Teachers as Partners in the Treatment of Special Education Students Prescribed Psychotropic Medications
By Anisha Asher
The administration of psychotropic medication to treat mental health and behavioral disorders in children has increased dramatically.1 Students in special education in particular are medicated at higher rates than the general population of children.2 And children in at least one subgroup—children prescribed medications for ADHD—are also frequently administered multiple psychotropic medications.3 While the ADHD drugs—Adderall, Concerta, Ritalin—have FDA approval for children, many other psychotropic medications administered to children are prescribed “off-label” for the treatment of behavioral disorders. Practices for prescribing psychotropic medications to children are receiving increased scrutiny at many levels.
Teachers are in a unique position to assist parents, physicians, and therapists in monitoring the benefits, risks, and adverse effects of psychotropic medications on the students in their classroom. Students spend a significant portion of their day at school where they interact with other children and adults. They face the challenges of working and socializing with their peers as well as many different academic tasks. A teacher’s observations of a child in these different situations can provide a wealth of information to help assess the impact of the medication upon the child’s safety, well being and adjustment. If teachers are going to be effective collaborators with parents and others in the treatment of students being given psychotropic medications, they need to be knowledgeable about what to look for; they need to know the possible side effects, benefits, and risks of the medications their students are being given.
Use of Psychotropic Medication in the Special Education Student Population
Psychotropic medications “are those medications administered for the purpose of affecting the central nervous system to treat psychiatric disorders or illnesses.”4 Psychotropic medications include anticonvulsants, antidepressants, antihypertensives, antipsychotics (neuroleptics), anxiolytics (antianxiety), mood stabilizers, selective norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, and stimulants.5
Students in special education are administered psychotropic medication at a higher rate than the general population of children. Among the general population of children and adolescents, two or three percent are being prescribed some sort of psychotropic medication, while 26 percent of special education students are prescribed a psychotropic medication.6 Furthermore, the rate of concomitant (multiple) prescription of psychotropic medications to special education students is higher than it is for the general population of youth. One estimate indicates that 11.7 percent of youths under 19 who were given at least one psychotropic medication were prescribed an additional medication.7 This rate is higher for special education students: a survey of elementary school students in a special education program revealed that the rate of concomitant psychotropic medication was 20 percent.8
The Role of the Teacher
Teachers play a major role in identifying behaviors that often lead to the prescription of psychotropic medications for their students. For example, in one survey 58 percent of parents reported that school personnel first suggested that their children seek treatment for attention-deficit hyperactivity disorder (ADHD).9 The same study showed that school personnel were the primary source of ADHD identification.10
While teachers may be the first to alert parents to concerns regarding the students’ mental health or behavioral issues, teachers often are not involved in the “referral, diagnosis, or withdrawal of medication.”11 Historically, teachers were the primary people responsible for the administration of medications during the school day.12 However, they rarely evaluated the drug response using standardized procedures, nor did they communicate with their students’ physicians.13
Teachers’ daily observations and experiences with students should be used to assess the child’s responses to any medication regimen. They should be partners with parents, physicians and others in evaluating the risks and benefits of the medication. Researchers have noted that, “[n]ot including school staff in the pharmacological process may limit the potential benefits a medication might afford a child, and negatively impact their educational performance.”14 It is important for teachers to have a working knowledge of the medications their students are taking so they can better understand and better communicate about the effects of the medications on their students.15
The Need for Improved Training Among Special Educators
While teachers are in a position to collaborate with others on the treatment of special education students, they currently have little knowledge about psychotropic medications. This lack of awareness may be a barrier to productive communications with other caregivers.
In one survey, teachers were asked to report “what you know about medications and how they affect behavior.”16 Only 7.4 percent of teachers responded correctly, and 92.6 percent of teachers gave incorrect or partially correct responses.17 In another recent survey, more than 50 percent of special educators and paraprofessionals reported dissatisfaction with their current level of knowledge regarding psychotropic medications and their side effects.18 Over 90 percent of the same groups expressed a desire to increase their knowledge in this area.19
This lack of knowledge may be due to a lack of adequate training. Nearly half of all educators in one study stated that they relied on “in-house” staff development training to increase their knowledge of medications.20 However, this method may not be particularly effective, given that a majority of special education teachers reported that they received no training on psychotropic medication from staff development.21 The majority of special education teachers and paraprofessionals also reported that they received no training on psychotropic medications from professional seminars.22
Statutes and Regulations Provide Limited Guidance
There are few laws governing teacher involvement in treatment of students with psychotropic medication specifically. This allows schools to treat psychotropic medication in the same way as other medications. At the federal level, “IDEA [Individuals with Disabilities Act] 2004 does not prevent school personnel from dispensing medication, or consulting with parents regarding the efficacy of medications on the academic, functional, or behavioral performance in school.”23 Furthermore, the Office of Civil Rights “has ruled that a school’s responsibility regarding medications should include (a) determining a child’s needs for the administration of medication, (b) administering medications, and (c) supervising the administration of medications, including safeguards, training personnel to administer it, and communicating with the prescribing physician.”24
Some state laws affirm the power of teachers to be involved in the treatment of their students. For example, while California’s Education Code does not mention psychotropic medication specifically, Education Code section 49432 allows a student who is required to take medication during the school day to be “assisted by a school nurse or other designated school personnel” if there are written instructions from the child’s physician and written permission from the child’s parent or guardian.25 The California Code of Regulations confirms that “designated school personnel” may administer medication to pupils.26 The California Supreme Court recently found that “section 49423 and its implementing regulations plainly establish, as the Legislature, the Board, and the Department intended, that unlicensed school personnel may administer prescription medications.”27
If teachers are administering psychotropic medication to their special education students, they should have basic knowledge about the medications and basic training on how to monitor the students and provide useful feedback to medical and psychiatric professionals regarding the possible effects of the psychotropic medication observed in the classroom.
A Model for Improving Teacher Involvement to the Benefit of Students
The knowledge teachers have of their special education students, coupled with a better understanding of psychotropic medication, would make teachers helpful partners in the treatment of students with mental, emotional, and behavioral issues. Teachers can help identify behavioral, mental, or emotional issues a child may face at school, and can also help track a child’s progress as he or she receives treatment. The child will benefit from a collaboration between the child, parents, health care providers, and teachers, who spend a significant amount of time with the child on a daily basis, and are aware of the child’s “academic performance, social-emotional functioning, and behavior at school.”28
A study found that those students in a “rigid medication management condition” with teachers closely monitoring student improvement resulted in greater positive outcomes than traditional outpatient care and behavioral and medication management without teacher monitoring.”29
For example, the Agile Behavioral Model for monitoring stimulant medication utilizes teachers for problem identification.30 In this model, teachers collaborate with parents and the child’s doctor to pinpoint the struggles a child faces in the classroom.31 Teachers are also asked if they would be willing to assess the child on an ongoing basis and provide samples of the child’s work so the effects of the medication can be evaluated by another professional, such as a psychologist or psychiatrist.32
Students in special education use psychotropic medications at a higher rate than the general population of students. Teachers may even be the ones administering these medications to their students. Despite this, teachers’ knowledge regarding psychotropic medication is limited. The amount of time teachers spend with students puts them in a unique position to be useful collaborators in the treatment of special education students. Given this, it is important that educators working with these students have a working knowledge of psychotropic medications and their effects. Training about the risks, benefits, and side effects to watch for would help teachers collaborate with other caregivers throughout the treatment process, from identifying problems to monitoring the effects of psychotropic medication. Improving teachers’ understanding of the risks, benefits, and side effects of psychotropic medications would equip them to become partners in helping to improve not only the child’s performance in school but his or her overall well being.
Anisha Asher was a 2013 summer law clerk at NCYL, working with Senior Attorney Bill Grimm researching psychotropic medication policies concerning foster care youth. Anisha is in her second year at University of Michigan Law School.
- Julie Magno Zito, Ph.D.; Mehmet Burcu, M.S,; et al, Antipsychotic Use by Medicaid-Insured Youths: Impact of Eligibility and Psychiatric Diagnosis Across A Decade, 64 Psychiatric Services (2013); Joseph B. Ryan, Prevalence Rates of Psychotropic Medications for Students Placed in Residential Facilities, 33 Behavioral Disorders 99, 99-101 (2008).
- See id. at 99.
- Jule Magno Zito, Ph.D., Daniel J. Safer, et al, Psychotropic Medication Patterns Among Youth in Foster Care, 121 Pediatrics 157 (January 2008)(describing common three drug class combinations, all including stimulants – e.g. one stimulant, one antipsychotic, and one antidepressant medication).
- CA. Welf. & Inst. Code section 369.5 (d)
- Joseph B. Ryan, Special Educators’ Knowledge Regarding Psychotropic Interventions for Students Wit,h Emotional and Behavioral Disorders, 29 Remedial and Special Education 269, 270 (2008).
- Joseph B. Ryan, Prevalence Rates of Psychotropic Medications for Students Placed in Residential Facilities, 33 Behavioral Disorders 99, 99 (2008).
- Daniel J. Safer, Concomitant Psychotropic Medication for Youths, 160 Am. J. of Psychiatry 438, 439 (2003).
- Id. at 440.
- Susan Dosreis, Parental Perceptions and Satisfaction with Stimulant Medication for Attention-Deficit Hyperactivity Disorder, 24 J. of Developmental and Behavioral Pediatrics 155, 157 (2003).
- My T. Lien, A Pilot Investigation of Teachers’ Perceptions of Psychotropic Drug Use in Schools, 11 J. of Attention Disorders 172, 173 (2007).
- Joseph B. Ryan, The Importance of Teacher Involvement in Medication Therapy, 6 TEACHING Exceptional Children Plus, December 2009 at 1, 6.
- My T. Lien, A Pilot Investigation of Teachers’ Perceptions of Psychotropic Drug Use in Schools, 11 J. of Attention Disorders 172, 173 (2007).
- Id. at 174.
- Joseph B. Ryan, Special Educators’ Knowledge Regarding Psychotropic Interventions for Students With Emotional and Behavioral Disorders, 29 Remedial and Special Educ. 269, 273 (2008).
- Joseph B. Ryan, The Importance of Teacher Involvement in Medication Therapy, 6 TEACHING Exceptional Children Plus, December 2009 at 1, 7.
- Joseph B. Ryan, Special Educators’ Knowledge Regarding Psychotropic Interventions for Students With Emotional and Behavioral Disorders, 29 Remedial and Special Educ. 269, 275 (2008).
- Joseph B. Ryan, The Importance of Teacher Involvement in Medication Therapy, 6 TEACHING Exceptional Children Plus, December 2009 at 1, 7; see 20 U.S.C. §1400 et. seq.
- Joseph B. Ryan, The Importance of Teacher Involvement in Medication Therapy, 6 TEACHING Exceptional Children Plus, December 2009 at 1, 8.
- Cal. Educ. Code §49432 (West 2013).
- 5 CCR §604.
- Am. Nurses Ass’n v. Torlakson, 2013 WL 4046566 (Cal. 2013)
- Nancy Rappaport, Psychotropic Medications: An Update for School Psychologists, 50 Psychology in the Sch. 589, 589-590 (2013).
- My T. Lien, A Pilot Investigation of Teachers’ Perceptions of Psychotropic Drug Use in Schools, 11 J. of Attention Disorders 172, 172 (2007).
- Robert J. Volpe, An Agile Behavioral Model for Monitoring the Effects of Stimulant Medication in School Settings, 42 Psychology in the Sch. 509, 513 (2005).
- Id. at 515.