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Attention-deficit/hyperactivity disorder (ADHD) is a group of chronic disorders that begin in childhood and sometimes last into adult life.

Problems generally associated with ADHD include inattention, hyperactivity and impulsive behavior. They can affect nearly every aspect of life. Children and adults with ADHD often struggle with low self-esteem, troubled personal relationships and poor performance in school or at work.

The best treatment for ADHD is a matter of debate. Currently, psychostimulant drugs are the most common treatment. But although these drugs can relieve many symptoms, they don't cure ADHD. Counseling, special accommodations in the classroom, and family and community support are other key parts of treatment.

At various times, ADHD has been called attention-deficit disorder (ADD), hyperactivity, and even minimal brain dysfunction. But ADHD is the preferred term because it more accurately describes all aspects of the condition. Yet changing the name hasn't made ADHD less controversial.

For some time, experts disagreed on how ADHD should be diagnosed — and even on whether it was a real disorder. But in 1998, the National Institute of Mental Health decided that ADHD is a legitimate condition. In addition, most doctors believe that a child shouldn't receive a diagnosis of ADHD unless the core symptoms of ADHD appear early in life — before age 7 — and create significant problems at home and at school on an ongoing basis.

The symptoms of ADHD fall into two broad categories:

• Inattention
• Hyperactivity-impulsive behavior

In general, children are said to have ADHD if they show six or more symptoms from each category for at least six months. These symptoms must significantly affect a child's ability to function in at least two areas of life — typically at home and at school. This helps ensure that the problem isn't with a particular teacher or only with parents. Children who have problems in school but get along well at home are not considered to have ADHD. The same is true of children who are hyperactive or inattentive but whose schoolwork and friendships aren't affected by their behavior.

In most children diagnosed with ADHD, signs and symptoms appear between 4 and 6 years of age, although they sometimes may occur even earlier. They include the following:

Inattention

• Often fails to pay close attention to details or makes careless mistakes in schoolwork or other activities
• Often has trouble sustaining attention during tasks or play
• Often doesn't seem to listen when spoken to directly
• Often doesn't follow through on instructions and fails to finish schoolwork, chores or other tasks
• Often has difficulty organizing tasks or activities
• Often avoids or dislikes tasks that require sustained mental effort, such as schoolwork or homework
• Often loses things needed for tasks or activities, such as books, pencils, toys or tools
• Is often easily distracted
• Is often forgetful

Hyperactivity-impulsive behavior

• Often fidgets with hands or feet or squirms in seat
• Often leaves seat in the classroom or in other situations where remaining seated is expected
• Often runs or climbs excessively when it's not appropriate, or, if an adolescent might constantly feel restless
• Often has difficulty playing quietly
• Is often "on the go" or acts as if "driven by a motor"
• Often talks excessively
• Often blurts out the answers before questions have been completely asked
• Often has difficulty waiting his or her turn
• Often interrupts or intrudes on others by butting into conversations or games

Most healthy children exhibit many of these behaviors at one time or another. For instance, parents may worry that a 3-year-old who can't listen to a story from beginning to end or finish a drawing may have ADHD. But preschoolers normally have a short attention span and aren't able to stick with one activity for long. This doesn't mean they're inattentive — it simply means they're normal preschoolers.

Even in older children and adolescents, attention span often depends on the level of interest in a particular activity. Most teenagers can listen to music or talk to their friends for hours but may be a lot less focused about homework.

Being different isn't ADHD
The same is true of hyperactivity. Young children are naturally energetic — they often wear their parents out long before they're worn out themselves. And they may become even more active when they're tired, hungry, anxious or in a new environment. In addition, some children just naturally have a higher activity level than others. Every child is unique, with a distinct personality and temperament. Children should never be classified as having ADHD just because they're different from their friends or siblings.

Most children with ADHD don't have all the signs and symptoms of the disorder. Furthermore, symptoms may be different in boys and girls. Boys are more likely to be hyperactive, and girls tend to be inattentive. In addition, girls who have trouble paying attention often daydream, but inattentive boys are more likely to play or fiddle aimlessly. Boys also tend to be less compliant with teachers and other adults, so their behavior is often more conspicuous.

At the same time, children diagnosed with ADHD may have some things in common. They tend to be especially sensitive to stimuli such as sights, sounds and touch, for instance. And when overstimulated, they can quickly get out of control, becoming giddy and sometimes aggressive or even physically or verbally abusive. Children with the inattentive form of ADHD may seem to drift away into their own thoughts or lose track of what's going on around them.

Symptoms of ADHD in adults
ADHD always begins in childhood, but it may persist into adult life. The core symptoms of distractibility, hyperactivity and impulsive behavior are the same for adults as for children, but they often manifest differently and far more subtly in adults. Hyperactivity, in particular, is generally less overt in adults. Children may race around madly; adults are more likely to be restless and to have trouble relaxing.

On the other hand, problems with organization and concentration often increase as people get older and their lives become more complicated and demanding. Adults diagnosed with ADHD often say that their biggest frustration is their inability to focus and to prioritize, leading not only to missed deadlines but also to forgotten meetings and social engagements.

As difficult as this is, the impulsive behavior of some adults with ADHD can be even more problematic. The inability to control impulses, which some experts say may be the defining characteristic of ADHD, can range from impatience waiting in line or driving in heavy traffic to mood swings, intense outbursts of anger and troubled relationships.

One set of guidelines used to diagnose adult ADHD, called the Utah criteria, lists the following as characteristic of adults with the disorder:

• A childhood history of ADHD
• Hyperactivity and poor concentration
• Inability to complete tasks
• Mood swings
• Hot temper
• Inability to deal with stress
• Impulsivity

Parents often blame themselves when a child has been diagnosed with ADHD, but scientists increasingly believe that structural changes in the brain, not parenting, may be a leading cause of the disorder. At the same time, certain environmental factors may contribute to or worsen a child's symptoms. Although much still isn't understood about ADHD, researchers have identified several factors that may play a role:

• Altered brain function. Scientists once thought that a chemical imbalance was involved in many cases of ADHD because adults and children diagnosed with ADHD appear to have low levels of dopamine (dopa decarboxylase), a chemical that sends messages to the part of the brain involved in attention, movement and motivation. But brain scans of children with ADHD also show changes in the neural pathways along which these messages move. It's possible that this may interfere with communication between the parts of the brain that regulate attention, planning, impulsive behavior and motor control — all areas of difficulty for people with ADHD.

• Heredity. ADHD tends to run in families. About one in four children with ADHD have at least one relative with the disorder, and when one identical twin has ADHD, the other twin almost always has it as well.
• Maternal smoking, drug use and exposure to toxins. Pregnant women who smoke are at increased risk of having children with ADHD. And alcohol or drug abuse during pregnancy may reduce activity of the nerve cells (neurons) that produce dopamine. Pregnant women who are exposed to environmental poisons such as polychlorinated biphenyls (PCBs), also may be more likely to have children with symptoms of ADHD. PCBs are industrial chemicals that were widely used until they were finally banned in 1976. But PCBs are slow to degrade and high levels remain in the environment, in animal and human tissue and in breast milk, which tends to attract contaminants because of its high fat content.
• Childhood exposure to environmental toxins. Preschool children exposed to certain environmental toxins, particularly lead and PCBs, are at increased risk of developmental and behavioral problems, many of which are similar to those found in children diagnosed with ADHD. Exposure to lead, which is found mainly in paint and pipes in older buildings, has been linked to disruptive and even violent behavior and to a short attention span. And high levels of PCBs are known to interfere with many aspects of a child's development, in addition to being human carcinogens. Children may be exposed to PCBs in the womb as well as after birth — both breast milk and certain fish are high in these toxins.

In the 1990s, diagnosed cases of ADHD in the United States increased dramatically. The number of children with a diagnosis of the disorder climbed from 950,000 in 1990 to more than 2.4 million in 1996, and the number of adults with a diagnosis of ADHD more than tripled between 1992 and 1997. Some experts believe this increase was due, at least in part, to the intense media coverage ADHD received and to greater public awareness of the disorder.

The strong interest in ADHD likely means that more children with the disorder are receiving needed treatment. It may also mean, however, that children who don't have ADHD or who have other problems such as depression, anxiety, learning disabilities or sleep disorders are being diagnosed and treated incorrectly.

In general, if your child has trouble concentrating, sitting still or controlling his or her behavior, and these problems are creating significant difficulties at home and at school, see your pediatrician or family physician. Your doctor may later refer you to a specialist, such as a developmental-behavioral pediatrician, psychologist, psychiatrist or pediatric neurologist, but it's important to have a medical evaluation first to rule out other causes of your child's symptoms.

Difficult to identify in very young children
Although symptoms of ADHD can sometimes appear in preschoolers, diagnosing the disorder in very young children is extremely difficult. Often, developmental problems such as language delays and adjustment difficulties can be mistaken for ADHD. For that reason, preschoolers suspected of having ADHD are more likely to need evaluation by a pediatrician, psychologist or psychiatrist, speech pathologist, or developmental pediatrician.

Children being treated with medication should see their doctor regularly — up to once a week until the proper dosage has been established and every three to six months after that. Studies show that many children don't receive adequate follow-up care, so be sure to discuss subsequent appointments with your doctor. You also may want to consider retesting every few years, depending on your child's grade level, age and diagnosis.

Call your physician if your child is taking medication for ADHD and experiences side effects, such as loss of appetite, trouble sleeping or increased irritability. Over time some children taking stimulant medications may also lose weight. This is another reason why follow-up visits are important.

No single test for ADHD exists, making the disorder difficult to diagnose. But a variety of exams are used to differentiate ADHD from learning disabilities and mood disorders. For this reason, make sure that the physician performing the evaluation has training in ADHD or in the diagnosis of developmental and behavioral disorders. You may want to start by talking to your child's pediatrician or your family doctor. Some pediatricians evaluate children themselves, but others may refer you to a mental health professional they know and trust.

The following chart from the National Institute of Mental Health lists the types of doctors who are qualified to diagnose and supervise treatment for ADHD, although not all may have specific training in the disorder. Be sure to look for a professional who does.

Diagnosing ADHD in children
Assessing a child for ADHD usually begins with complete medical, school and family histories, and a medical exam to exclude other causes of your child's symptoms. A number of medical conditions may cause signs and symptoms similar to those of ADHD, including learning disabilities, mood disturbances, hyperthyroidism, seizure disorders, fetal alcohol syndrome, vision or hearing problems, and Tourette's syndrome — a neurological disorder characterized by compulsive body movements and vocalizations.

An evaluation for ADHD should also include checking for learning or language problems, depression, anxiety and sleep disorders. These and other coexisting conditions are found in as many as one in three children with ADHD.

Because ADHD symptoms may not be obvious in a medical office, your doctor is likely to use questionnaires and interviews to learn more about your child's behavior. You, your child's teachers and other people who know your child well, such as babysitters and coaches, may be interviewed, and your doctor may also use ADHD-specific rating scales, such as the Vanderbilt questionnaire, the Connors' Rating Scales or the Achenbach Child Behavior Checklist (CBCL), to help collect and evaluate information about your child.

It's important to determine not just how your child behaves but whether the behavior is long-standing or temporary and when it occurs. Children diagnosed with ADHD exhibit symptoms over a long period of time and have particular trouble in stressful, demanding situations or in those that require sustained attention such as reading, doing math problems or playing board games.

Gathering as much information about your child as possible is the best way to ensure an accurate diagnosis. Brain scans aren't a reliable way to diagnose the disorder, nor is a child's response to a psychostimulant medication.

Diagnosing ADHD in adults
It can be even more challenging to identify ADHD in adults than it is in children. The signs and symptoms in adults are often especially subtle and subjective, and no single test can confirm the diagnosis, including self-report tools such as the Copeland Symptoms Checklist for Adult ADHD or the Brown Adult Attention Deficit Disorder Scales.

What's more, adults may have a hard time remembering whether their problems date back to childhood. And yet a persistent pattern of signs and symptoms, beginning no later than age 7, is essential for a diagnosis of adult ADHD. For that reason, your doctor is likely to ask for your old school records and to gather information from teachers, parents and anyone else who knew you when you were young. If your difficulties are recent or only occurred occasionally in the past, you're not considered to have adult ADHD. In addition, your doctor will carefully assess the impact of your core symptoms on your current life — your performance at work or in school and your relationships with friends and family.

As with children, your evaluation should include a thorough physical exam to rule out other reasons for your symptoms. This means ruling out not only medical conditions that can mimic ADHD, such as hyperthyroidism and hearing loss, but also psychological problems such as bipolar disorder, which are much more common in adults than ADHD is. Substance abuse, for instance, can cause mood swings and affect memory and concentration. Severe depression can also affect attention and memory and can make it difficult to concentrate or complete tasks.

To help arrive at a diagnosis, some specialists use tests that objectively measure your cognitive ability, your short-term memory, your concentration and your problem-solving skills. Even so, many factors can affect your performance on these tests, and by themselves, they're not necessarily good indicators of the presence of adult ADHD. Combined with extensive medical and behavioral histories and school and job records, however, they can help provide a fuller and more accurate picture of how you function in the world.

Getting an accurate diagnosis
Most experts agree that ADHD is both under- and overdiagnosed in the United States. In some areas of the country, an exceptionally high percentage of children are being treated for ADHD. These children are typically white, male and from affluent families. This has led to concern among some public health officials that ADHD has become a fad diagnosis in certain communities. On the other hand, ADHD may be underdiagnosed in black and Asian-American children or in children living in poor and rural areas, either because their families lack insurance coverage for medical evaluations or because of geographic, gender or racial biases.

Sleep disorders and ADHD
Diagnosing ADHD is further complicated because some children who are hyperactive or inattentive actually have sleep problems, not ADHD. Researchers have discovered that two sleep disorders in particular — snoring and sleep apnea — may lead to hyperactivity and inattention.

Sleep apnea is a potentially serious condition in which you stop and start breathing — sometimes dozens of times — during sleep. Researchers don't completely understand the link between sleep apnea and hyperactivity, but when children with sleep apnea are treated for the disorder, their hyperactivity often disappears completely.

Children with true ADHD usually don't experience sleep apnea, but they may have disturbances in their REM cycle — the dream stage of sleep — which may affect their behavior. If you have a child who is hyperactive and snores or who has trouble sleeping, a pediatric sleep specialist, an ENT doctor, or both may be able to help.

As many as one in three children with ADHD also have other psychological or developmental conditions, including:

• Oppositional defiant disorder (ODD). Generally defined as a pattern of negative, defiant and hostile behavior toward authority figures, ODD tends to occur more frequently in children who are impulsive and hyperactive and is especially common in boys.

• Conduct disorder. A more serious condition than ODD, conduct disorder is marked by distinctly antisocial behavior: stealing, fighting, destroying property, harming people and animals. Children with conduct disorder need immediate help.
• Depression. Depression may occur in both children and adults with ADHD. It's more likely to appear when there is a family history of depression.

• Anxiety disorders. Anxiety disorders tend to occur fairly often in children with ADHD and may cause overwhelming worry and nervousness as well as physical signs and symptoms, such as a rapid heartbeat, sweating and dizziness. Although anxiety disorders can cause severe symptoms, most people can be helped with therapy or medication. Once anxiety is under control, children are better able to deal with the problems arising from ADHD.
• Learning disabilities. Children with both ADHD and learning disabilities are the children most in need of special education services.
• Tourette's syndrome. Many children with ADHD are at increased risk of Tourette's syndrome, a neurological disorder characterized by compulsive muscular or vocal tics.

Other difficulties
In addition to conditions that may occur with ADHD, the disorder itself can make life difficult for both children and adults. Children often struggle in the classroom, which can lead to academic failure and ridicule from both other children and adults. Although ADHD doesn't affect intelligence, the majority of ADHD children are underachievers in school and many have been held back at least one grade. They are also more likely to drop out of school than are children who don't have ADHD. These problems are likely related to poor organizational skills, lack of attention and hyperactivity. As a result, children with ADHD often endure an ongoing cycle of ostracism and punishment for behavior they can't control.

In addition, children with ADHD are much more likely to experience minor trauma, such as fractures and lacerations, than are other children. And teenagers and adults with the disorder are far more likely to be involved in car accidents. In fact, people with ADHD tend to have more accidents and injuries of all kinds than do those who don't have the disorder.

ADHD has been associated with an increased risk of alcohol and drug abuse and delinquency. Some studies suggest that this is more likely to occur in people who have emotional problems in addition to ADHD.

Adults with ADHD are at increased risk of marital stress and divorce. Often, these adults didn't have the condition diagnosed during childhood and may have spent their lives struggling to understand their own behavior. In fact, many adults don't realize they have ADHD until a child or grandchild receives a diagnosis of the condition.

Optimal treatment for ADHD is a matter of intense debate. Current treatments typically involve therapy, medication or both.

Therapy
Children and adults with ADHD often greatly benefit from counseling or behavior therapy, which may be provided by a psychiatrist, psychologist, social worker or other mental health care professional. Some people with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.

Counseling therapies may include:

• Psychotherapy. This allows older children and adults with ADHD to talk about issues that bother them, explore negative behavioral patterns and learn ways to deal with their symptoms.
• Behavior therapy. This type of therapy helps teachers and parents learn strategies (contingency management procedures) for dealing with children's behavior. These strategies may include token reward systems and timeouts. Behavior modification using contingency management techniques has proved especially beneficial for people with ADHD.
• Family therapy. Family therapy can help parents and siblings deal with the stress of living with a child who has ADHD.
• Social skills training. This can help children learn appropriate social behaviors.
• Support groups.Support groups can offer adults and children with ADHD and their parents a network of social support, information and education.
• Parenting skills training. This can help parents develop ways to understand and guide their child's behavior.

The best results usually occur when a team approach is used, with teachers, parents, and therapists or physicians working together. You can help by making every effort to work with your child's teachers and by referring them to reliable sources of information to support their efforts in the classroom.

Medications
Drugs known as psychostimulants are the most commonly prescribed medications for treating ADHD in children and adults. Sometimes antidepressants may also be used — especially for adults and for children who don't respond to stimulants or who are depressed or have other problems.

Although scientists don't understand exactly why these drugs work, stimulants appear to boost and balance levels of the brain chemicals dopamine, which is associated with activity, and serotonin, which is associated with a sense of well-being. Methylphenidate (Ritalin, Concerta), the primary medication used to treat ADHD, seems to increase levels of dopamine in the brain by blocking the activity of dopamine transporters, which remove dopamine after it has been released. Besides methylphenidate, ADHD medications include d- and l-amphetamine racemic mixture (Adderall), dextroamphetamine (Dexedrine) and the nonstimulant drug atomoxetine (Strattera).

All these medications may help alleviate the core symptoms of inattention and hyperactivity — sometimes dramatically. But drugs don't address other problems, such as lack of academic achievement, poor social skills or conflict at home. In addition, some doctors question giving stimulants to young children, especially when no studies have been done to determine the long-term safety of these drugs.

The number of children treated with psychostimulants has increased dramatically in recent years. Many of those children are very young — between 2 and 4 years of age. Yet studies have shown that without behavior therapy and educational services, medication alone isn't likely to be effective in improving a child's long-term outcome.

Side effects in children
The most common side effects of psychostimulants in children include decreased appetite, corresponding weight loss, nervousness and problems sleeping. Some children experience irritability or increased activity as the effect of the medication tapers off. Adjustments in doses can often offset these side effects.

A small percentage of children may develop jerky muscle movements, such as grimaces or twitches (tics), but these usually disappear when the dose of medication is lowered. Ritalin also may be associated with a slightly reduced growth rate in children, although in most cases growth isn't permanently affected.

Strattera has been linked to side effects that include rare liver problems. If your child is taking Strattera and develops yellow skin (jaundice), dark-colored urine or unexplained flu symptoms, contact your doctor right away. In September 2005, the U.S. Food and Drug Administration (FDA) issued a public health warning to doctors about the risk of suicidal thinking in children and adolescents being treated with Strattera. The FDA urged doctors to closely observe pediatric patients being treated with Strattera for signs such as "agitation, irritability, suicidal thinking or behaviors, and unusual changes in behavior."

Adderall has raised concerns because of reports of sudden unexplained deaths in children taking the medication. Canada suspended sales of Adderall XR in February 2005. In the United States, the FDA is evaluating the drug.

Parents also are understandably concerned about psychostimulants — which are similar to amphetamines — and the risk of addiction. But dependence hasn't been reported in children who take medications orally and at the proper dosage. That's because drug levels in the brain rise too slowly to produce a "high." On the other hand, reported abuse of ADHD medications by siblings and classmates of children and teenagers with ADHD is a growing problem.

Side effects in adults
In general, psychostimulant side effects in adults are similar to those in children. But ADHD drugs are also more likely to cause certain problems specifically in adults, including mild increases in blood pressure that may be significant for people who already have hypertension, and the liver disease hepatitis. In addition, because adults usually require higher dosages of these medications than children do, the risk of abuse or addiction may be greater.

Adults diagnosed with ADHD are far more likely to be given antidepressants than children are. Side effects may include dry mouth, urinary retention, weight gain, drowsiness and sexual dysfunction.

Experimental treatments
Behavior therapies and medications are the most thoroughly researched treatments for ADHD. Other approaches are being studied but are still considered to be unproven and experimental.

• Biofeedback. Ordinarily, this stress-reduction technique is used to help people learn to control certain body responses, such as heart rate and muscle tension. It has also been used with the intent of teaching adults and children with ADHD to change their brain wave patterns to more normal ones.
• Brain wave biofeedback. The goal of brain wave biofeedback (Neurobiofeedback) is to teach people to control their own brain wave patterns using electroencephalography (EEG) feedback. EEG measures the waves of electrical activity of the brain. A variation on this technique, developed by NASA, blends biofeedback with video games.
• Special diets and supplements. Over the years, a great deal of media attention has focused on diets for ADHD. Most diets involve eliminating additives and foods thought to increase hyperactivity, such as sugar and caffeine, and common allergens such as wheat, milk and eggs. So far, however, studies haven't found a consistent link between diet and improved symptoms of ADHD. If you think certain foods affect your child's behavior, however, try eliminating them for a time.

Because ADHD is a complex disorder and each person with ADHD is unique, it's hard to make recommendations that are right for every child or adult. But some of the following suggestions may help:

Children at home

• Show your child lots of affection. Children need to hear that they're loved and appreciated. Focusing only on the negative aspects of your child's behavior can harm your relationship with him or her and affect self-confidence and self-esteem. If your child has a hard time accepting verbal signs of affection, a smile, a pat on the shoulder or a hug can show you care.
• Be patient. Try to remain patient and calm when dealing with your child, even when your child is out of control. If you're calm, your child is more likely to calm down too.
• Keep things in perspective. Be realistic in your expectations for improvement — both your own and your child's.
• Take time to enjoy your child. Make an effort to accept and appreciate the parts of your child's personality that aren't so difficult. One of the best ways to do this is simply to spend time together. This should be a private time when no other children or adults interfere. Try to give your child more positive than negative attention every day.
• Try to keep a regular schedule for meals, naps and bedtime. Use a big calendar to mark special activities that will be coming up. Children with ADHD have a hard time accepting and adjusting to change.
• Make sure your child is rested. Try to keep your child from becoming overtired, because fatigue often makes symptoms of ADHD worse.
• Identify difficult situations. Try to avoid situations that are difficult for your child, such as sitting through long presentations or shopping in malls and supermarkets where the array of merchandise can be overwhelming.
• Use timeouts or the loss of a privilege to discipline your child. For children with ADHD, a timeout from social stimulation can be very effective. Timeouts should be relatively brief, but long enough for your child to regain control. The idea is to interrupt and defuse out-of-control behavior. A timeout doesn't work for everything, but many parents have found that it's one of the best tools for managing the behavior of an overactive or impulsive child.
• Work on organization. Help your child organize and maintain a daily assignment notebook and be sure your child has a quiet place to study.
• Find ways to enhance your child's self-esteem and sense of discipline. Children with ADHD often do very well with art projects, music or dance lessons, or martial arts classes, especially karate or tae kwon do. But don't force children into activities that are beyond their abilities.
• Use simple words and demonstrate when giving your child directions. Speak slowly and quietly and be very specific and concrete. Give one direction at a time.
• Take a break yourself. If you're exhausted and stressed, you're a much less effective parent.

Children in school

• Ask about school programs. Take advantage of any special programs your school may have for children with ADHD.
• Talk to your child's teachers. Stay in close communication with your child's teachers, and support their efforts to help your child in the classroom. Be sure teachers closely monitor your child's work, provide positive feedback and are flexible and patient. They should also be very clear about their instructions and expectations.
• Ask about having your child use a computer in the classroom. Children with ADHD often have trouble with handwriting and can greatly benefit from using a computer or a typewriter.

Medications

• Administer medications carefully to children and teenagers. They shouldn't be in charge of their own medicine.
• At home, keep medication locked in a childproof container. Psychostimulant drugs are nervous system stimulants. An overdose can cause severe confusion, agitation, an accelerated heart rate and is potentially fatal. Children age 5 and younger are especially sensitive to drug overdoses.
• Don't send supplies of medication to school with your child. Deliver any medicine yourself to the school nurse or health office.
• Talk to your child about his or her medications. Make sure your children understand that it's not OK to give or sell medication to others. Ask them to tell you right away if classmates pressure or threaten them.

Adults in the workplace

• Choose work that uses your strengths. If you're creative, high energy and intelligent, avoid jobs that are dull or detail oriented.
• Ask your boss to repeat instructions rather than guess at what is meant.
• Try to work at home, at least part time.
• Ask for a private office. If that's not possible, work in a quiet area and use headphones to muffle noise. Arriving before most of your co-workers can also help reduce distractions.
• Work on more than one project at a time. When you get bored with one, switch to the other.
• Work on boring tasks when you feel most alert.
• Break up big jobs into smaller tasks.
• Use deadlines for structure.
• Make lists of things to do and use them to prioritize your day.
• Use a day planner and to-do lists. Post notes for yourself.
• Ask your secretary or office assistant to help with details.

Adult relationships
The behavior of many adults diagnosed with ADHD can be unpredictable and sometimes difficult. Forgotten appointments, missed deadlines, impulsive or irrational decisions, and angry outbursts can strain the patience of the most forgiving co-worker, friend or partner.

Therapy that focuses on these issues and helps adults better monitor their own behavior can be extremely helpful. So can classes to improve communication skills, conflict resolution and problem solving. Couples therapy and classes in which family members learn more about ADHD can sometimes significantly improve relationships.

Caring for a child with ADHD can be challenging for the whole family. Parents may be hurt by their child's behavior as well as by the way other people respond to it. And the stress of dealing with ADHD can sometimes lead to marital stress and even divorce. These problems may be compounded by the financial burden that ADHD can place on families.

Siblings of an ADHD child also may have special difficulties. They can be affected by a brother or sister with ADHD who is demanding or aggressive, and they may also receive less attention because the ADHD child requires so much of a parent's time.

Resources
There are no easy answers for struggling families, but many resources are available that may help. Parents can get advice on raising a child with ADHD from a social worker or other mental health care professional or from a support group. Support groups don't appeal to everyone, but they often can provide excellent information about coping with ADHD from people who know.

There are also excellent books and guides for both parents and teachers, and Internet sites dealing exclusively with ADHD.

Techniques for coping
Many parents notice patterns in their children's behavior as well as in their own responses to that behavior. For instance, your child might throw a tantrum every night before dinner, and you might routinely give him or her a snack so you can finish preparing the meal in peace. Although you don't mean to, you end up encouraging your child's behavior. Both you and your child need to act differently. But substituting new habits for old ones isn't easy — it takes real awareness and a lot of hard work.

You can help make change easier by ensuring that your child has the right kind of structure. For children with ADHD, structure doesn't mean rigidity or iron discipline. Instead, it means arranging things so that a child's life is as predictable, calm and organized as possible. Children with ADHD don't handle change well, and having predictable routines can make them feel safe as well as help improve behavior.

It's also important to have realistic expectations and not ask more of your child than is physically or mentally possible. Set small goals for both yourself and your child and don't try to make a lot of changes all at once.

How to provide positive reinforcement
One of the best ways to instill new habits is to provide firm, loving discipline that rewards good behavior and discourages destructive actions. Children with ADHD usually respond well to positive reinforcement, as long as it's genuinely earned. It's best to start by rewarding or reinforcing a new behavior every time it occurs. After a short time, this probably won't be necessary, but you need to continue to let your child know that you're serious about encouraging new habits.

Rewards can lose their effectiveness when they're overused. Instead of always offering food treats, for instance, try using a special privilege, such as staying up an extra half-hour or playing a favorite game, as a prize. Don't promise a reward and then not follow through. This defeats the purpose of rewarding good behavior and can be extremely frustrating for your child.

Some parents object to rewards because they seem like bribery. But changing old habits is extremely hard, and rewards are simply a concrete way of recognizing your child's efforts.

Stay calm and set a good example
You also need to set a good example by acting the way you want your child to act. Try to remain patient and in control — even when your child is out of control. If you speak quietly and calmly, your child is more likely to calm down, too.

Finally, the relationship among all the family members plays a large part in managing or changing the behavior of a child with ADHD. Couples who have a strong bond often find it easier to face the challenges of parenting than do those whose bond isn't as strong. That's one reason it's important for partners to take time to nurture their own relationship.

If you're the parent of a child with ADHD, be sure to give yourself a break now and then. Don't feel guilty for spending a few hours apart from your child. You'll be a better parent if you're rested and relaxed. And don't hesitate to ask friends, grandparents and other relatives for help.