The Center for Psychotropic Drugs and Children Health and Health Care in Schools A 2007 Update The School of Public Health & Health Services December 2007 THE GEORGE WASHINGTON UNIVERSITY References Background
The safe and effective use of medications for the treatment of certain medical conditions and
1 National Association of School Nurses.
Position statement: medication administration
illnesses has enabled many children to attend school and achieve academic success.1 In
in the school setting. Revised 2003. Available at
medical practice, widespread acceptance of drug therapy for behavioral disorders has
facilitated diagnosis and treatment of these conditions in ambulatory care.2
2 CDC. Attention Deficit Disorder and Learning
Recent changes in the use of psychotropic medications by children and adolescents, and
Disability: United States, 1997 – 1998. Centers
concerns about adverse consequences, have prompted the US Food and Drug Administration
(FDA) to revise their guidance for prescribers and patients. The need for up-to-date drug
2002.Vital and Health Statistics: Series 10, No. 206.
information, and for monitoring of students on medication, prompted the Center to updatethis fact sheet for those who may be called upon to administer medications to students during
Emotional and Behavioral Health Problems inChildren3 NIMH. Child and Adolescent Mental Health.
NIH, National Institute of Mental Health,
Emotional and Behavioral Health Problems in Children
March 2007. Available athttp://www.nimh.nih.gov/health
• Studies show that at least one child in 5 has a mental, emotional, or behavioral disorder
severe enough to cause some level of impairment. At least one child in ten has a mental
4 SAMHSA. Child and Adolescent Mental Health.
illness severe enough to cause extreme functional impairment.3,4,5
Health Services Administration. November2003. Available at
• A national survey of pediatricians showed that 19% of pediatric visits involved a psychosocial
problem requiring attention or intervention. Psychosocial problems are the most common
chronic condition for pediatric visits, eclipsing asthma and heart disease.2
5 U.S. DHHS. Mental Health.A Report of theSurgeon General: Executive Summary and
• In 2006, 4.7 million children (8%) were reported to have a learning disability; 10% of boys
were identified as having a learning disability, compared with 6% of girls.6
• Four and a half million children 3–17 years of age (7%) were reported to have Attention
6 Bloom B, Cohen RA. Summary Health Statisticsfor US Children: National Health Interview Survey,
Deficit Hyperactivity Disorder (ADHD). Boys are more than twice as likely as girls to have
2006. CDC. National Center for Health
Statistics;Vital and Health Statistics, Series 10,No. 234, September 2007. Available at:
• Research indicates that depression is present in 1% of children and 5% of adolescents at any
given time. Before puberty boys and girls are at equal risk for depression; after puberty onset
the rate of depression is twice as high for girls.7
7 Brent DA, Birmaher B. Adolescent depression. N Engl J Med. 2002; 347(9):667-668.
• Up to half of all children with ADHD—mostly boys—also have oppositional defiant disorder
8 Strock M. Attention Deficit Hyperactivity Disorder
(ODD), which is characterized by defiance and outbursts of temper. About 20% to 40% of
(ADHD). Bethesda, MD: NIH, NationalInstitute of Mental Health. Reviewed October
ADHD children may eventually develop conduct disorder (CD), a more serious disorder
characterized by behaviors such as lying, fighting, and other antisocial acts. These children
tend to get into trouble in school, at home, and in their communities. Some children with
ADHD (mostly younger children and boys) can also experience anxiety and depression.8
9 NIMH. Child and adolescent bipolar disorder:
• Some evidence suggests an increasing prevalence of bipolar disorder in youth.9 Researchers
an update from the National Institute ofMental Health. September 25, 2007. Available
find that children and adolescents show more intense but somewhat different symptoms than
adults,10 but others note that it is difficult to apply standard diagnostic criteria to them.11,12
Until studies identify specific treatments for pediatric bipolar disorder, adult medications are
10 NIMH. Largest study to date on pediatric
prescribed off-label. Caution and close observation are warranted as some treatments for
depression or co-occurring conditions—such as ADHD—can cause mania to develop in
characteristics and short-term outcomes.
NIH, National Institute of Mental Health. Science Update, February 6, 2006. Available at
• In 2006, there were 9.6 million children in the US (13%) who had a health problem for
which medication had been taken regularly for at least 3 months. Boys (15%) were more
likely than girls (12%) to have been on regular medication for at least 3 months. Overall,
16% of youths aged 12–17 years were on regular medication compared with 14% of children
aged 5–11 years, and 8% of children under 5 years of age.6
11 Brotman MA, Kassem L, Reising MM, et al.
Parental diagnoses in youth with narrowphenotype bipolar disorder or severe mooddysregulation [Abstract]. Am J Psychiatry.Definition: Psychotropic drugs are those that affect the function, behavior, or experience
of the mind.13 While their exact mechanism of action is not known, psychotropic drugs are
12 Simon GE.The antidepressant quandary—
thought to act upon the biochemistry of the brain and positively affect thinking mechanisms,
adolescent depression. N Engl J Med. 2006;
emotional control, mood, and other behavioral processes. Included are neuroleptics (such as
13 Ayd F. Lexicon of Psychiatry, Neurology, and the
Haldol), antipsychotics (such as Zyprexa), antidepressants (such as Prozac), stimulants (such
Neurosciences. Baltimore:Williams & Wilkins;
as Ritalin), and antianxiety agents (such as BuSpar).13
www.healthinschools.org The Center for Health and Health Care in Schools Treatment: What we know Psychotropic Drugs
• Stimulant and non-stimulant medications can be effective for the short-term treatment of
ADHD.14 Some studies demonstrated that stimulants or stimulants in combination with
behavioral treatments produce long-term improvements when the drug continues to be taken.15
• The use of selective serotonin reuptake inhibitor (SSRI) antidepressants to treat major
depression in children and adolescents has been controversial. Many studies have shown SSRI
14 AACAP. Psychiatric Medication For Children AndAdolescents: Part 2—Types Of Medications.
agents to be only modestly effective in the treatment of major depression among adolescents.16
However, a large 2004 study by the National Institute of Mental Health (NIMH) concluded
that the combination of fluoxetine [Prozac], approved for treatment of pediatric depression,
with cognitive behavioral therapy (a form of talk therapy) was successful in helping 71% of the
study’s teenagers overcome depression. The Treatment for Adolescents with Depression Study
(TADS) also showed that fluoxetine alone was effective in 61% of subjects, while talk therapy
alone worked with 43%. Thirty-five percent of those who received a placebo also improved.
treatments in child and adolescent psychiatry:An inventory. J Am Acad Child Adolesc Psychiatry.
Patients became significantly less suicidal, no matter which treatment they were given.17
• Children and adolescents with major depressive disorder who are treated with
16 Delate T, Gelenberg AJ, Simmons VA, Motheral
BR.Trends in the use of antidepressants in a
antidepressants, may experience suicidal thinking and behavior.18 The FDA’s warning did not
prohibit use of the medications in youth but called on physicians and parents to closely
pediatric patients, 1998 to 2002. Psychiatric
monitor children and adolescents taking antidepressants for any worsening in symptoms of
17 Treatment for Adolescents with Depression
depression or unusual changes in behavior.19
Study (TADS) Team. Fluoxetine, cognitive-
• The long-term effects of antidepressants on a child’s developing nervous system have not been
behavioral therapy, and their combination foradolescents with depression:Treatment for
studied. Some physicians have expressed concern about the possibility of central nervous
system problems after long duration therapy, or the development of additional disorders.20
randomized controlled trial. JAMA. 2004;
Questions also have been raised about the longer-term use of antidepressants, whether they
18 Treatment for Adolescents with Depression
would continue to be effective, and if effective, would produce more or different side effects.21
• The effectiveness of selective serotonin reuptake inhibitors (SSRIs) and clomipramine
Adolescents with Depression Study (TADS):Long-term effectiveness and safety outcomes.
[Anafranil] for obsessive-compulsive disorder (OCD) has been indicated by a number of
Arch Gen Psychiatry. 2007;64(10):1132-1144.
studies. The FDA approved the use of two SSRIs, fluvoxamine [Luvox] and sertraline [Zoloft],
for use in pediatric OCD. Fluoxetine [Prozac] also is approved for use in pediatric OCD.22
American Academy of Child and AdolescentPsychiatry. Physicians’ MedGuide—The Use of
• An NIMH-funded study to test the efficacy and safety of medications commonly used to treat
Medication in Treating Childhood and Adolescent
children and adolescents (in off-label applications), found that fluvoxamine, an SSRI antidepressant
Depression: Information for Physicians. January2005. Available at http://www.parentsmed
approved for treating OCD in children, was both safe and effective in treating social phobia,
separation anxiety disorder, and generalized anxiety disorder in children 6–17 years of age.23
perspective on the controversy surrounding
• In 2007, the FDA approved use of risperidone [Risperdal] for the treatment of schizophrenia
the use of SSRIs to treat pediatric depression.
in adolescents ages 13–17, and for the short-term treatment of manic or mixed episodes of
Am J Psychiatry. 2007;164(9):1302-1306.
bipolar 1 disorder in children and adolescents, ages 10–17.24 Risperdal was approved in 2006
antidepressants in children? N Engl J Med.
for treatment of irritability associated with autistic disorder in children ages 5–16.25
• Data reported by a pharmacy benefits manager indicated that use of antidepressants slowed
Medications in Children. N Engl J Med.
considerably during 2005, in response to concerns about the risk of suicidality—especially
during the first few months of therapy or when dosages are adjusted—but began to increase
23 Walkup JT, Labellarte MJ, Riddle MA, et al., for
again in 2006. Approximately 7.8% of US schoolchildren (ages 4 to 17) have been diagnosed
the Research Unit on PediatricPsychopharmacology. Fluvoxamine for the
with ADHD, and about 4.3% of children currently receive medication for the condition.25
treatment of anxiety disorders in children andadolescents. N Engl J Med. 2001;344(17):1279-
• Between 2000 and 2005, ADHD treatment rates increased an average of 9.5% per year for
• Schools are often where students’ mental health needs are discovered and where support is
provided.26 Fear and isolation can be harmful for students in treatment—but inclusion andcaring can really help. Children and adolescents recover sooner and better when theenvironment is made a safer place for recovery.27
FDA Advisories on Antidepressants, ADHD Medications In May 2007, the FDA updated health advisories28,29 alerting prescribers to the increased risk of suicidal thinking and behavior that may occur in children, adolescents, and young adults 18–24 when antidepressant medication is started. Patients should be observed closely for signs of worsening illness, suicidality, or unusual changes in behavior. FDA also cautioned that depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide.29 Patients will receive an updated MedGuide30 with their prescription or renewal, informing them of the risks. FDA cautioned in February 2007, that patients taking medications for ADHD should become aware of risks for possible development of cardiovascular complications, and/or adverse psychiatric symptoms.31 This information has been added to the MedGuides for ADHD medications. In addition, patients taking SSRI or SNRI antidepressants should be cautioned that starting concurrent triptan medication for migraine can result in serotonin syndrome, a life-threatening condition characterized by fast heartbeat, hallucinations, restlessness, loss of coordination, nausea, vomiting, and diarrhea. Because these medications may be prescribed by different physicians, patients are cautioned to tell their health care provider what medications they are taking.32 www.healthinschools.org The Center for Health and Health Care in Schools Psychotropic Drugs Encountered in the Health Suite Psychotropic Drugs
** Observed effects of medication (side effects), improper dosing, medication conflicts, missed doses,
discontinued medication, or individual adverse reactions. Symptoms * What To Watch For **
Psychiatric Conditions in Children andAdolescents [press release]. Rockville, MD: US
Drugs used for ADD and ADHD, including stimulants and non-stimulants
Food and Drug Administration, FDA News:August 22, 2007. Available at
Signs of inattention include being easily
25 Medco Health Solutions, Inc. Drug Trend Report
following directions, forgetting or losing
things, failing to finish tasks, and skipping
26 Skalski AK, Smith MJ. Responding to the
Signs of hyperactivity-impulsivity
are often where students’ mental health
needs are discovered and where support is
climbing, or leaving a seat at inappropriate
provided. Principal Leadership. National
times, blurting out answers, and difficulty
agitation, tremors, muscle twitching,convulsions, euphoria, hallucinations,
27 SAMHSA. What a Difference a Friend Makes.
Health Services Administration, 2005.
Available at http://download.ncadi.samhsa.
gov/ken/pdf/SMA07-4257/SMA07-4257.pdf. NON-STIMULANT Medications:28 FDA. FDA Proposes New Warnings about
Suicidal Thinking, Behavior in Young Adults
Who Take Andtidepressant Medications. FDA
News, May 2, 2007. Available athttp://www.fda.gov/bbs/topics/NEWS/2007/NEW01624.html. Antidepressants for depression, mood disorders, obsessive-compulsive disorder
Antidepressants—Revisions to ProductLabeling. FDA, May 2, 2007. Available at
Depression Persistent sad, anxious, or
“empty” mood; feelings of hopelessness,
pessimism; feelings of guilt, worthlessness
30 FDA. FDA Public Health Advisory: Revisions
pleasure in usual activities; slowed thinking
Mental Illnesses, and Suicidal Thoughts or
Actions. US FDA, May 2, 2007. Available athttp://www.fda.gov/
Suicidality: Patients should be
February 21, 2007. Available athttp://www.fda.gov/bbs/topics/NEWS/2007/NEW01568.html. Obsessive-compulsive disorder
32 FDA. Public Health Advisory—Combined Use
(OCD) Recurrent unwanted ideas, Serotonin Syndrome: Patients
thoughts, impulses, or images (obsessions)
Inhibitors (SSRIs) or SelectiveSerotonin/Norepinephrine Reuptake
threatening Serotonin Syndrome. US FDA.
medications prior to startingtreatment with triptans (such as
Psychotropic Drugs Encountered in the HealthSuiteOther anxiety disorders
33 Ritalin [package insert]. East Hanover, NJ:
Panic disorder—sudden attacks of terror,
Novartis Pharmaceuticals, Corp; April 2007.
34 Bezchlibnyk-Butler KZ,Virani AS (Eds.). Clinical
pounding heart, sweating, faintness. Handbook of Psychotropic Drugs for Children andPost-traumatic stress disorder (PTSD)—startled
Adolescents. Cambridge, MA: Hogrefe & Huber
response, irritability, aggression, violence.
35 Strattera [package insert]. Indianapolis, IN: Eli
Social anxiety disorder (SAD)—extreme self-
consciousness, fear of being watched, anxiety.
36 Prozac [package insert]. Indianapolis, IN: Eli
Generalized anxiety disorder (GAD)—
exaggerated worry or tension, insomnia;trembling, irritability.44
www.healthinschools.org The Center for Health and Health Care in Schools Symptoms * What To Watch For ** Psychotropic Drugs Other psychotropic drugs used to manage ADD/ADHD, anxiety, or depression and Children
Symptoms of anxiety: shakiness, jumpiness,
trembling, tension, muscle aches, tiredness;
inability to relax, twitching, fidgeting,
37 Fluvoxamine maleate [package insert].
Elizabeth, NJ; Purepac Pharmaceutical Co;
38 Anafranil [package insert]. Hazelwood, MO:
39 NIMH. Antidepressant Medications for Children
breathing, fever, sore throat, swelling of
and Adolescents: Information for Parents andCaregivers. NIMH, 2007. Available at
Other anxiety disorders, as described above.
Agitation, anxiety, insomnia; hypertension;
possible hallucinations or delusions.Weight
Adolescents. FDA News, Aug. 22, 2007.
Available at http://www.fda.gov/bbs/topics/NEWS/2007/NEW01686.html.
41 American Psychiatric Association. Diagnosticand Statistical Manual of Mental Disorders DSM-IV-TR, Fourth Edition (Text Revision).
42 NIMH. Depression. Natl Institute of Mental
Health, 2007. Available athttp://www.nimh.nih.gov/health/topics/depression/index.shtml. Atypical Antipsychotics used in psychotic disorders and dementia
43 NIMH.When Unwanted Thoughts Take Over:
Obsessive-Compulsive Disorder. NIMH, 2007.
respiratory infections; nausea, vomiting,
44 NIMH. Anxiety Disorders. National Institute
of Mental Health, October 5, 2007. Available
multiple conditions occurring together.
45 BuSpar [package insert]. Princeton, NJ: Bristol-
46 Wellbutrin [package insert]. Research Triangle
47 Inderal [package insert]. Philadelphia, PA:
48 Effexor [package insert]. Philadelphia, PA:
Mood Stabilizers used for bipolar disorder and mania
49 NAMI. Effexor (venlafexine). National Alliance
on Mental Illness Fact Sheet. 2007. Available at
50 Risperdal [package insert].Titusville, NJ:
51 Lithobid [package insert]. Marietta, GA: Solvay
need for sleep; talkativeness, distractibility;
52 Depakote [package insert]. North Chicago, IL:
53 Yager J, Anderson AE. Anorexia Nervosa. NEngl J Med. 2005;353(14):1481-1488.
54 Spearing M. National Institute of Mental
Health. Eating Disorders. Bethesda, MD: NIMH;
Drugs used with eating disorders, specifically bulimia nervosa and binge-eating disorder; occasionally in anorexia nervosa, after weight regain Anorexia nervosa—Abnormal
restriction of eating due to intense fear of
gaining weight or becoming fat; resistance
to maintaining weight at or above aminimally normal weight for the age and
Bulimia nervosa—Recurrent episodes of binge eating, followed by forced purging through self-induced vomiting, or use of
medications; fasting; excessive exercise.54
nervousness, insomnia; mania; agitation;decreased appetite; rash or hives;seizure; suicidality.28,29,30,36
Binge-eating disorder—Uncontrolled eating (often rapidly and in great quantities) without forced purging or compensating behavior.54 www.healthinschools.org The Center for Health and Health Care in Schools Mental Health Medications and the Risk of Suicide Psychotropic Drugs
In May 2007, the FDA expanded the requirement for “black box” warningsto include all antidepressants. and Children
• Antidepressants, which are often effective in treating depression and other
mental disorders, carry a risk of harmful side effects and complications. Mental Health Medications and the Risk of
Some studies showed that antidepressants may cause suicidal thinking and
Suicide55 Brent DA. Antidepressants and pediatric
behavior in children and adolescents. In the studies, children taking
depression—The risk of doing nothing. N Engl
antidepressants had a 3.8% chance of developing suicidal thoughts or
J Med. 2007;356(23):1598-1601.
behavior, compared with 2.1% of children taking placebos.55
56 FDA. Public Health Advisory: Suicidality in
children and adolescents being treated with
• These results prompted the FDA in 2004 to require that all antidepressants
include a warning, printed in bold type, framed in a black border—the
Drug Administration, October 15, 2004. Available at http://fda.gov/cder/drug/
“black box”—at the top of the paper insert.56
57 Friedman RA, Leon AC. Expanding the black
• Antidepressants also will come with a medication guide that advises parents
box—depression, antidepressants, and the risk
and caregivers about the risks and precautions.56
of suicide. N Engl J Med. 2007;356(23):2343-2345.
• Considering the warning, why use antidepressants? The FDA label itself
58 Gibbons RD, Hur K, Bhaumik DK, Mann JJ.
warns practitioners that the depression for which the medication is
prescribed is the most important cause of suicidality.57 A 2006 study showed
prescription rates and rate of early adolescentsuicide [Abstract]. Am J Psychiatry.
that higher SSRI prescription rates were associated with lower suicide rates
in children and adolescents.58 The greater risk may be in doing nothing.55
A child or adolescent taking antidepressant medication should be closely monitored for any
changes in behavior, particularly when medication is initiated, or when dosing is changed or
discontinued. Antidepressant therapy should not be stopped all at once but rather
children and adolescents: information for
discontinued gradually, on a tapering schedule, under the physician’s guidance.59
parents and caregivers. NIH, National Instituteof Mental Health. Available at
Changes to watch for include worsening depression, emergence of suicidal thinking or
behavior, or unusual behavior, such as sleeplessness, agitation, or withdrawal from normal
60 Gibbons RD, Brown H, Hur K, et al. Early
Suicidal thinking, feeling, and behaviors are core symptoms of depression; consequently, there
suicidality warnings on SSRI prescriptions and
is no way to know whether suicidal symptoms that develop during treatment are due to the
suicide in children and adolescents. Am JPsychiatry. 2007;164(9):1356-1363.
61 Libby AM, Brent DA, Morrato EH, et al.
An inverse relationship appears to exist between diagnoses of pediatric depression with
Decline in treatment of pediatric depression
prescriptions for SSRI antidepressants on one hand, and rates of suicide in children and
after FDA advisory on risk of suicidality withSSRIs [Abstract]. Am J Psychiatry.
adolescents on the other.60 Before SSRI antidepressants were introduced, the adolescent
suicide rate tripled in two decades. When prescriptions for SSRI antidepressants increased for
62 Kurian BT, Ray WA, Arbogast PG, et al. Effect
adolescent depression, suicide rates declined for a decade.55 In the two years following the
of regulatory warnings on antidepressantprescribing for children and adolescents. Arch
October 2004 FDA advisory, significant reductions in diagnosis of pediatric depression,61 and
Pediatr Adolesc Med. 2007;161(7):690-696.
decreases in antidepressant prescriptions for children and adolescents were found,57,62 and
63 Bridge JA, Iyengar S, Salary CB, et al. Clinical
these decreases were associated with increases in suicide rates in the same group.60
response and risk for reported suicidalideation and suicide attempts in pediatric
Although depression and suicidal thinking are significant risk factors for suicide, depression in
antidepressant treatment: a meta-analysis of
patients in a 2004 fluoxetine study improved four times as often as suicidality developed.55 The
benefits of antidepressants appear to be much greater than risks from suicidal thinking or behavior.63
Medication Administration in the School and The Role of Schools Medication Administration in the School
64 National Association of State Boards of
• Forty-nine states have state-level school health policies. Of those, 36 states have mandatory or
Education—State-Level School HealthPolicies: State-by-State Administration of
recommended policies concerning administration of prescription medications at school. Ten
states specifically address administration of psychotropic drugs.64
• Control of prescription medications is particularly important in the school. Medications
65 US Drug Enforcement Administration.
administered at school should be taken in the presence of the school nurse or her designate.65
Stimulant Abuse by School Age Children:A Guidefor School Officials. US DOJ, DEA, Office of
• Peers and family members are the leading sources of prescription drugs for illicit use by
Diversion Control: June 2001. Available at
• Students who use their prescription medications as prescribed are at a lower risk for probable
drug abuse than individuals who have nonmedical use, or both medical and nonmedical useof prescription medications.66
• In 2003, the annual prevalence of illegal use of Ritalin was reported as 2.6% among 8th
graders, 4.1% among 10th graders, and 4.0% among 12th graders.67 In 2006, the annualillegal use among 8th graders remained the same, in 10th graders use declined to 3.6%, andamong 12th graders illegal use increased to 4.4%.68
• One survey of more than 44,000 high school students found that nearly 7% reported having
using methylphenidate (Ritalin) illicitly at least once and 2.5% reported using it monthly ormore often.65
www.healthinschools.org The Center for Health and Health Care in Schools The Role of Schools: What to know, how to help64,66,69,70,71 Psychotropic Drugs
The FDA’s medication guidance does not prohibit the use of antidepressants in pediatricpopulations but urges caution in administration and vigilance in monitoring. and Children
• Obtain from your state and local governments, and Board of Education the specific rules for
medication storage and administration. (See box.)
66 McCabe SE, Boyd CJ,Young A. Medical and
nonmedical use of prescription drugs among
• Get to know the FDA resources on medications available on the FDA Web site, and be aware
secondary school students. J Adol Health.
of public health advisories issued by the agency.
67 Johnston LD, O’Malley PM, Bachman JG,
• Be aware of the possible side effects of the drugs being administered; learn to recognize
Schulenberg JE. Ecstasy use falls for second year
symptoms of missed doses or overdosage. If you observe any of the behavioral warning
in a row, overall teen drug use drops [pressrelease]. Ann Arbor: University of Michigan
signs—worsening illness, or agitation, irritability, suicidality, and unusual changes in
behavior—contact the physician or parent immediately.
19, 2003. Available athttp://www.monitoringthefuture.org.
• Ask parents to notify the school when dosing begins, any dosing changes are made, or
68 Johnston LD, O’Malley PM, Bachman JG,
medication is replaced or discontinued. These are the times when the student is most likely to
Schulenberg JE. Teen drug use continues down in
experience changes or additional effects. 2006, particularly among older teens; but use ofprescription-type drugs remains high [press
• Have an emergency plan for each student taking psychotropic medications, in case there is
release]. University of Michigan News and
ever a need to use one. Familiarize every relevant staff member with warning signs of
Information Services: Ann Arbor, MI;December 21, 2006. Available at
medication lapse, misuse, or abuse, and provide training on how to respond.
• Safeguard the privacy of students and protect them from any stigma that may be associated
69 AAP Policy Statement—Guidelines for the
with their disorder or the administration of medications during school hours.
Administration of Medication in School. Pediatrics. 2003;112(3):697-699.
70 U.S. Drug Enforcement Administration. VirginiaProcedures for Medication Safety69,70,71 School Health Guidelines—General Guidelines forAdministering Medication in School. US DOJ,
Prescription medications can be stored and distributed safely and securely at school.
DEA, Office of Diversion Control: June 2000. Available at http://www.deadiversion.
Certain procedures will provide the surest handling:
• Obtain appropriate authorization forms from physicians and parents.
71 Maryland State Dept. of Education.
• Ask parents to bring the medication to the school, rather than sending it with the
Administration of Medication in Schools: MD StateSchool Health Services Guideline. Baltimore, MD:
MD State Department of Education; January
• Ensure that medication is in the original container, bearing the name of the student,
2006. Available at http://www.marylandpublicschools.org/NR/rdonlyres/6561B955-9B4A-
the name of the medication, dosage and timing, the name and phone number of the
prescribing physician, with a copy of the package insert.
• Review the MedGuide provided with some medications.
• Store medications in a properly secured, controlled space.
• Observe students taking medication, to ensure the dose is consumed.
• Keep accurate and complete records of all administration. Resources Government Resources Non-Government Resources Mental Health America National Mental Health Association National Institute of Mental Health Bright Futures National Alliance on Mental Illness Children and Adults with Attention- Supported by a grant from US Food and Drug Administration Deficit/Hyperactivity Disorder the Robert Wood Johnson Foundation
The Five Rights The Center for of medication administration Health and Health Care in Schools • The right patient
School of Public Health and Health ServicesThe George Washington University
• Receives the right drug • In the right dose
Washington, DC 20037202-466-3396 fax: 202-466-3467
• By the right route • At the right time. www.healthinschools.org
The Pontifical Anthem or Papal Anthem The Pontifical Anthem or Papal Anthem is the official anthem of the Pope, the Holy See and the Vatican City State. It is played at solemn occasions of the State and ceremonies in which the Pope or one of his representatives, such as a nuncio, is present. When the Vatican's flag is ceremonially raised, only the first eight bars are played. The music was c