

Note that clomipramine (trade name Anafranil) is one of the medications that can produce flatulence. Sometimes teachers erroneously assume that the child is just not trying to control it or is engaging in age-related misbehavior.

"REBOUND" PROBLEMS:  HYPERACTIVITY, WEEPINESS, IRRITABILITY

When some medications wear off, the student may experience a worsening of symptoms -- more than they would have had without the medication. Such worsening is generally referred to as "rebound" when it occurs in this way, and is most frequently reported with the shorter-acting stimulant medications that are used to treat ADHD.

If the student is experiencing "rebound" problems of increased hyperactivity, weepiness, or irritability as their medication wears off, provide less demanding academic activities during that time and allow more opportunities for the student to move around or engage in activities that are gentle and calming for them. Also speak to the parents and/or physician about whether the in-school dosing schedule should be adjusted. Due to the fact that there are many more longer-acting medications on the market than there were a few years ago, this is becoming less of a problem, but it still occurs.

APPETITE/WEIGHT CHANGES

If the student has no appetite at lunch time because they are on a stimulant medication (such as Ritalin, Dexedrine, Adderall, Concerta, etc.), the in-school dosing of the medication may need to be adjusted if the child's lunch period can't be changed (although that would be the first thing to try). In general, stimulant medications should not be taken 30 - 40 minutes before mealtime, as they suppress appetite.

If the student is on a neuroleptic (e.g., Risperdal, Zyprexa, Haldol, etc.) or Anafranil (clomipramine), they may experience increased appetite and significant weight gain. Speak with the parents and physician about whether to allow the student to have a snack on them at all times or whether to schedule snack breaks, etc. If the physician suggests that the student be allowed to snack, you may want to ask the parents to send in healthy snacks that can be left in the classroom for easy access (for younger students).

The significant weight gain that has been associated with the neuroleptic medications can be socially devastating to a child or teenager. Teachers may wish to speak with the parents and student about whether some peer education might be helpful to reduce any teasing or rejection.

COGNITIVE DULLING

Some medications can cause cognitive dulling or are so sedating that the student feels as if their mind is a cotton ball. If the student experiences cognitive dulling:

• Allow the use of word banks and other accommodations for word retrieval
• Allow more time for assignments
• Allow the student to take more breaks if they cannot sustain their effort on intellectually demanding tasks
• Do not call on the student to answer questions in class unless the student raises his/her hand to volunteer or tells you that it is OK to call on them
• Consider decreasing workload and/or homework assignments

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