Attention deficit/ hyperactivity disorder (ADHD) is a common neurological disorder that begins in childhood and may continue into adulthood. ADHD is characterized by persistent inattention, hyperactivity and impulsivity (Willard & Spackman, 2014). Most individuals diagnosed with ADHD struggle in social participation, formal education participation as well as play exploration (AOTA, 2014). In the case of Jacob he has a hard time maintaining friendships, struggles in school, is forgetful, and does not complete his household chores. Jacob has been prescribed Focalin by his pediatrician to help with some of the symptoms.
A common interdisciplinary intervention for ADHD is medication. Stimulants are the most researched class of drugs to help alleviate the symptoms of ADHD. Common types of medications prescribed include methylphenidates, atomoxetines and dexamphetamines (Bonder, 2015). Stimulants facilitate presynaptic release and inhibit post-synaptic reuptake of norepinephrine and dopamine; these medications activate arousal systems in the CNS (Halperin, 2019). It has been proven that stimulants increase children’s on-task behavior, improve academic work and improve focusing abilities (Bonder, 2015); (Willard & Spackman, 2014). Although medication may be effective for children with ADHD there may be problematic side effects that may occur, and medication can be ineffective depending on the child being treated. Using medication for ADHD in children is quite controversial. The controversy revolving around stimulants being prescribed to children is that they may become addicted later in life, or the side effects of nausea, loss of appetite, stomachaches, weight loss, agitation, moodiness etc. may outweigh the benefits in a young child (Halperin, 2019).
Focalin is a stimulant specifically a dexmethylphenidate. This medication comes in tablet form and is taken orally twice a day with each dosage being taken at least 4 hours apart (FDA, n.d.). Jacob has been suffering from stomachaches after taking focalin, these stomach problems have further complicated his situation in school and at home. One of the adverse reactions of focalin is gastrointestinal complications, which include stomachaches, nausea and loss of appetite (FDA, n.d.). Jacob has a tendency to lose track of his lunch box, which may be a sign that he does not have an appetite or does not have an interest in eating because of his frequent stomachaches due to the medication. To combat this problem, it may be recommended that the family return to Jacob’s pediatrician to look into other medication options that may have less side effects than focalin. One particular study looked into the mothers and child’s perceptions of medication for children with ADHD. Both the child and mother shared the common belief that once side effects increased, the mother was hesitant in giving their child the medication because of the additional barriers this created. However, both agreed that the benefits of effective behavior management out weighed the negative side effects (Mcneal, 2000). Overall, the mother’s reported higher rates of satisfaction with the medication benefits.
The IADL of health management and maintenance, specifically medication management at school, is also apart of Jacob’s daily routine. Overall, stimulants are taken by approximately 56% of children and an estimated 4-6% of all school age children often receive medication in school on a typical day (Clay, 2008); (Halperin, 2019). In a study of 37 children with ADHD it was found that about 63.6% of the children brought their own medication to school and about 33% of the parents brought the child’s medication to school (Clay, 2008). Jacob is very forgetful and it could be a possibility that his parents are putting his medication in his back pack or coat and he is forgetting to bring it to school, so it may be beneficial if Jacob’s mother brought a supply of his medication to the school nurse so that it would not be left behind on the school bus. Medications are often stored at the nurse’s office and often times the student is cued to go to the nurse’s office to receive their medication.
There is a significant impact on both the parent and child when the child misses a dose of their medication at school. In the study, majority of the students stated that if they missed taking their medication at school, their schoolwork was affected, friendships were affected negatively, and there was an effect on their physical health. Specifically, 36.4% of the students were not able to concentrate, 15% felt confused and 12% felt anxious (Clay, 2008). When looking specifically at how non-adherence of a medication plan affected their schoolwork, 39.4% of the children had trouble paying attention, 27.3% misbehaved in class, and 18% do poorly on exams (Clay, 2008). When students do not adhere to their medication plan this may lead to a multitude of problems in school, their social life and may lead to physical consequences. It may be beneficial that the nurse have a daily checklist in his or her office to make sure Jacob is adhering to his medication schedule. The nurse could also send a daily or weekly email to Jacob’s mother based on their discretion so she knows that his medication was taken that day or week. This system will ensure that Jacob is taking his daily medication at school and will hopefully help him focus better and help improve his peer relationships.
