(Supplementary to Chapter 6, “Meeting of the Minds” in Autism Spectrum Disorder in the Inclusive Classroom, 2nd Edition: How to Reach and Teach Students With ASDs)
Parent Perspectives on Medication
Parents and caregivers may have widely ranging beliefs and attitudes regarding medication. Their choices may powerfully impact the functioning of your whole class every day. This section will help you understand what may be behind parents’ decisions about medication so that you can begin to recognize every family’s effort to do right by their child and adapt to those efforts. Then read on to learn about some common alternatives to medication that parents may pursue.
The Medication Decision
When you feel as though you’re at your wits’ end with a student, it may be even more exasperating to know that his or her parents are unwilling to try medication. Parents or guardians retain the absolute right by law to choose whether or not to medicate their children, and their decision is never an easy one. Here are some of the considerations parents grapple with.
Fear of Side Effects
Many parents and guardians’ fear long-term physiological effects or short-term sedating effects of psychiatric medications on the developing brains and bodies of their children. If you work with parents or guardians who express concern about side effects, you might suggest they discuss their concerns with a doctor to get straightforward, factual answers to these questions.
Remember, as a teacher, you are not allowed to make any kinds of recommendation regarding how or whether a child should be medicated. And federal law prohibits schools from making medication compliance a requisite for school attendance. No parent or guardian should feel pressured into sticking with a medication regimen that makes them uncomfortable; they will always have the opportunity to give feedback to their doctor, to change doctors, to seek alternative treatments, or to stop treatment.
If parents or guardians choose to pursue conversation about this topic with you, here is some basic information you can share:
- When medication is properly dosed and monitored by a credentialed psychiatrist (or in some cases by a pediatrician or neurologist), the cost/benefit ratio and potential for long-term effects are carefully considered.
- The kind of zombie sedation that many parents and guardians fear would, in most cases, be indicative of improper dosing.
- When introduced, medication should be started in smallest possible doses and increased as needed in tiny increments, in pursuit of a clear positive outcome via minimal dose and side effect.
Fear of Failure
Many parents feel like failures for resorting to medication. They may judge themselves as not being capable enough parents to teach or coax their children to behave or perform “appropriately,” as other parents seem able to do, and they may wonder: Where did I go wrong? If parents express these feelings to you, remind them that autism spectrum disorders are believed to be neuro-developmental in origin. Parents would not blame themselves if their child developed eczema or lactose intolerance. They would instead seek advice from professionals who would work with them to help relieve the symptoms.
Fear of Judgment
Parents or guardians may fear being judged by others for making the decision to medicate their children. Often “friends” and family members have strong opinions about giving psychotropic medications to children and they rarely hesitate to share those opinions. A neighbor of mine once warned me not to let my children play with another neighbor’s son. Eyes wide and voice lowered to a conspiratorial whisper, she shared the scandalous news: “You don’t want your kids over there. I heard they give him Ritalin.”
Some parents or guardians may worry about confidentiality and stigmatization. Many even resist seeking diagnosis for these reasons. Assure them that everyone who works with their child is a professional and is bound by confidentiality. All members of the team are in it to ensure that their child gets the best services to promote the best outcome. Personal information will be shared only with those who are authorized to have access to it.
You might mention to parents and guardians that they would be surprised if they knew how many students rely on maintenance medications to help them with issues ranging from attention to allergy, from composure to constipation. (Be careful, always, to never name names; your steadfast respect for the privacy of those families will demonstrate how carefully you uphold confidentiality.)
Out of the Loop
Teachers are often frustrated when parents or guardians deliberately withhold information about use of medication. In addition to any of the privacy reasons listed above, some parents and guardians feel that when a teacher is aware that a student is taking medication, this knowledge will influence the teacher’s impression of the child. These parents prefer to get “unbiased” feedback from the teacher. Some doctors even recommend that parents or guardians not tell the teacher at first when they make a change to medication. That way, when a teacher is asked to provide feedback regarding behavioral changes, responses are considered more objective and unaffected by expectations.
In an effort to avoid using pharmaceutical interventions, many parents and caregivers go to considerable effort to pursue alternative avenues toward improving their children’s behavioral, emotional, and/or physical health.
Some students on the spectrum are given supplements to support various aspects of their functioning. These may include vitamins and minerals (for nutritional balance), enzymes and probiotics (for effective digestion), fish oils such as Omega 3 DHA or Cod Liver Oil (for brain and nervous system functioning), electrolyte solutions (for hydration), and others. These supplements are usually administered at home.
Special diets, on the other hand, need to be followed through at school. The most common such regimens for autism spectrum disorders are gluten-free and casein-free diets. These diets are based on the notion that students on the spectrum have certain digestive problems that allow some food proteins to pass through the digestive system only partially digested. These kinds of proteins are believed then to turn into peptides which influence behavior, perceptions, and responses. The worst offenders seem to be the gluten found in certain grains and the casein usually found in certain dairy products. Additionally, some students have been found to have sensitivities to other specific foods that affect their functioning in adverse ways. Many parents and caregivers have seen tremendous differences in their children’s functioning when these ingredients are removed from their diets.
A gluten-free diet might require students to avoid foods that contain wheat, oats, rye, barley, starches, certain flavorings, artificial colors, and more. A casein-free diet would require avoidance of milk products including cheese, butter, yogurt, ice cream, and other non-dairy items including soy cheese and hot dogs.
Dietary Compliance in the Classroom
When parents or caregivers inform you about their child’s dietary restrictions, compliance in the social classroom setting can be tricky. Pizza parties and birthday cupcakes suddenly take a toxic turn. Your cooperation is crucial because the slightest deviation from the diet could trigger a dramatic physiological or behavioral reaction. Just as you need to make accommodations for students who have life-threatening peanut allergies or whose religion prohibits them from celebrating holidays, you must make similar accommodations in these cases.
Whenever you are unsure, check with the parents or caregivers. And ask them to send in alternatives. There are many gluten-free, casein-free foods on the market today. The parents or caregivers of affected students can send in substitute treats on an as-needed basis, or you can keep a cache of them in your classroom.
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