Many children with attention-deficit/hyperactivity disorder (ADHD) struggle with school. Recently, children have faced a variety of changes in the way that they attend school. Some might be attending virtual classes; others might attend school in-person with many new rules. To help your child with ADHD adjust to these changes,learn about the resources available for parents.

ADHD and schools

Children with ADHD might experience more obstacles in their path to success than the average student.

Most children with ADHD receive some school services. This can mean special education services, such as individual or small group instruction with a special education teacher; or accommodations, such as changing how assignments, tasks, and tests are done, extra help with remembering and organizing work, and frequent communication. Together, teachers and parents can help children with ADHD succeed in school.

A changing school environment

Many children experience more than one learning environment, for example, moving from one school to another as they age. In the COVID-19 pandemic, many children experienced changes in their learning environment, switching from in-person schooling to distance schooling, including learning at home and online. Many children returned to in-person schooling, but with more online learning as part of the school day. Some children continued with home or virtual-only schooling.

School can present challenges for many children with ADHD. Because ADHD symptoms include difficulty with attention regulation, hyperactivity, and impulsivity, which can affect planning, organizing, and managing behavior, many children with ADHD struggle with change. Here are some of the challenges that children with ADHD can face in different learning environments:

• Physical activity and movement are important for all children, but especially so for children with ADHD. More time spent with virtual learning can mean sitting still without moving for longer periods of time. Finding time to move may be especially important for children who struggle with hyperactivity.
• Children with ADHD struggle more with boredom and putting mental effort into challenging tasks. Virtual learning or in-person school with more rules may lack the novelty and excitement. Teachers may need to find new ways to keep children with ADHD from being bored and keep them engaged in learning.
• Children with ADHD are more likely than their peers to have some difficulties with social relationships. If the school environment provides fewer opportunities to interact freely during the day, children may need other ways to practice social skills and build on relationships.
• Transitions can be challenging for children with ADHD; they may need extra help getting ready, and more time getting used to new settings.
• Having to spend time doing schoolwork, homework, and family activities in the same space where parents may also have to do their own work can create additional stress for students and parents.
• Children with ADHD are likely to have other disorders in addition to ADHD, which can make coping with stress, change, and social isolation associated with virtual learning even more difficult. They may need additional support.

With changes in how school is being conducted, there is also the possibility that children who have special needs are not getting the services they need. The U.S. Department of Education has issued information for implementing special education services for schools that use distance learning.

However, some children with ADHD may respond positively to some of the changes. For example, virtual learning may provide fewer distractions for children who find it more difficult to tune out other people around them. More structured classrooms with more distance between students might help some children focus. With fewer activities in their daily schedules, some children may have more time to get the sleep they need. Since each child may react differently to changes in their environment, parents, teachers, and students need support that works for each individual child.

Working to help parents, students, and teachers

To help parents and students adapt to the changing environment, the National Resource Center on ADHD (NRC), a funded CDC partner, has worked to create resources and support for parents. These resources include advice for parents and teachers on

• creating enough structure so that the child can learn new routines,
• keeping the child engaged with learning,
• managing difficulty with attention while coping with changes,
• setting up the home learning environment,
• helping children stay connected with other children, and
• keeping children healthy and active.

Caring for a child with special needs can mean extra challenges. Parents of children with ADHD may experience extra stress from supporting their child while coping with changes and may need additional help. The NRC has created a parent toolkit, including information and resources to help parents understand more about ADHD and how to support their child, and tips and advice that help parents with their own stress during uncertain times.

Schools are a part of ADHD treatment

To meet the needs of children with ADHD, schools can

• Be part of effective treatment plans for children with ADHD; and
• Provide special education services or accommodations.

The American Academy of Pediatrics’ recommendations for ADHD treatment state that school is a necessary part of any treatment plan. Behavioral classroom management focusing on positive responses is an evidence-based treatment for ADHD and can complement parent training in behavior management. The NRC also provides some tips for receiving treatment via when in-person treatment is not possible. Parents, teachers, healthcare providers, and older children and teens can collaborate to develop an approach that works best for each student.

Asthma is a leading chronic illness among children and adolescents in the United States. It is also one of the leading causes of school absenteeism. On average, in a classroom of 30 children, about 3 are likely to have asthma. Low-income populations, minorities, and children living in inner cities experience more emergency department visits, hospitalizations, and deaths due to asthma than the general population.

When children and adolescents are exposed to things in the environment—such as dust mites and tobacco smoke—an asthma episode can occur. These things are called asthma triggers. Asthma symptoms can be controlled by avoiding triggers and taking medications prescribed by a health care provider, if needed. Asthma is common but treatable: using treatment based on current scientific knowledge reduces illness and future episodes.

Managing Asthma in Schools

Asthma-friendly schools are those that make the effort to create safe and supportive learning environments for students with asthma. They have policies and procedures that allow students to successfully manage their asthma. Research and case studies that looked at ways to best manage asthma in schools found that successful school-based asthma programs:

• Establish strong links with asthma care clinicians to ensure appropriate and ongoing medical care.
• Target students who are the most affected by asthma at school to identify and intervene with those in greatest need.
• Get administrative buy–in and build a team of enthusiastic people, including a full-time school nurse, to support the program.
• Use a coordinated, multi–component, and collaborative approach that includes school nursing services, asthma education for students, and professional development for school staff.
• Provide appropriate school health services for students with asthma, ensuring that students take their medicines and learn to use them when appropriate.
• Provide asthma education for students with asthma and awareness programs for students, school staff, parents, and families.
• Provide a safe and healthy school environment to reduce asthma triggers.
• Offer safe and enjoyable physical education and activities for students with asthma.
• Support evaluation of school–based programs and use adequate and appropriate outcome measures.

Ensuring that students with diabetes have the health services they need in school is important in helping them stay healthy and ready to learn. Managing diabetes at school is most effective when there is a partnership among students, parents, school nurses, health care providers, teachers, counselors, coaches, transportation staff, food service employees, and administrators. Support may include helping a student take medications, check blood sugar levels, choose healthy foods in the cafeteria, and be physically active.

Managing Diabetes at School

Diabetes doesn’t have to get in the way of a good experience at school. Remember, parents and schools have the same goal: to ensure that students with diabetes are safe and that they’re able to learn in a supportive environment. Schools can:

• Develop a plan to help students care for diabetes and handle any diabetes-related emergencies, including updated physician and emergency contacts.
• Work with a student’s parents, doctor, and school staff to create a Diabetes Medical Management Plan including information on services the school will provide and how to recognize high and low blood sugar levels. For more information, visit Helping the Student with Diabetes Succeed: A Guide for School Personnel, which includes hypoglycemia and hyperglycemia emergency care plans
• Ensure that school staff have a glucagon emergency kit and know how to use it if a student experiences a low blood sugar emergency.

Diabetes Self-Management

Help students to manage diabetes at a level right for his or her age.

• If a child is going to monitor his or her blood sugar, ensure that he or she feels comfortable doing so.
• If a trained school employee will do the monitoring, be sure the student knows where and when to go for testing.
• Encourage students to eat healthy foods, including a healthy breakfast, which will help students stay focused and active. Students and parents should look at the school menus together to help them make choices for a healthy meal plan.
• Having diabetes doesn’t mean that a child can’t be physically active or participate in physical education classes. They should get at least 60 minutes of physical activity every day. In fact, being active can help a child improve his or her blood sugar control.
• Check that students with diabetes have all recommended vaccinations, including the flu shot. If a child with diabetes gets sick, he or she can take longer to recover than children without diabetes. Talk to the student’s parents to make sure their child has all the vaccinations they need before starting the school year.
• Encourage students to wash their hands regularly, especially before eating and after using the bathroom.

Epilepsy is a common disorder of the brain that causes recurring seizures. Epilepsy affects people of all ages, but children and older adults are more likely to have epilepsy. Seizures are the main sign of epilepsy and most people can control this with treatment. Some seizures can look like staring spells while other seizures can cause a person to collapse, stiffen or shake, and become unaware of what’s going on around them. Many times the cause is unknown.

Picture a school with 1,000 students—that means about 6 students would have epilepsy. For many children, epilepsy is easily controlled with medication and they can do what all the other kids can do, and perform as well academically. For others, it can be more challenging.

Compared with students with other health concerns, a CDC study shows that students aged 6–17 years with epilepsy were more likely to miss 11 or more days of school in the past year. Also, students with epilepsy were more likely to have difficulties in school, use special education services, and have activity limitations such as less participation in sports or clubs compared with students with other medical conditions.

Managing Epilepsy at School

Managing epilepsy while at school may involve:

• Educating the school nurse, teachers, staff, and students about epilepsy and its treatment, seizure first aid, and possible stigma associated with epilepsy.
• Following the seizure action plan and administering first aid (including the use of rescue medications).
• Understanding the importance of medication adherence and supporting students who take daily medications.
• Helping students avoid seizure triggers, such as flashing lights, or other triggers identified in the seizure action plan.
• Monitoring and addressing any related medical conditions, including mental health concerns such as depression.
• Providing case management services for students whose medical condition disrupts their school attendance or academic performance.
• Referring students with uncontrolled seizures to medical services within the community or to the Epilepsy Foundation for more information.
• Understanding the laws related to disability, medical conditions, and special education to ensure that children with epilepsy are able to access the free and appropriate education afforded to them under the law.
• Monitoring student behavior to prevent bullying of students with epilepsy.

What is a Seizure Action Plan?

A Seizure Action Plan contains the essential information school staff may need to know in order to help a student who has seizures. It includes information on first aid, parent and health care provider contacts, and medications specifically for that child. Seizure Action Plans are an important tool that help parents and schools partner to keep children safe and healthy during the school day.

Food allergies are a growing food safety and public health concern that affect an estimated 8% of children in the United States. That’s 1 in 13 children, or about 2 students per classroom. A food allergy occurs when the body has a specific and reproducible immune response to certain foods. The body’s immune response can be severe and life threatening, such as anaphylaxis. Although the immune system normally protects people from germs, in people with food allergies, the immune system mistakenly responds to food as if it were harmful.

There is no cure for food allergies. Strict avoidance of the food allergen is the only way to prevent a reaction. However, because it is not always easy or possible to avoid certain foods, staff in schools, out-of-school time, and early care and education programs (ECE) should develop plans for preventing an allergic reaction and responding to a food allergy emergency, including anaphylaxis. Early and quick recognition and treatment can prevent serious health problems or death.

Eight foods or food groups account for most serious allergic reactions in the United States: milk, eggs, fish, crustacean shellfish, wheat, soy, peanuts, and tree nuts.

The symptoms and severity of allergic reactions to food can be different between individuals and can also be different for one person over time. Anaphylaxis is a sudden and severe allergic reaction that may cause death. Not all allergic reactions will develop into anaphylaxis and more than 40% (2 in 5) of children with food allergies in the United States have been treated in the emergency department.

In the United States, the percentage of children and adolescents affected by obesity has more than tripled since the 1970s. In 2017–2018, about 1 in 5 school-aged children were affected by obesity (20.3% of all 6-11 year olds, 21.2% of all 12-19 year olds) . The prevalence of obesity among 2-19 year old children was 25.6% for Hispanic children, 24.2% for Black children, 16.1% for White children, and 8.7% for Asian children. Many factors contribute to childhood obesity, including:

• Metabolism—how your body changes food and oxygen into energy it can use.
• Eating and physical activity behaviors.
• Community and neighborhood design and safety.
• Short sleep duration.
• Negative childhood events.

Genetic factors cannot be changed. However, people and places can play a role in helping children achieve and maintain a healthy weight. Changes in the environments where young people spend their time—like homes, schools, and community settings—can make it easier for youths to access nutritious foods and be physically active. Schools can adopt policies and practices that help young people eat more fruits and vegetables, eat fewer foods and beverages that are high in added sugars or solid fats, and increase daily minutes of physical activity.These kinds of school-based and after-school programs and policies can be cost-effective and even cost-saving.

Addressing Obesity in Schools

The COVID-19 pandemic has disrupted students’ routines and access to the school environment. Children gained weight at a faster rate during the pandemic (June 1-November 2020) compared to pre-pandemic, with younger school-aged children (6-11) experiencing a rate of BMI change that was 2.5 higher than before the pandemic.

Schools are a priority setting for obesity prevention efforts because they reach the vast majority of school-aged youth, provide regularly scheduled opportunities for physical activity, and offer nutritious foods through school meal programs.

With a widespread return to in person learning, children can have consistent access to physical activity opportunities, healthy meals, and services provided by school nurses and counselors.

A comprehensive approach is effective at addressing childhood obesity in schools, especially for elementary and middle school students. Scientists know less about what school-based obesity prevention approaches are effective for teenagers. A comprehensive approach means directing attention to nutrition and physical activity in schools and even involving school nurses, parents, caregivers, and other community members (e.g., pediatricians, after-school program providers) in the process. This approach aims to support the health and well-being of all students. It does not single out students according to their weight status or body size. Overweight and obesity are sensitive issues for students and families and must be addressed with compassion, understanding, and care. School-based programs to promote physical activity and improved diet quality do not appear to contribute to increases in depression, anxiety, or body-dissatisfaction; however, many studies do not collect information about these unintended effects. To avoid embarrassing or shaming students, schools should not emphasize physical appearances or reinforce negative stereotypes about obesity.

How School Nurses Can Help

School nurses play an important role to prevent and reduce student overweight and obesity prevalence. School nurses can address the complex physical, social, and health education needs of children and adolescents who are overweight or who have obesity. School nurses have the knowledge and skills to do the following:

• Create a culture of health and wellness in school.
• Promote and implement school-based policies and strategies for healthy eating and physical activity.
• Coordinate care with families and health care professionals.
• Lead the school community to influence policy changes that reinforce healthy eating, physical education, and physical activity before, during, and after school.

Cavities (tooth decay) are one of the most common chronic diseases of childhood in the United States. By age 8, over half of children (52%) have had a cavity in their primary (baby) teeth. Children from low-income families are twice as likely to have cavities as children from higher-income families.

Poor oral health can have a detrimental effect on children’s quality of life, their performance at school, and their success later in life. Cavities are preventable and ensuring that students have the preventive oral health services they need in school is important in helping them stay healthy and ready to learn. Dental sealants prevent cavities for many years. Children aged 6–11 without sealants have almost three times more first molar cavities than children without sealants.

Addressing Oral Health in Schools

School sealant programs are an effective way to reach millions of children in a school setting with dental sealants to prevent cavities. Increasing access to school sealant programs could reduce cavities, especially for children at higher risk for poor oral health. Compared with children from higher income families, children from low-income families are more likely to:

• Have untreated cavities.
• Have few or no dental sealants.
• Not have had yearly dental visits.

School sealant programs have been shown to increase the number of children who receive sealants and are especially important for reaching children who are at greater risk for developing cavities and less likely to receive private dental care.

School sealant programs that offer oral health care to students should:

• Use evidence-based guidelines, recommendations, and studies for implementing programs.
• Voice support for policies that allow the use of dental personnel to operate at the top of their licensure when dentists are not required to be on site, as per state or local regulations.
• Develop referral networks with dental practitioners in the community.