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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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