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Article Excerpt
This primer on the medical aspects of treating ADHD youth will help counselors feel better informed about the types of medications available, the possible side effects, and the advantages and disadvantages for use. In addition, we discuss the long- and short-term consequences for using interventions requiring medication alone, psychosocial interventions alone, or a combined, multimodal approach. Mental health and school counselors can partner to provide information to nurses, parents, physicians, and youth to design developmental interventions for our ADHD youth.
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Mental health counseling and school counseling roles are expanding to include not only working with ADHD youth, but also working with specific aspects of involvement related to their medication trials (James & Nims, 1996). For this reason, counselors need to know about medications and their side effects and about situations when drugs are either the sole intervention or when they are used in conjunction with psychosocial interventions. School counselors in particular may actually be expected to administer medications to youth, and they may do so in the belief that medication enables ADHD youth to better manage their classroom behavior. In many schools today, school counselors consider it their job to know about medications and their possible side effects. In fact, parents believe school counselors are competent in this role when counselors demonstrate knowledge in this area. If youth are to comply with their medication schedule, there often must be a person in the school who can administer and monitor its effect in youth as they proceed through their school day. When mental health and school counselors partner with school nurses, teachers, and parents to help youth manage their ADHD through the use of medication and psychosocial interventions, then youngsters often improve their academic performance.
School counselors are looking to team with other counseling professionals, including mental health counselors and marriage and family counselors to deliver more powerful intervention and prevention efforts in their schools. In fact, school comprehensive guidance programs encourage a team approach for delivering their services to all students, often involving at least a limited partnership with school staff, community counselors, and community members in order to effectively serve every child's academic, career, and personal/social needs. Consistent with this, school counselors may be expected to work with mental health counselors, family physicians, or with school nursing personnel to monitor the safe use of drugs for ADHD youth. This critical aspect of both intervention and prevention is necessary if our youth are to safely and effectively comply with their medical treatment protocol. With teachers suggesting to parents that youth could benefit from medication, it seems that schools are intimately involved with parents and children in determining whether or not medication is warranted. School counselors are often in the center of the communication hub related to treatment, care, and follow up of youth's progress and management of ADHD symptoms. Families decide whether or not to medicate a child based on perceived or actual severity of ADHD symptoms and their relation to problems at home, school, or with peers (Dulcan, Dunne, et al., 1997). For this reason, school personnel are intricately connected to the data gathering process associated with determining whether or not ADHD symptoms exist, symptom severity, and potential prevention or intervention efforts. Often, medication is the result of this complex process of detecting, treating, and monitoring ADHD symptoms.
The purpose of this article is to discuss the long- and short-term consequences of deciding to use interventions requiring medication alone, psychosocial interventions alone, or a combined, multimodal approach. Our hope is that mental health and school counselors can see how their roles as facilitators of communication between and among parties can ultimately improve the care of ADHD youth as they move from home, to school, to community. Even more, we hope that counselors can know their own views on this topic and be able to communicate their reasons for agreeing or disagreeing with the use of medication to help ADHD youth manage their academic and personal spheres of development. We do not advocate use or nonuse of medication. We simply advocate becoming informed so that mental health counselors can partner with school counselors as they take their rightful place as communication facilitators for parents, youth, teachers, and physicians who try to help ADHD youth live fuller lives.
Both mental health and school counselors are involved at some point in the process of gathering data, assisting with diagnosis or assessment, and determining a treatment plan for ADHD youth. When decisions are made to medicate, proper medical protocol requires careful comparison of a child's pre- and postbaseline performance in both the academic and behavioral domain. Several persons must monitor the effects of medication for impulsive ADHD youth who can neither be expected nor be allowed to self-manage their medication schedules. Several persons must also track specific potential negative effects in youth related to the use of medication such as low self-esteem, social isolation, dosage, and reliance on drugs. Monitoring is vital because research is contradictory regarding both the safety and effectiveness of medications. In fact, some of these drugs are even prescribed without FDA approval (James & Nims, 1996). Because ADHD children are seen for only parts of each day and by various people who interact in separate spheres of the child's worlds, someone must be designated as the "point person" who will communicate between and among these people so that continuity of care is accomplished. The mental health or school counselor may or may not be the point person, but they can see that someone serves in this...
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