November 2003

Question: 
What do teachers/counselors do when parents refuse medication for their child even when meds have been extremely helpful in the past?

Answer: 
Medication issues are tricky, not just because of the legalities involved but because of the emotions involved. Teachers often feel frustrated and angry with both student and parents. Parents feel frightened for their child. While it is illegal to recommend medication in most states, it is entirely permissible to describe a student’s daily classroom behavior. There are three steps to dealing with this challenge effectively.

1) Acknowledge feelings.
2) Give non-judgmental, clear, and specific descriptions of the child’s behavior.
3) Walk them through the thinking process

1. Acknowledge the feelings.
Try the following or some similar version: “I know you are concerned for your child’s success in school. I understand your concern about giving medication that affects the brain to your child. Any responsible parent would be nervous and would prefer not to give children any kind of medicine they aren’t certain is necessary. I know only you and your child’s doctor can make an important decision like that.”

You have affirmed two things with this statement. First, you have affirmed that they are anxious or nervous and second that they are responsible and caring parents. This simple compassionate statement will help bring their emotional defenses down so that you can help them understand more about what their child is experiencing on a daily basis at school.

2. Describe the child’s behavior.
Once you have affirmed that the parents are trying to do the best for their child, you can then offer your help. Keep in mind it is usually best to affirm parent’s good intentions whether or not you really believe in their genuine concern or not. Even responsible parents believe they are doing the best they can and verbally affirming this goes a long way towards establishing a working rapport. 

Now offer to help them make whatever decision they must by providing them with regular reports on how the child is faring in your class. Be very careful to describe behavior only. Example: “After the assignment was given and the children began working on their worksheets, he/she got up from their desk and went to the coat closet. After being called back to his desk, he rummaged through his book bag and began a conversation with another student. After being reminded to focus on the worksheet, he worked two problems and then began drawing a picture and so on and so on.” This description helps the parents “see” what the child is experiencing when required to stay on task and work independently.

Do not add commentary or interpretation such as: “He is completely disorganized and cannot stay in his seat. He bothers other children who are trying to work and I have to constantly remind him to do his work.”

The first example paints a picture for the parents. The second reveals the teacher’s frustration and concerns for herself and the other students. These are legitimate concerns for the teacher but expressing them to the parents in such a way will only cause them to be defensive and/or discouraged. Once these feelings are triggered in the parents, it is highly unlikely that they will be in a problem-solving mode.

A well-written description of ADD behavior in the classroom will help parents draw the conclusions you hope for. In a severe case where the parent is unable to accept their child’s limitations, it may be necessary to do this on a regular basis. Any well-written description includes the reassurance of the teacher’s concern for the child’s success.

3. Walk them through the thinking process.
This is a technique I discuss in all of my books. It refers to verbally describing in emotional terms the possible future outcome of the here and now choices a person is making. (See Good Kids, Difficult Behavior). After you empathize with the parent’s concerns and describe the child’s current classroom difficulties, it can be helpful to state your concerns in this fashion. Example: “I am concerned that your child experiences so much frustration on a daily basis because he does not seem able to do what his peers are doing. I am also concerned that if he is not able to complete work and stay on task when necessary that his grades will suffer. Once that starts happening, I have seen other children become terribly discouraged, even quit trying altogether and eventually learn to hate school.” Remember to keep the focus on how the child will feel or might feel if things continue as is. Walking through the thinking process is not just a matter of predicting the future. Example: “If this keeps up he’s going to feel.” Predictions tend to trigger emotional defenses. Descriptions lead a person to consider outcomes they may not have considered in the moment. 

A Final Word: Always keep your focus with the parents on what the child is experiencing. It is painful to go everyday and do something at which you are not successful. It erodes confidence and self esteem even in children who are extremely bright. Helping parents feel their children’s’ frustrations can some times give them another perspective on whether or not their child needs medication. If the child was previously on medications and did well but is no longer receiving treatment providing the descriptions (be careful not to impose your interpretation of their day-to-day experiences) should be very helpful.