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MEDICATION-INDUCED
MOVEMENT DISORDERS
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Some medications may induce
involuntary movements or sounds. If the involuntary
movements or sounds are tics,
inform the parents so that they are aware of the
tics, but in the meantime, do not comment on the
tics (ignore them) while you figure out what types
of interference they are creating so that you can
make accommodations for the tics (see the article,
"Tips
on Dealing with Tics in the
Classroom").
Some medications may induce
other types of movement disorders, however, and it
may be difficult for the classroom teacher to
identify what type of problem the student is
experiencing. If the student seems to have
medication-related increased motor restlessness
(e.g., they report a type of "inner restlessness"
and can't seem to sit still at all and have to keep
getting up and moving around), it may be a
medication-related akathisia. Medication-related
akathisia has been reported for neuroleptic
medications and for SSRIs.1
Because it is can be very difficult to
distinguish between medication-related akathisia
and hyperactivity, ongoing communication between
the home, school personnel, and treating physician
is very important.
Another type of
medication-related movement disorder that teachers
may encounter in the classroom is dyskinesia, a
term that refers to involuntary movements. One type
of dyskinesia that is of particular concern to
parents of children on neuroleptic medications for
tics or behavioral issues is tardive dyskinesia.
The National Institute of Neurological Disorders
and Stroke says "Tardive dyskinesia is
characterized by repetitive, involuntary,
purposeless movements. Features of the disorder may
include grimacing, tongue protrusion, lip smacking,
puckering and pursing, and rapid eye blinking.
Rapid movements of the arms, legs, and trunk may
also occur. Impaired movements of the fingers may
appear as though the patient is playing an
invisible guitar or piano" (NINDS, 2001). Many of
the symptoms they list could look very much like
tics, which is another reason that ongoing
communication is so important.
If the student experiences
any medication-related movement disorder, you will
generally need to allow for more opportunities for
movement and you will probably need to allow for
more time to complete tasks. To the extent that the
movements distract the student, you may also need
to provide assistance in the forms of hard copies
of notes, gentle assistance focusing, and giving
the student more breaks from activities that
require sitting.
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INCREASED "WILDNESS," ACTIVATION,
AGGRESSION
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Some medications can cause
behavioral "activation," wildness, or aggression or
increase those problems if they already existed. In
particular, some children or teens experience this
type of problem when on SSRI medications that are
used to treat depression or OCD. In some cases,
these medications appear to activate the child or
"trip" them into hypomania.
If the student has had a
change in medication or dose of medication and
seems to be getting more aggressive or "wild,"
inform the student's parents and the prescribing
physician immediately to alert them to your
observations. In the meantime, you may need to
provide more individualized attention and support
to the student to help them calm themselves and
stay focused on the work. If the student appears
particularly agitated or wild, you may want to work
out a signal that they can use to tell you that
they're leaving the room to go to the nurse or some
designated "safe place" or "safe
person."
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TIREDNESS/FATIGUE/SLEEPING
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If the student cannot wake up
in the morning to attend school (due to a
medication side effect or a sleep component of the
condition itself), there are various accommodations
to explore if the medication is not going to be
changed:
- Reduce the student's
course load and allow the student to start the
day later.
- Schedule "heavy" academic
courses later in the day.
- Allow the student to
start the day later and provide tutoring in the
home so that the student doesn't become
demoralized over falling further behind.
- Ask the student if
scheduling a highly motivating class for first
period might help them wake up; be guided by
their assessment of their situation.
- If the student is falling
asleep in school due to medication side effects
or the condition itself, speak to the physician
about whether to let the student sleep or to try
to rouse them, but provide the student with hard
copies of all notes and presentations, and
insure that all assignments are recorded.
- Conference with the
parent about whether the student is capable of
keeping up with homework or is falling asleep at
home. You may need to reduce homework or
significantly extend time on
assignments.
- For some medications (such as clonidine),
having the student get up and walk around or get
involved in a highly motivating activity may be
sufficient to diminish the sleepiness or
tiredness
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IMPAIRED CONCENTRATION AND/OR MEMORY PROBLEMS
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A number of the
disorders discussed on this web site may be
associated with impaired concentration and/or
memory problems, but medications can also produce
concentration difficulties or memory problems. If
the student is experiencing these types of
problems:
- You may need to
record the student's assignments for him/her.
This can be done by the teacher or assistant but
responsibility for it should be assigned to a
staff member.
- For older
students, provide hard copies of all board work
and lecture notes.
- Remind the
student at the end of the school day which
materials he or she needs to take home, or
provide Resource Room as the last period of the
day so that the student can use the time to go
get missing papers, notes missed while out of
class, materials, etc.
- Allow extended
time on in-class assignments, homework, and big
projects. Conference frequently with student on
big projects to assist them in getting started
and staying on schedule.
- Provide a second
set of books for the student to use at
home.
- Assign an
assistant teacher or paraprofessional to the
class to assist the student
discreetly.
- Pitch to the
student's strengths. By providing enriching and
interesting materials, the student's focus and
energy levels will be enhanced.
- Testing
accommodations may have to include alternative
forms of testing such as allowing for word banks
if the student is experiencing word retrieval
problems due to medication side
effects.
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COMMENTS
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The school's nurse is
an important member of the child's team in terms of
educating teachers about medication side effects or
serving as a liaison with the prescribing physician
if there are concerns about adverse reactions to
medications. The school nurse can also provide a
safe place or sanctuary for the student who is
experiencing discomfort or frustration from
medication-related problems.
Teachers or parents
who wish to learn more about side effects ("adverse
effects") of particular medications can ask the
child's physician or pharmacist for information,
but there are also some resources online:
SafeMedication.com,
MEDLINEplus,
WebMDHealth
(Drugs and Herbs)
are some of the many online resources.
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FOOTNOTE
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1 Neuroleptic
medications include haloperidol, pimozide,
fluphenazine, risperidone, olanzapine, thiothixene,
and quetiapine fumarate. SSRI medications include
fluoxetine, paroxetine, fluvoxamine, sertraline,
citalopram, and escitalopram oxalate. For their
trade names, see the on-site
chart.
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