By: Steven C. Schlozman

The Shrink in the Classroom: The

Prescription Challenge

Summary • According to Schlozman, “Doctors

increasingly use psychiatric medications to treat children and adolescents who have psychosocial difficulties, but the practice is controversial.” In addition, critics say that we know little about prescribing these medications. On the other hand, treatments have been known to alleviate suffering in children and adolescents with psychiatric problems.

Summary (cont’d.)• Schlozman states that students who

take psychiatric medications can often exhibit both positive benefits in the classroom as well as negative side effects. Teachers often have difficulty deciding whether a student’s behavior is the result of the medication (i.e. a student may be tired due to medication because of sedation).

Side Effects • “Side effects of some medications often

result in problem behavior that mimic the very behaviors for which they are intended” (i.e. If a student who does not pay attention and is hyperactive takes medication, he or she may become agitated when given a drug that treats symptoms of ADHD).

• Oftentimes, teachers do not know that a student is on medication.

When to Treat • It is often challenging to decide

whether or not a child needs medication and when.

• Some parents may refuse medication while others may desire it.

• Some doctors rely on medication while others do not.

• Each child is different.

When to Treat (cont’d.)

• Steps to careful assessment of a child:

Development of the child (will the child be bothered more by the treatment than by the medication?)

Accommodate concerns of parents and child (be sure that the parent and child have a clear understanding of medication.)

Be sure the parents and child know the side effects and what these medications may need to be be accompanied by.

Commonly Prescribed Medication

• Inattention, hyperactivity, and impulsivity(ADHD):

Psychostimulants such as Ritalin, Adderal, Concerta, and Dexedrine

In the classroom: increased agitation, or anxiety (for those who are misdiagnosed or who have anxiety or mood changes), and nonresponsiveness

Antidepressents such as Wellbutrin, Strattera, and Clonidine

Commonly Prescribed Medications (cont’d.)

• Depression, obsessions, and anxiety:

Selective Serotonin Reuptake Inhibitors (SSRIs)-Most common for depression, obsession and compulsion. SSRIs include: Prozac, Paxil, Zoloft, Celexa, Luvox, and Lexapro.

In the classroom: Increased levels of serotonin, rarely work immediately, possible sedation or agitation (bipolar).

Commonly Prescribed Medications (cont’d.)

• Severe aggression and out-of-control behavior(Psychiatric Disorders such as Pediatric Bipolar):

Seroquil, Zyprexa, Risperdal, and Geodon.

In the classroom: Can control mood changes and intense aggression, but may have severe sedative side effects.

Mood stabilizing medications: Lithium, Depakote, and Tegretol. These can be sedating as well.

Only Connect • According to Schlozman, “Medication

intervention can be enormously beneficial to students who are struggling to maintain their academic and social standing in the face of serious psychosocial difficulties. Without careful management, however, the effects of these medications can be negative repercussions for classroom performance.”

References • Schlozman, Steven. (2003). The

Shrink in the Classroom: The Prescription Challenge. Massachusetts: Massachusetts General Hospital.