THE SCHOOL SETTING INCLUDING THE ROLE OF COMMUNITY CHILD HEALTH MEDICAL AND SCHOOL NURSING SERVICES

THIS GUIDELINE DESCRIBES THE PHARMACOLOGICAL MANAGEMENT OF Attention Deficit Hyperactivity Disorder IN THE SCHOOL SETTING INCLUDING THE ROLE OF COMMUNITY CHILD HEALTH MEDICAL AND SCHOOL NURSING SERVICES This guideline is designed to assist both health-care and non-health-care personnel involved in the care of children

2 Description of clinical condition Condition - description ADHD occurs in 1.5 to 5% of children. It is characterised by inattention, over-activity and impulsiveness and is present from early childhood. It is 3 to 4 times more common in boys than in girls. Education is often disrupted, family life stressful and peer relationships may suffer. In the majority of cases ADHD will persist throughout life. Complications at school 1. Poor academic achievement is common Poor concentration Poor attention Distractibility Impulsivity Behavioural difficulties Poor memory Problems with productivity and motivation Reduced ability to express ideas and emotions Problems with social interaction Low self esteem Risk of injury Higher risk of substance misuse 1a. Precipitating factors Lack of structured classroom environment Lack of clearly defined rules and expectations, Lack of consistent and immediate reinforcement Lack of regular feedback Distractions Food and drink additives in some children 1b. Preventative measures Position in the classroom Tools to do the job Use of visual reminders Positive reinforcement Options for safe havens Learning style inventory 1c. likely symptoms Inattention Does not attend Fails to finish tasks Can t organise Avoids sustained effort Loses things, forgetful Easily distracted Hyperactivity Authorised by: Page 2 of 7

3 Fidgets Leaves seat in class Runs/climbs excessively Cannot play/work quietly Always on the go Talks excessively Impulsivity Talks excessively Blurts out answers Cannot await turn Interrupts others Intrudes on others 1d. treatment Treatment relies mainly on behavioural management, educational and support strategies. These will not be discussed in this document. Where this is not proving adequate symptom control, medication may also be used. First line treatment for severe ADHD is Methylphenidate, a stimulant medication. It is licensed for the treatment of ADHD from the age of 6 years as part of a comprehensive treatment strategy. Methylphenidate is available as a shorter acting tablet, which lasts for about 4 hours. It is common for children to take this with breakfast before attending school and with lunch. Methylphenidate is also available as a longer acting tablet (Concerta XL /Equasym XL /Medikinet XL) which may last for between 8 and 12 hours and allows children who have been stabilised on treatment to avoid taking medicines in school. Where methylphenidate is not effective or not suitable for some pupils, a different type of medication may be given. These include Atomoxetine, Ddexamfphetamine, Elvranse, Cloniandine. These medicines may reduce a pupil s appetite and have been known to cause stomach aches and headaches. They may also cause mood swings in some children. Treatment must be started under the supervision Authorised by: Page 3 of 7

4 of a child psychiatrist and/or a paediatrician with a special interest and training in this field. Methylphenidate is a controlled drug and so safe and appropriate storage of shorter acting methylphenidate in schools is required. 1e. Follow-up Feedback to parents on any issues or concerns. A daily diary may be useful. 1f. Issues for school /preschool trips Ensure parental permission for the trip is obtained. Ensure adequate supplies of medication are available. The medication may be liable to abuse and so adequate arrangements may need to be made to ensure safe and appropriate storage. Responsibilities of Organisations Health There will be Community Paediatrician advice and support for each school/pre-school. There will be public health nurse support and advice for each school/pre-school. Providing relevant training on the medicines aspects of management of ADHD at school to school staff if requested. Education Ensuring relevant staff receive appropriate training. Ensuring appropriate facilities and procedures are in place in education environments to manage children with ADHD. Liaison with parents in relation to sharing information on health and medicine requirements for their children. Named Person to have available relevant detail. Authorised by: Page 4 of 7

5 Responsibilities of personnel involved Community Paediatricians The Community Paediatrician should be aware of all children within their schools with ADHD. Meet parents and monitor children who have problems with ADHD in school or about whom there are concerns. Take part in education sessions for staff in schools if required/requested. Contribute to the Child s Plan as appropriate. School Nurses Should ensure that they - refer any problems or concerns to community paediatrician - Contribute to the completion of the Child s Plan as appropriate Parent - Informing the school of their child s condition, symptoms and treatment - Keeping school information current - Providing pupil with appropriate food where necessary - Providing school/pre-school with appropriate emergency requirements - Contribute to Child s Plan as appropriate Education staff e.g. teachers, playgroup leaders, ancillary staff - Obtaining relevant information about children with ADHD in their class - Attending training on how to recognise symptoms and manage them and keeping this information up to date - Liaison with health and Integrated Services Officer if appropriate Requirements for implementation Training Health staff Training School and social work staff Equipment/facilities Documentation - Continuing professional development - Continuing professional development Storage of supplies from parents for treatment of ADHD and procedure for access Child health care plan Child s Plan identifies agencies Authorised by: Page 5 of 7

6 responsibilities supporting child with ADHD and actions including the production of the Child s health plan How I grow and develop section Exceptions - school/pre-school not advised by parent of child s condition - staff member declines to provide treatment References SIGN Guideline 2009 Policies in place in school e.g. child protection, health and safety, consent (age child is responsible for own decisions and who is given advice should be followed where appropriate/relevant) Authorised by: Page 6 of 7

Appendix I Staff agreeing to administer medicines The head teacher is responsible for ensuring that staff agreeing to administer medicines obtain the recommended training to do so and for maintaining an up-to-date record of such persons. The staff member administering medicines is responsible for ensuring that he or she understands and is competent to undertake the duties required. The staff member is also responsible for ensuring that administration is carried out as described in the policy and according to his or her code of professional practice and conduct. Name Signature Date Approved by: Name Date