Stimulant Treatment for Attention-Deficit/Hyperactivity Disorder: Medication Monitoring Practices of School Psychologists.

Abstract. Attention-Deficit/Hyperactivity Disorder (ADHD) is commonly treated with stimulant medications, and several models for school-based medication monitoring have been proposed. Nevertheless, there is a paucity of research examining the prevalence of medication monitoring. A survey examining the medication monitoring practices of school psychologists was sent to 700 potential participants, with a usable return rate of 64.7%. Nearly 55% of the respondents were involved in monitoring the effects of medications for students with ADHD, and a higher percentage indicated that medication monitoring is an important role for school psychologists. Teacher and parent rating forms and interviews, direct observation, and review of work samples were perceived as the most effective, acceptable, and feasible monitoring methods. These findings suggest that many school psychologists are engaged in medication monitoring and are willing to perform this role. Barriers and facilitators to medication monitoring in the schools are discussed. In addition, the implications for school-based medication monitoring are explored. ********** Attention-Deficit/Hyperactivity Disorder (ADHD) is the most commonly diagnosed childhood behavior disorder, and is believed to occur in 3% to 7% of school-aged children (American Psychiatric Association, 2000). The most common treatment for this disorder is pharmacotherapy, with stimulants being the most widely prescribed class of medication. The number of stimulant prescriptions has increased dramatically in recent years (Hoagwood, Kelleher, Feil, & Comer, 1998). For example, in 1996 methylphenidate (MPH or Ritalin) was used as a treatment for ADHD in 2.4% of the school-age population, whereas in 1987 this medication was used in only .6% of these children (Olfson, Marcus, Weissman, & Jensen, 2002). Estimates indicate that 2 million children and youth in the United States are prescribed MPH (Greenhill, Halperin, & Abikoff, 1999). A landmark study, the multimodal treatment study of children with ADHD (MTA), examined the separate and combined effectiveness of empirically supported interventions for ADHD (The MTA Cooperative Group, 1999). This study compared the effects of medication management (primarily MPH), behavioral treatment, a combination of medication and behavioral treatment, and standard community care on the functioning of a large sample of children diagnosed with ADHD Combined Type. Children in the medication management and combined treatment groups showed significantly greater improvement in ADHD symptoms than children in the behavioral treatment and community care groups. In addition, participants in the combined treatment group also showed additional gains in academic performance and family interactions (Carey, 2000). As such, the MTA study provided support for the use of stimulant medication as a major part of the treatment plan for children with ADHD. Finally, this study suggested that carefully monitored medication management was superior to routine community care that included medication for children diagnosed with ADHD. Stimulant medications generally are associated with positive responses in approximately 70% of the children who take them for ADHD symptoms (Barkley, 1998). Nevertheless, specific behavioral effects vary across dosages (within children) and across children (Rapport, Denney, DuPaul, & Gardner, 1994). Although minor side-effects (e.g., loss of appetite and insomnia) are experienced quite frequently, major side effects are rare and this treatment is widely viewed by experts as safe. At this point, there is essentially no way to predict the beneficial and adverse effects of stimulants prior to initiating a trial of medication (Rapport & Denney, 1997). Considering the difficulty in predicting the effects and possible side-effects of stimulant medications, it is important to carefully monitor the outcomes associated with this treatment. …