• Students with disabilities are often nonverbal or have limited communication skills, leaving teachers guessing about symptoms such as nausea, headache, dizziness, tired, fatigued, thirsty, weakness, or muscle pain.
• Many students oscillate between hypo or hypersensitivity, with sometimes only feeling "pressure" or "minor discomfort," and not the true "pain" or "sensation" that is present from internal/external (e.g., abdomen, heart, back, feet, skin) bodily problems (or they may feel overwhelming "pain" for no real reason).
• Memory deficits may result in not knowing when and how much medication to take, or decrease their ability to remember side-effects that occurred in the past, as well as not being able to recognize early danger signs and respond appropriately.

Teachers are not alone with this struggle. Parents, nurses, and doctors share the same concerns, including diagnosing appropriate medication and dosage.

One major advantage in diagnosing medication's side-effects in our field is they are frequently more visible during physical activity vs. a typical classroom setting. For example, if a students' medication is making him/her lethargic or weak, classroom teachers may not recognize this problem when students are sitting or only taking short walks. However, once a sustained physical demand is encountered, the student may show rapid signs in decreasing performance.

Tragically, students with disabilities are often over medicated, with the resulting side-effects being a dramatic reduction of health related benefits from exercise. However, if medication and dosage are appropriate, drugs can have a positive behavioral and physical effect for these students. This is why physical educators need to share what they observe with all parties involved, to help with appropriate medication usage. Remember, doctors rely considerably on the observations of parents and others for proper diagnosis; therefore educators should have written documentation of appropriate or inappropriate behaviors for future doctor appointments.

Following is a list of additional teaching strategies, possible side-effects, danger signs to look for, and common medications used by individuals with a variety of disabilities.

• Behavioral changes (positive or negative) can result from a student trying a new medication, having their medication timetables change, and/or missing a medication dose. For example, if a student has not been taking their medication (such as Ritalin) for several weeks and is continuing to function and learn skills successfully, perhaps their medication is no longer needed or a lower dosage is recommended.

  On the other hand, a more destructive behavior could appear, suggesting a higher dosage or change in medication might be necessary. Behavioral changes are usually not evident with some medications for several days or even weeks. For example, methamphetamines typically take 3 to 6 days to dissipate from the body, whereas antianxiety drugs take 3 to 6 weeks before their removal produces noticeable changes. Therefore, multiple observations (over several weeks) should be documented before formalizing a conclusion and collaborating with the parents about your beliefs, concerns, and suggestions.

• In general, medication effectiveness could be influenced by "stressors" such as the common cold, menstrual cycle, hyper/hypoglycemia, fatigue, anger, exhilaration, dehydration, hypoxia, hyperventilation, air temperature, body temperature, rapid change in body temperature, food, sleep, and/or other drugs. One stressor alone will usually not result in noticeable behavioral changes; however, several stressors combined could result in dramatic affects.

  For example, seizure medication may not be effective for a child with cerebral palsy who is also having minimal sleep, has a cold, and is dehydrated. Remember, the biological systems of students with disabilities are usually weaker than the normal population, thus making them more susceptible to stressors.

• Physical educators should note that side-effects will vary from person to person and day to day; therefore, behavioral problems, mood shifts, and lower activity levels should be assessed regularly for appropriate modifications. Having alternative activities, different environments, and verbal support/understanding can really change a negative situation into a positive. A simple change from playing a group game to an individual activity could be all that is needed for an appropriate accommodation.
• If the student has an injection port or other implanted medication delivery device, avoid putting pressure on the spot where the plastic tube enters the body.
• Medications may affect exercise response by lowering or increasing heart rate, producing a slower response to heat stress (e.g., sweating) and/or decreasing the body's ability to dissipate heat. Furthermore, medication could increase dehydration, increase hypoglycemia, lower blood pressure, and restrict bronchial tubes.
• Early danger signs that a student may be in trouble due to their medication include, but are not limited to: breathing changes, dizziness, drowsiness, early fatigue, weakness, muscle cramps, poor balance or coordination, respiratory distress, lack of perspiration, excessive thirst or dry mouth, cool pale skin, swelling, joint pain, aggressiveness, hyperactivity, and mood swings.
• If educators notice any symptoms of distress, they need to make changes such as:
  • stop exercising or slow down the pace
  • increase the number of rest breaks
  • change the activity
  • change the environment
  • change the group size to small, one-on-one, or individual activity
  • use 20-30 beats above resting heart rate as a indicator of effort because HRmax becomes invalid with some medications
  • drink more water or fluids high in sugar and potassium
  • schedule snacks or meals prior to exercise
  • go indoors, find shade, or cool the person down with wet towels if overheated
  • schedule medications to maximize physical activity, such as give depressants further away from, and stimulants closer to, exercise time
    • if appropriate have students medications available
  • teach meditation or yoga to release hypertension

Many children with disabilities do not live with loving and caring parents, and instead live in group homes or state schools where under-paid and over-worked staff manage their care. Showing extra sensitivity, demonstrating love, and giving hugs to children without parents is especially important. Educators also need to demonstrate and teach peers friendship skills, such as trust, respect, listening, problem sharing, acceptance, empathy, inclusiveness, cooperation, self-responsibility.

The following information presents several classifications of medications including: anticonvulsants, antipsychotics, antidepressants, antimanics, respiratory medications, cardiac medications, stimulants, anti-inflammatory, and corticosteroids.

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