Working as a freelance writer for Granite State News Collaborative I was given the opportunity last spring to explore the impact the ADHD medication shortage had on New Hampshire schools districts. As a mother who has had to spend far to many hours calling both doctors offices and pharmacies to ensure my children had the medication they needed this piece hit home.

National ADHD Medicine Shortage Impact Granite Staters
By Cheryl Linskey, Granite State News Collaborative

Balancing a full-time job, raising a family, and serving as President of the New Hampshire Association of School Psychologists, Kate Grieve already had a lot on her plate. But the last few months have seen the additional stress of making sure her son has the medication he needs daily.
Grieve is one of many parents dealing with the impact of the national shortage of stimulant medication used to control ADHD. Each month she needs to make sure the pharmacy she uses has the prescription medication Vyvance in stock that her son takes.
“As a parent, you have to push and call. You are the middleman,” she said. “I had to work with different pharmacies to get what we needed. You need to be proactive or your child will have a lapse.”
Grieve had a scare earlier this year when her local pharmacy was unable to fill the prescription because of the shortage, so she had to call around to other pharmacies to see if they had the medicine in stock. She was one of the lucky ones who was able to get it filled before he ran out. Her son was on his last pill before she finally was able to get his prescription filled.
The Food and Drug Administration posted a notice of an immediate Adderall shortage on their drug-shortage website in October 2022, and many other ADHD medications have since been added to the list, including Vyvance, the medicine Grieve’s son is prescribed.
Grieve said the shortage is having a domino effect, causing a supply crunch for other stimulant medications besides Adderall. When pharmacies are unable to fill one prescription due to a shortage, doctors may prescribe other drugs that are more readily available. That, in turn, increases the demand for those backup medications, causing those to be in shorter supply. The prescription drug Metholphanidate, also used to help with ADHD, has also been in short supply because of the national shortage.
Even with other stimulant mediations available not all medications used for ADHD affect patients the same way, and it can take several attempts for patients to find the right medication that will help them focus.
Keith Nice, a reading specialist at Barrington Middle School who also suffers from ADHD, said he has experienced both professionally and personally that not all stimulant drugs used for ADHD work the same for each person. “ADHD medication is very much like finding the best sneaker that fits you,” he said. “You need to find the best medicine that will fit.”
Nice said many of his students feel the difference when they are on their medication and when they are not. “We call it engine medicine and one of my students said to me, ‘It definitely helps me read,’” he said.
Grieve echoed that her son knows how important this medication is for his learning and ability to interact with his friends.
“[He} wakes up every day and he knows he needs his meds,” she said. “When he
is not on his meds he is a different child.”
The main issue her son has when he is not on his medication is the inability to focus, which becomes very frustrating for him. Her son would not be learning without it, Grieve said.
“My heart just breaks when he can’t get his medication,” she said. “Kids and adults with ADHD often know social norms in life, but they can’t always apply them and that is why medication helps.”
‘Finger-pointing’
There are conflicting explanations for the shortage, ranging from additional restrictions being placed on manufacturing companies, to difficulty in getting the active ingredients needed to produce the medication.
“There is a lot of finger-pointing,” said Dr. Michael Smith, a clinical pharmacist at Dartmouth-Hitchcock Medical Center.
According an article, Understanding Why Adderall Shortages Are Shrouded In Mystery, published in Bloomberg.com, every year the Drug Enforcement Administration sets a quota or limit on the amount of raw materials used for many controlled substances, like ADHD medications. This is to make sure these medications are not abused. The DEA divides the quota up, giving each manufacturer an allotment.
Smith said drug manufacturers blame the DEA’s restrictions for the shortage, but the DEA says drug companies aren’t even producing as much as they are legally allowed under the quotas.
“It is important to understand how many steps are in the process in making a drug before it gets on your doorstep,” Smith said.
Another possible reason for the shortage is an increased diagnosis of ADHD during the pandemic, Smith said. During the pandemic, doctors were able to meet with patients and prescribe medications virtually. That may have allowed doctors to reach previously undiagnosed patients, he added.
An additional burden to those patients is how often they are required to have prescriptions filled. Because ADHD medications are controlled substances, many states place a 30-day limit on prescriptions, meaning doctors need to call in a new prescription each month and the availability of specific medications can fluctuate. Smith said pharmacists are contacting drug manufacturers regularly to find out what is available to buy.
“This is a stress on patients, providers, and pharmacies,” he said. “There is no good solution. The best thing you can do is keep checking.”

According to New Hampshire Board of Pharmacy, controlled substances is limited to a 34-day supply, but not more than 60 days. Physicians in New Hampshire can increase the length of prescriptions, which may help ease the burden for patients. In May 2021, the board approved an increase to a 90-day supply for Adderall, Methylphenidate if either such prescription specifies it is being used for the treatment of attention deficit disorder, attention deficit disorder with hyperactivity, or narcolepsy.
Smith said there are seeing a record number of drug shortages in the country, not just with ADHD medication. The average drug shortage lasts about a year and a half. “Unfortunately, there is no way to determine the end,” he noted.
Leveling the playing field
Grieve stresses that it is important to understand that medication on its own is not a cure-all for those who are battling ADHD. There needs to be a combination of medication, teaching tools, and strategies to help students focus in school, she said.
Felicia Sperry, a school psychiatrist for the Oyster River School District in Durham, agreed. There are three recommendations for helping students with ADHD in school: providing accommodations at home and school, providing occupational or cognitive behavioral therapy, and medication.
“One by itself is effective, but not as effective as all three working together,” Sperry said. “Meds don’t make it all better, but it levels the playing field.”
She explained that ADHD is not just about attention; it is the inability to stop what you’re doing. It is a combination of the need to focus and regulate behavior. Sperry explained that a child with ADHD needs to exert more energy to do even simple things like sit in a chair and having to struggle with these things can have a severe impact on their mental health as well she said. “Kids with ADHD have an increase in anxiety and depression,” she added.
Sperry said many of her students see the difference when they are on the correct medication. “One kid compared it to horseback riding. ‘Oh, this must be how my horse feels with his blinders on.’”
The lack of medication can not only harm education but there are also health concerns with a student being off their medication for a significant amount of time.
Laurie Fleming, a school nurse for the Gilbert H. Hood Middle School in Derry, said when students are not getting their medicine and have to stop abruptly and then restart, they report significant symptoms like dizziness, headaches and not eating.
“Being consistent is huge,” she said.
Fleming provides ADHD medication to eight students in her school, and two have repeatedly had issues filling their medication. In particular, the 5-milligram Methylphenidate has been difficult for her students to get filled.
Workaround
A workaround one family has found is filling 10 milligrams and cutting them in half. The prescription is able to be filled and the medicine lasts twice as long.
It is important for parents to stay in constant contact with the pharmacy, Fleming said. “I know at least one of the moms is checking regularly to get them filled.”
She is also concerned about how the shortage will impact students in their schooling long term: “If you can’t learn a certain skill set, you can’t build on it.”
Fleming stresses that parents should keep schools aware of being unable to fill their medication. “It is hard when parents don’t tell educators about the meds issues,” she said. “The nurses can’t tell (by law), but it would be helpful for them (classroom teachers) to know what is going on.”
Adult impact
This shortage has also impacted many adults attempting to concentrate in the work and home environment.
Nice shared his experience of having to go without his medication. Several months ago, he was unable to fill his Dextroamp prescription for a week and a half and noticed a major difference when he had no medication.
“I am pretty easy-going, but when I don’t take my meds it is amazing to me how short I am,” he said. “I was not as patient with my kids. I know I was upsetting my kids and my family, and that prompted me to call around to make sure I could get it filled.
“I’m worried that every month … it won’t get filled,” he said.
Not being able to fill his medication is something 25-year-old Jace Troie of Manchester experienced. Troie, an employee at the state’s office of the National Alliance on Mental Health Illness (NAMI-NH), was not able to get his prescription filled for six weeks.
“A friend of mine, who was a pharmacy tech, called and told me about the Adderall shortage,” he said. “At first, I didn’t feel the impact because I took the slow-release capsules. But, after about a month, I was impacted (not being able to fill his prescription at all).”
Troie said he found a temporary solution by rationing the low-dose boosters that he had at home.
“I think I have about a week left of the low dose,” he said. “So it would probably be a good time to start calling around to area pharmacies.”
Checking area pharmacies to see if they have the proper prescription and asking his doctor’s office to call it that pharmacy was one of the many tips he received from his mother, a retired pharmacist. She also suggested calling the pharmacist to see if they have a higher dose that can be split, having the pharmacy call when the prescription is filled so the medicine it doesn’t get sold to someone else if he doesn’t pick it up on time, or ask the pharmacist what strength is available and have his doctor call in a prescription that meets what the pharmacy carries.
He said that even with all the advice his mother is giving him, the shortage is still difficult to navigate.
“Without having Adderall, I am having a difficult time focusing on important things, like filling my Adderall,” he said.
Troie said following specific steps helps keep him organized, but without medication, it is more difficult. “It’s not that we don’t want to do the task. It is starting the task that is the problem,” he explained.

His co-workers have all been very supportive by offering to help him organize his calendar to take tasks off his plate so he is not as overwhelmed. Troie, a DEI (diversity/equity/inclusion) and program assistant for NAMI-NH, said working for the mental health nonprofit has provided the support he needed in the workplace.

“When I was first impacted, I told them and they all offered to help. I feel like I’m in a work environment where I can be honest about what I need,” he said.
Troie encourages open communication and understanding in both the classroom and the workplace.
“We could use a little extra patience. A little extra patience goes a long way.”

These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.

“Sensemaking with Learning Analytics @gsiemens #apereo14 keynote” by giulia.forsythe is licensed under CC0 1.0

Social-Emotional Learning (SEL) is the latest buzz word in education. But, the thing with buzz words is they can be used so often that they simply lose their meaning. If there is a time to understand the meaning behind the SEL program this is it.

In simple terms, Social Emotional Learning is the ability to understand how you feel, how you learn, and how you interact with others. It is also the ability to understand how others are feeling, how they learn, and why they are behaving how they behave.

As educators and parents, these are skills that our children need to develop to be able to not only succeed academically, but in life. These are skills we all need in order to succeed.

The trauma of social distancing and distant learning has placed a strain on students, parents, and educators. How do we help our children understand something we don’t completely understand ourselves?

This summer we have a unique opportunity to prepare our children for a school year that will be different from any other and no one seems to have the answers to what that will look like right now. This can bring up fears, anxiety, and frustration. Identifying these emotions and learning how to communicate them effectively will go along way to helping our children successfully move forward.

The Collaborative for Academic, Social, and Emotional Learning (CASEL), identifies the SEL program as teaching 5 related goals: self-awareness, self-management, social awareness, relationship skills, and responsible decision-making.
Jonathan Erwin, Director of the Western NY Teacher Center and author of 3 books on the topic of SEL, refers to this as soft skills where students understand self-awareness, self-regulation, and relationship building. In the age of distance learning teaching these skills have fallen heavily on parents.

As parents and educators practicing self-awareness and self-regulation is the best way to help our children see the positive impact these practices can have. This is not a “do what I say not what I do” mindset. Parents need to model healthy emotional learning and practice it each day.

There are several practical ways parents can model this behavior. Take care of yourself mentally and physically, make sure you are eating well, sleeping, and get exercise. Especially during these stressful times, it is important to show healthy ways of handling stress. Be present with your family, not just physically, but really listen to what your children are saying and truly interact with each other in a real meaningful way. Help your children identify their emotions and express them in a way others can understand. Also, show with your actions it is alright to be angry for example, but help them see how to express this anger appropriately. We are all human so it is also important to identify and own up to when you as the parent did not practice self-regulation or make the healthiest choice dealing with a stressful situation.

Unfortunately, not all children have the homes where these steps are taken. Their safe place is not their home. Schools will have an additional responsibility not only to help those students who academically struggled during distant learning, but also struggled with home trauma that has been a constant since mid-March. It is important for educators as we re-enter the classrooms to be aware of the impact this will have on some of their students and help them in this transition.

The biggest element is creating an atmosphere of love and belonging in the classroom, Erwin said. Helping kids feel a sense of connectedness and this can be done online as well as in a traditional classroom setting. Morning meetings to kick off the day or having the students have a role in “naming their classroom” are simple ways of creating this sense of community.

He said he noticed in his own school system and his daughter’s school that some teachers have found unique ways to reach out to students online, but there have also been others who created a tremendous amount of drudgery and busywork online. He recognizes the strain teachers are under with needing to meet curriculum needs and focus on the importance of SEL.
“It can be impossible to do both,” he said. “Hopefully, this current climate can help us get away from that obsession with testing.”

Educators face tremendous stress with pressure to prepare children not only for the next school year, but also the heavyweight of preparing for standardized tests and meeting all the common core curriculum.

Whether we are continuing with distant learning or re-entering the school buildings in the Fall, Erwin explains it will be important to eliminate the fear of failure for our students. Educators must create an atmosphere for the students so they are confident they are going to be successful.

Create a safe environment for students and helping them understand they are not going to be abandoned. This is done by not only telling them that they are safe, but showing them, he said.

An activity Erwin has implemented with his high school students a program called, “Senior Show and Tell”. Students come into class and demonstrate a skill they exceed in and show others. The skills vary from cooking to car work. He said it amazed him how providing this platform allowed students who usually do not participate in class really opened up and was excited to share.

“Give recognition to what they are good at because everyone is good at something,” he said. “This helps tremendously especially with children who may struggle academically.”

This could be done at any grade level. Children can be encouraged to share about an interest they have developed during Quarantine and teach others.

A Kindergarten teacher in Northwood New Hampshire has implemented, “teaching time”, in her curriculum for several years. Students are invited to prepare and teach their class something that they are an expert at. The other students are encouraged to ask one question or make one positive comment at the end of the presentation. Activities like these are done across the country in classrooms of every grade.

The biggest element of SEL is self-awareness. The Internal Profile Assessment identifies the relative strengths of the 5 basic needs that drive an individual: survival, belonging, power, freedom, and fun. In his book, The Classroom of Choice: Giving Students What They Need and Getting What You Want,” Erwin outlines these 5 needs:

1-Survival: the need for physical and emotional safety, order and security
2- Love and Belonging: the need to feel accepted
3- Power: the need for learning, competence, achievement, recognition, and being listened to,
4- Freedom: the need for movement and choice
5- Fun: the need to play.

Once you understand someones basic needs then it helps to understand how they can best be communicated with and learn, he said.

The Internal Profile Assessment is a great tool for teachers, parents, and students to fill out. This can be done as a family and parents get to understand each other and once you understand each other you can communicate better, Erwin said. The assessment invites you to consider your behavior and personality as if you were an objective observer of yourself over the course of your life. There are word clusters listed in categories for you to learn about our most prominent needs. Behavior is driven by the 5 categories of human needs and drives.

The assessment breaks down these categories and instructs the participants to rank their preferences and then score the color-coded key. It would be a great tool for families to use, staff members during a workshop activity, or even to be used in your classroom. Attached is a copy of the assessment. Check it out and learn a little more about yourself and others as we keep improving our social and emotional skills in and outside of the classroom.

Internal_Profile_Assessment_SCORING_KEY

Sundials and graduation posters.

Neither would be in our yard right now if not for the pandemic.

We woke up early one morning and placed 12 rocks in a circular shape and carefully placed a stick in the middle.

My daughter’s 6th-grade science class assignment was to make a functioning sundial and check on it throughout the day to see if the sun moved. This activity did not involve a google classroom or an actual classroom. All you needed was rocks, a stick, the outdoors, and some sunshine !!!

There is no way my daughter would have the time or ability to experience this at any other point. It was a little gift of this time to learn about the sun in a different way.

We also received a visit from two eighth grade teachers earlier this week, hand-delivering a graduation sign for my oldest daughter.

Yes, there are so many things she is missing and it breaks my heart. No DC trip. No celebrating with her friends at her semi-formal dance or graduation. No last walk through the only school building she known since the age of 4.
There are so many things these kids have lost. It is easy to lose sight of what they gained.

Two of her favorite teachers stood on our front lawn, played with our dog, and joked around with both girls. This would not have happened without the pandemic.

Earlier in remote learning, the eighth-grade class had an opportunity to zoom with U.S. Senator Jeanne Shaheen and take turns asking questions and learn a little about her experiences in Washington and as Governor of NH. They even learned what a couple of her favorite books were. It was such a small group of kids that the senator was able to really interact with them on a personal level. I watched as the senator noticed a flag hanging up in one of the student’s bedrooms and she asked about it. The student explained it was the flag from the country her mother was born. That entire conversation would never have happened under any other circumstance.

Teachers have been forced to be creative. To reach out to their students in a way we have never been asked to before. I have been challenged to figure out how to get materials to my student without online access and provide as much support to his family as I can without interaction. The behavior plan, teaching modifications for classroom settings – all were thrown out the window in the middle of March. We needed to find a different way to help grab students attention and keep them engaged.

I have witnessed my co-workers find incredible websites to show their students. I have seen reading intervention transformed into google meets and interactive reading applications. Students have had the opportunity to do more creative writing for their assignments and I have been able to read how their imaginations have risen to the occasion. Students are learning math from online presentations, Kahn Academy, and Mr. MathBlog. Guess what if you missed a step you can actually pause what your teacher said and go back. Try doing that in the classroom.

Parents and teachers are communicating together and sharing resources to help these students succeed. Yes, we are all burnt out. Parents, educators, and students. Remote learning is hard. Really really hard. There are days my eyes feel like they are going to fall out from staring at the computer so much. There are days that I am so frustrated seeing yet another missing assignment from a student and there is really nothing you can do, but send another reminder note and let them know you are there if they need help.

But, there are also days when the assignment is turned in early and it is really good. There are days when you have a chance to see a student’s face even if it is online and it makes you smile.

There are days, like today, that I can sit on my couch with my dog next to me and experience a private percussion concert from my 12-year-old for her band assignment. She got a standing O by the way.

As we prepare for the last couple of weeks in this crazy school year try not to focus just on what we lost, but everything we have gained. Teachers, parents, and students are learning from each other in ways we never had time or the ability to before. Whenever we go back into those buildings it will never be the same and maybe that will be the ultimate silver lining.

Burnt cookies.

Accidents happen to everyone. That was my lesson plan that was never taught.

Let me explain.

Since, remote learning started we needed to figure out creative ways to teach our kids.

As a paraprofessional, my school district also had to try to figure out what my job would look like. There was a lot of juggling on who we should be supporting and how. There was also A LOT of professional development webinars. I have never watched more webinars in my life.

This wasn’t bad. I have actually learned a lot over the last few weeks. One, birthed a great weekly tradition. Baking with my daughter.

It has been so much fun. She films. I bake. And she puts it all together to be put be shown to our school community Facebook page. She gets excited to film them. She actually cleans the kitchen!

During this particular webinar one of the presenters explained how she had her students look at a recipe and they worked together on how to double it.

So I took it a step further and we did a little baking show. Our first show was making peanut butter cookies from a kid cookbook I had on hand.

There were so many executive functioning lessons and math skills it was great.

Steps I focused on:

1- Reading the entire recipe
2- getting all the ingredients out before starting
3- Washing your hands before cooking
4- count how many cookies are in each row across and down
5- how many cookies do you have in total

Fast forward a few weeks, this time we are making ginger snaps. Similar process as the peanut butter cookies, I am trying to be more comfortable in front of the camera.

After all I am pro and should actually have my own show on The FoodNetwork by now.

Anyway, I take a look at the cookies and 10 minutes they don’t seem to be cooked enough. I make the executive decision, off-camera to keep them in a couple of more minutes. It is important to mention that there were two trays of cookies and I only looked at the top tray.

I am sure you can see where this is going. The top tray was great. The bottom not so much – burnt completely on the bottom. I took a page from Mr. Rogers, and decided to show my mistake. Because mistakes happen right and we at least have some yummy cookies to eat.

Well in the editing process, my daughter was working on the segment and the entire video got deleted by accident.

So again, accidents happen and another lesson brought home. You just pick things up and try again. We are currently making Apple Crisp for our next segment. Cross your fingers !!!!

Yep, this was printed on a T-shirt my family thought was perfect to give me during our vacation on the beach last summer.

Hidden in the white plastic bag it was sold in, my 11-year-old hands it to me with a smirk on her face. She starts to giggle as I hold up the shirt.

“Get it Mama,” she said.

Ya, I get it. I apparently have a teacher voice and I use it A LOT.

I didn’t always have a “teacher voice”.

I actually used to think my sister, who is a reading specialist, spoke a different language when she pulled out hers. We would be on the beach in the summer and she would talk about work. She infested the air with gross motor skills, decoding, and using multi-sensory methods to build phonemic awareness.

OH MY GOD!!!!!

Now, not only do I understand all of this. I speak this crazy language with her.  I have jumped on this bandwagon and brought it home with me. My children are now subjected to being asked “is this a big problem or a little problem”, “what zone are you in right now”,  “what is the expectation right now?” “I’ll wait. It seems like you need a minute.”

To be honest, the “I’ll wait. It seems like you need a minute.” has actually been used on my husband before and was not received well. I wouldn’t advice it.

Also don’t forget this gem, “What tools do you have in your toolbox to solve this problem?”

Seriously, I’m giving myself a headache.

But, this is the language we are trained in. All of these skills are so important to help our kiddos learn. Heck these skills are important to help all of us learn.

Knowing your audience is the best way to communicate. Knowing that hearing these terms at school all day and then mom repeating them during homework time or dinner is OVERKILL.

I got this message loud and clear when my youngest was mocking the Zones of Regulations. She learned this in school  since kindergarten.

For those who do not know what Zones of Regulation is let me enlighten you. It is  is a complete social-emotional learning curriculum, created to teach children self-regulation and emotional control. Can you tell I pulled that definition from an educational website, extraordinary.com.

Zones of Regulations are color coded to identify various emotions you are feeling. Check out the link to learn more. For the purpose of the blog, I will just let you know Red Zone identifies with feeling angry or out of control.

So my daughter, who took delight in giving me the t-shirt, complains how annoying the zones are  during dinner one night. She turns to me and in a tongue and check tone, asks me, “Mama, What Zone are you in?”

Deadpan, I  look  at her and say, “Well right now I’m in  the red zone. You want to go start the dishes.”

Don’t get me wrong, I think identifying your emotions and finding the best way to express them is so important. I have seen first hand how effective the zones are.

I just need to also remember to find other terms when I am not at school. Figuring out how to reinforce what I have learned by working in a school setting and use that to help my own children. I don’t need to talk about zone colors to find out how my children are feeling. I don’t need to use the term expectation to make sure they clean their rooms or clear the table or simply treat each other with kindness.

I can bring all these life lessons home as a parent and perhaps keep my tools and my toolbox in the classroom.