We all know the kids: they’re bouncing off walls, unable to wait their turn, so easily distracted that they just can’t focus on the task in front of them. Do they have Attention Deficit Hyperactive Disorder, or ADHD, as the inherited disorder is called? Or are they just frisky, normal kids who will outgrow this restlessness?

Few challenges of parenting are tougher than confronting the possibility of ADHD. The questions seem endless. How can you know if your child really has ADHD? How should you approach school about it? Are stimulant medications, the most common treatment, safe? What else works?

Defined by extremes

As anyone with a TV knows, the question of whether to medicate ADHD kids is the subject of passionate debate, usually defined by the extremes. In between, though, are caring professionals who treat each child as an individual. One is Dr. Lawrence H. Diller, a Walnut Creek, CA pediatrician. He wrote “Should I Medicate My Child? Sane Solutions for Troubled Kids with--and without--Psychiatric Drugs.” (Perseus Books Group, 2002).

Diller says that people with ADHD fall somewhere along a spectrum, from severe to mild. “The extreme ADHD kids, nobody has any problem, either in identify or in treating them with medication,” he says. But it’s worth first trying behavioral modification and educational intervention with those with less-severe ADHD. Medication can be added, if these don’t work alone. Stimulants work wonderfully, letting ADHD’ers focus scattered attention and succeed at what they want badly to do.

“It’s not that I am against medicine,” Diller continues. “I prescribe Ritalin or its equivalent every day. While medication ‘works,’ it is neither an ethical nor a moral equivalent to helping teachers and parents doing a better job with their kids.”

First, a diagnosis

Until recently, the first suggestion of ADHD was often made by schools. These days, schools are wary of appearing to push medication. They’re likely to tell parents a child is “highly distractible,” “unable to focus,” or “not able to work up to their potential.” Still, “these are code words for ADHD,” says Pennsylvania psychologist Michele Novotni, an ADHD treatment specialist and coach. “I think it’s important for parents to understand the schools are using coded language.”

And so, either because you got a notice from school, or because you suspect ADHD, Novotni recommends asking the school – in writing – for an educational assessment by a school psychologist or resource specialist (special education teacher). By law, schools have only a certain number of days to respond and to make the assessment.

Consider hiring an educational consultant to go with you to the parent-school assessment conference. Novotni tells of accompanying one couple who, new to the whole experience and suspicious of educators, didn’t realize that the school was bending over backwards to help their child. Novotni pulled the parents quietly aside to let them know they were getting a good deal.

School accommodations

The assessment describes a child’s difficulties in school and offers ways to help (“accommodations”), like assistance with homework, an aide to help the student record homework instructions, an extra set of books for home, or a classroom seat away from distractions.

This, however, is not a diagnosis. A diagnosis is critical. ADHD is distinguished from simple childhood friskiness by how it keeps a kid from succeeding, at school, at home, or with friends. The disorder involves differences in brain chemistry and perhaps in brain structure. Yet, inattentiveness and impulsivity (with or without hyperactivity) could also stem from, anxiety, a learning disorder or sleep disorder, depression or something else. Only a family doctor, pediatrician, child psychiatrist or psychologist is competent to diagnose, after talking with teachers, school officials and parents.

“This is not a diagnosis that can be made in fifteen minutes,” says David Rabiner, a clinical psychologist at Duke University’s Center for Child and Family Policy and publisher of Attention Research Update, a free online newsletter keeping lay people up on trends and research. If a doctor isn’t thoughtfully assessing all possibilities, Rabiner suggests finding another. Locate a clinician at a local meeting of CHADD, the non-profit advocacy group. At meetings, members circulate books with comments about their experiences with local professionals.

Coaching

Behavioral techniques work, but they require work, education and training by parents who learn to be consistent and structured, who hire a coach if possible and sometimes even confront their own ADHD.

A coach has a toolkit of techniques. One is giving students immediate rewards for good performance, tokens to be collected and redeemed for a treat. Novotni, who coaches children as young as two, says fidgeting helps with focus, so her students identify something they can quietly fidget with in class -- a pencil or a ring. One is allowed to take bathroom breaks at will. Since physical activity helps with focus, he runs in place for a few minutes, then returns to class.

The bottom line, experts say, is that a child who gets individualized help with ADHD is happier and more successful at home, at school and with pals.

To learn more, see the National Institutes on Mental Health’s ADHD site.

For links to more resources and tips on coping, see the Mayo Clinic’s article on ADHD.

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Marilyn Lewis is a freelance writer who lives in Northwest Washington State. She specializes in personal technology, health and medicine, business and lifestyle. She has written for MSNBC and The San Jose Mercury News.