In recent weeks, teachers have been forwarding emails from parents to Kelly Barlow-Eichman, the sole school nurse for the Shorewood, Wisc., school district, about possible behavioral struggles their children may be having in class.
The emails, Barlow-Eichman said, read something like this: Hey, if you’re noticing some behavioral struggles, please know my child is not taking their medications. Or they are trying a different dose.
It’s a message to which California mom Jess Berthold can relate. Berthold described the immediate change in her son as “night and day” when, at 6 years of age, he was diagnosed with attention deficit hyperactivity disorder, or ADHD, and prescribed Adderall, a stimulant commonly used to manage the inattentiveness, hyperactivity, and impulsivity that accompany the disorder.
Before he began taking the medication, Berthold said, “he was always climbing all over everything, clumsy and out of control. He was unable to sit still, even to eat a meal.”
There was also trouble at school. He wasn’t listening, wasn’t keeping his hands to himself. “His behavior was interfering with his learning,” she said.
Now 13 and in 7th grade, Berthold’s son continues to rely on a generic version of Adderall to help manage his ADHD symptoms. But a recent nationwide shortage of the medication has left Berthold stretching her son’s existing supply—he’s taking lower doses and going without it on weekends—while she continues to monitor area pharmacies for re-stocked inventory.
“He doesn’t like it. He says he feels out of control,” said Berthold.
It’s a feeling shared by countless families and, by extension, school nurses, who normally manage students’ medication at the 40 percent of the nation’s schools that have nurses on campus.
“It’s a little bit of desperation, for school nurses and families. It [the shortage] is impacting a lot of kids,” said Barlow-Eichman, who is also president of the Wisconsin Association of School Nurses.
The shortage, blamed primarily on manufacturing delays, was first announced by the federal Food and Drug Administration in October and continues to affect various parts of the country intermittently. It presents a problem for children in affected areas who rely on the medication to stay focused in school.
Nationally, about 10 percent of children ages 3–17 have received a diagnosis of ADHD, according to the Centers for Disease Control and Prevention, and up to 81 percent of them rely on medication as part of their treatment protocol.
School nurses monitoring the situation
School nurses are keeping a close watch on the shortage of Adderall. Frequently, they’re taking the lead in communicating updates and offering insight to parents, school staff and health-care providers.
“It is a lot for school nurses to do. We navigate the health-care and education system and know how to bring them together,” said Kate King, the president-elect for the National Association of School Nurses. “This is why we need a full-time school nurse in every building, every day.”
That’s especially true at a time like this. “Early last week, we started to have parents come to us letting us know their child was not going to be taking an afternoon dose of their ADHD medicine, because they either couldn’t get it, or switching to a different medication wasn’t an option for them,” said Barlow-Eichman.
Solutions aren’t necessarily simple
There are multiple types of stimulants used to manage symptoms of ADHD, but finding the one that works best can be a matter of trial and error, and families often hesitate to switch to a different medication that may not work as well or bring unwanted side effects, Barlow-Eichman said.
Berthold, the California mother, can relate. “I’ve talked with my doctor about switching to a different medication that’s not in shortage, but I’m terrified of it,” she said.
She’s so hesitant that she has opted to ration her son’s remaining Adderall pills rather than trying methylphenidate, another frequently used stimulant for ADHD known by the brand names Ritalin and Concerta.
Berthold said she’s spent upwards of five hours on the phone with various pharmacies in an effort to find Adderall. “I’m lucky. I have a job where I can take hours out of my day,” she said. “I really feel for parents who aren’t in my position.”
Having the time to spend searching for Adderall is one thing. Having the budget to spend on the brand-name version, which sources said is no longer in as short supply as its generic and less costly form (dextroamphetamine-amphetamine) is another. Berthold wrestled with the idea of paying about $400 for a month’s supply of brand-name Adderall, which she was able to find, versus the $5 she normally pays for the generic version, currently not in stock near her. But for now, she’s settling for the rationing method.
Barlow-Eichman acknowledges this challenge, even among school communities whose demographics, as in her district, skew to middle or upper middle-class. “I think financially, a lot of families have had the means to make adjustments. But I think we’re at a point where that’s not necessarily feasible or something these families are able to continue with,” she said.
Barlow-Eichman routinely checks the FDA website on her work computer to get updates on the shortage, which she will then share with affected families.
She’s also prioritizing communication with staff. “I’m working with principals now on a statement that will go out to all our staff that will let them know about shortages,” Barlow-Eichman said. “Making sure teachers understand that this is out of the control of parents and students.”