Monitoring sideeffects

Regular contact with the child's teacher is useful for monitoring behavioural improvement and side-effects in the school setting. The physician can organize this contact by having the child's parents take a behaviour-rating and side-effects scale to the teacher before the child's follow-up visits. Obtaining information directly from the teacher is preferable to the usual procedure of asking the parents about the child's response in the school setting. In many cases, the parents actually do not see their child during peak-medication effects because he or she takes the medication twice daily during school hours.

The presence of physical complaints such as headaches and insomnia must be assessed before the child starts taking medication. Otherwise, these symptoms may be construed incorrectly as side-effects, once treatment starts. Side-effects must be monitored continuously because many have a late onset. (!6!)

Since some side-effects such as overfocusing, preservation, and dystonia are subtle and unreliably reported by teachers and parents, direct observation of the child is important. A useful strategy for monitoring the effects of medication is to have the child attend follow-up visits at a time of peak-medication effect, for example, 1 to 2 h after taking an oral dose of medication. The physician can then systematically observe the child for tics, stereotypical movements, perseveration, overfocusing, and other side-effects during the course of a routine office visit, in addition to obtaining the reports of parents and teachers.

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