Checking In Before Heading Back to School: Advice With Thomas Priolo, MD

As the start of the academic year approaches, it is important to work with child and adolescent patients in adjusting to new schedules, routines, and environments, while evaluating psychiatric care needs.

It can be useful to schedule an appointment with the adolescent patient approximately 1 to 2 weeks prior to the start of school, Priolo said. This allows for a timely evaluation of current pharmacologic strategies and facilitates any necessary adjustments to optimize symptom management in the context of new environmental demands.

To continually assess treatment efficacy in both home and school settings, clinicians may consider recommending that caregivers and educators complete an assessment like the Vanderbilt Assessment Scales just before the school year begins and again within the initial weeks of term. These assessments can provide valuable longitudinal insight into symptom trajectory and functional outcomes across domains.

Priolo emphasized that it is also advisable to ensure the child has a comprehensive support plan in place, such as an Individualized Education Program or a 504 plan. Coordination with school personnel is essential to clarify accommodations and establish mutual expectations. Periodic verification that the school is adhering to the agreed-upon interventions can help maintain consistency in support and advocacy for the child’s needs. Physicians may support academic continuity by providing medical notes to excuse absences related to psychiatric appointments or symptom exacerbations, reinforcing a collaborative approach to care between healthcare providers and educational staff.¹

For adolescents, the academic transition period also offers an opportunity to engage in developmentally appropriate discussions around identity, self-esteem, and social relationships. Addressing the distinction between supportive and potentially harmful peer influences may be particularly useful during this time, Priolo noted.

Additionally, medication schedules may require modification to align with earlier wake times, ensuring sustained therapeutic coverage throughout the academic day. Where indicated, providing the school with a medication administration plan and emergency protocol can help facilitate safety and adherence. Priolo added that if patients are, for example, “on ADHD medications, and they were waking up at 9am during summertime, and now they have to wake up at 6 or 7am, we'll have to push those medications up. And as we know, the medications are only effective for a certain amount of time, especially the ADHD medication, so making sure that they continue to have a full day coverage of the medications is important. It might mean adding a booster dose of the immediate release stimulant in the afternoon if we need to.”²

References

1. Spiel CF, Evans SW, Langberg JM. Evaluating the content of Individualized Education Programs and 504 plans of young adolescents with attention deficit/hyperactivity disorder. Sch Psychol Q. 2014;29(4):452-468.

2. Abbas K, Barnhardt EW, Nash PL, et al. A review of amphetamine extended release once-daily options for the management of attention-deficit hyperactivity disorder. Expert Review of Neurotherapeutics. 2024;24(4): 421–432.