DAVE TRAXSON - TWENTY QUESTIONS FOR PROFESSIONALS IN EDUCATION ABOUT PSYCHOTROPIC DRUGS / STIMULANTS - for children who attend their schools.(Posted March 2010.)

Are these children jumping for joy or "hopping mad" and need methylphenidate medication?

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Twenty Questions Relating to the Ethical Issues Surrounding the Use of Psychotropic Drugs for Children in Schools.

I would like to pose some questions or dilemmas that educational professionals need to explore when working collaboratively with medical colleagues in an educational setting. This applies when a child we are directly involved with is on or about to receive psychotropic medication that we have concerns about:

Are you following your own professional body's Code of Practice in relation to ethical practice and endeavouring to pursue the principles of beneficence ( promoting the well being of the child) and non-malifecence ( avoiding direct or indirect harm to the child) shared by all professionals? Your professional Code may well have a clause about the Duty of Care you have to raise any concerns you may have about overprescription e.g."You must not do anything or allow someone else to do something that you have good reason to believe will put the health  or safety of a service user in danger." (Health Professionals Council - Duties as a Registrant,2009. This is the body to which  Educational Psychologists have to belong.)

Is the GOLDEN RULE, " Would I want this approach for my own child" a criterion that helps in selecting the appropriate response for each case?

Do education professionals and the general public get unduly influenced by the power of scientific rationalism and drug companies and what should be done to challenge this and achieve a more balanced perspective?

How far should education professionals cooperate or maybe even collude with medical professionals who are diagnosing mental health problems in children they jointly work with and prescribing psychotropic medication for them? How can we best challenge this practice in cases we have clear ethical , practical, or professional concerns about?

Should schools regularly administer these drugs and possibly act as agents of the medical profession ? Should staff be told of the rationale behind the recommended treatment and the possible Adverse Drug Reactions (A.D.R.s-side effects) prior to administration? Is this a legitimate"In loco parentis" role? Why do we refuse to give Paracetamol but not Amphetamines in some school settings?

What are the ethical and test validity issues that result from using diagnostic checklists in schools that have been designed by researchers who may have a vested financial interest in the diagnosis and medication of the children they are used on?

Is doing nothing or something very different harmful to the long term interests of the child concerned? ( Remember about the 60% spontaneous remission rate which is standard across a wide range of conditions.)

Why are boys four times more likely to be identified than girls and prescribed drugs? Is that the case in your educational setting? How does this relate to their later drug usage or dependence and adult life outcomes e.g. criminality rates?

Is the influence of the pharmaceutical companies and their use of inducements inappropriate in nature for health professionals, educational professionals and parents and does it constitute an abuse of their power?

Does the Headteacher, Governing body and Pastoral Care team know how many children are on specific psychotropic drug treatments within their school / year group?

Is the headteacher or pastoral care team member part of the monitoring process regarding behaviour with particular children on psychotropic medication , especially ones that they have concerns about?

Do members of the pastoral care team regularly get updated by health professionals as to any changes in dosage and what possible side effects might be expected that result from the change?

Do members of the pastoral care team get asked for their opinion about the child's pattern of behaviour prior to medication and / or whether they support the medication in this case?

Have pastoral care team members had conversations with the child's parents or carers about the treatment and whether there have been any Adverse Drug Reactions (ADR's - side effects) that they have observed from the treatment in school?

Is it your responsibility as a caring professional to draw the parent's attention to any published information you are aware of in relation to this specific medical intervention e.g. NICE parent information sheets?

Do you as an educational professional feel comfortable about possibly being drawn into a medical paradigm or do you feel you should be operating with a mainly socially constructed paradigm?(i.e. a "within child" explanation versus an " environmental / ecological" perspective)

Do senior managers within school have a means of challenging what they view as an inappropriate intervention from medical practitioners for one of their children, as they have an "In Loco Parentis" care role for the children in their school? What process has been agreed for this within your setting?

Would you or a member of the pastoral care team trigger a Common Assessment Framework (CAF) meeting involving parents to address any concerns you may have or speak to their school's nominated Child Protection coordinator for advice about the best way forward to challenge practice you are concerned about?

When does inappropriate prescribing of drugs that appears to cause some harm to a pupil constitute a Safeguarding issue which warrants action by the education professionals involved? What action should be taken ?

Does your local authority, school or professional body provide training in this complex area of ethical practice re medication for school aged children? Is such training also available for Governors?. Have colleagues benefited from such training?

Dave.Traxson Chartered Educational Psychologist