The treatment of Attention Deficit Disorder (ADD) begins with hope. Most people who discover they have ADD, whether they be children or adults, have suffered a great deal of pain. The emotional experience of ADD is filled with embarrassment, humiliation, and self castigation. By the time the diagnosis is made, many people with ADD have lost confidence in themselves. Many have been misunderstood repeatedly. Many have consulted with numerous specialists, only to find no real help. As a result, many have lost hope.

The most important step at the beginning of treatment is to instill hope once again. Individuals with ADD may have forgotten what is good about themselves. They may have lost, long ago, any sense of the possibility of things working out. They are often locked in a kind of tenacious holding pattern, bringing all theory, considerable resiliency, and ingenuity just to keeping their heads above water. It is a tragic loss, the giving up on life too soon. But many people with ADD have seen no other way than repeated failures. To hope, for them, is only to risk getting knocked down once more.

And yet, their capacity to hope and to dream is immense. More than most people, individuals with ADD have visionary imaginations. They think big thoughts and dream big dreams. They can take the smallest opportunity and imagine turning it into a major break. They can take a chance encounter and turn it into a grand evening out. They thrive on dreams, and they need organizing methods to make sense of things and keep them on track.

But like most dreamers, they go limp when the dream collapses. Usually, by the time the diagnosis of ADD has been made, this collapse has happened often enough to leave them wary of hoping again. The little child would rather stay silent than risk being taunted once again. The adult would rather keep his mouth shut than risk flubbing things up once more. The treatment, then, must begin with hope. We break down the treatment of ADD into five basis areas:

1. Diagnosis
2. Education
3. Structure, support, and coaching
4. Various forms of psychotherapy
5. Medication

In this article we will outline some general principles that apply both to children and adults concerning the non-medication aspects of the treatment of ADD. One way to organize the non-medication treatment of ADD is through practical suggestions.

50 TIPS INSIGHT AND EDUCATION:

1. Be sure of the diagnosis. Make sure you're working with a professional who really understands ADD and has excluded related or similar conditions such as anxiety states, agitated depression, hyperthyroidism, manic depressive illness, or obsessive compulsive disorder.
   
   
2. Educate yourself. Perhaps the single most powerful treatment for ADD is understanding ADD in the first place. Read books. Talk with professionals. Talk with other adults who have ADD. You'll be able to design your own treatment to your own version of ADD.
   
   
3. Coaching. It is useful for you to have a coach, for some person near to you to keep after you in a supportive way. Your coach can help you get organized, stay on task, give you encouragement, or remind you to get back to work. Friend, colleague, or therapist (it is possible, but risky for your coach to be your spouse), a coach is someone to stay on you to get things done, exhort you as coaches do, keep tabs on you, and in general be in your corner, on your side. A coach can be tremendously helpful in treating ADD.
   
   
4. Encouragement. ADD adults need lots of encouragement. This is in part due to their having many self-doubts that have accumulated over the years. But it goes beyond that. More than the average person, the ADD adult withers without encouragement and positively thrives when given it. The ADD adult will often work for another person in a way he won't work for himself. This is not "bad," it just is. It should be recognized and taken advantage of.
   
   
5. Realize what ADD is NOT, i.e., conflict with mother, etc.
   
   
6. Educate and involve others. Just as it is key for you to understand ADD, it is equally, if not more important, for those around you to understand it--family, friends, people at work or at school. Once they get the concept they will be able to understand you much better and to help you out as well. It is particularly helpful if your boss can be aware of the kinds of structures that help people with ADD.
   
   
7. Give up guilt over high-stimulus seeking behavior. Understand that you are drawn to high stimuli. Try to choose them wisely, rather than brooding over the "bad" ones.
   
   
8. Listen to feedback from trusted others. Adults (and children, too) with ADD are notoriously poor self observers. They use a lot of what can appear to be denial.
   
   
9. Consider joining or starting a support group. Much of the most useful information about ADD has not yet found its way into books but remains stored in the minds of the people who have ADD. In groups this information can come out. Plus, groups are really helpful in giving the kind of support that is so badly needed.
   
   
10. Try to get rid of the negativity that may have infested your system if you have lived for years without knowing what you had was ADD. A good psychotherapist may help in this regard. Learn to break the tapes of negativity that can play relentlessly in the ADD mind.
    
    
11. Don't feel chained to conventional careers or conventional ways of coping. Give yourself permission to be yourself. Give up trying to be the person you always thought you should be -- the model student or the organized executive, for example--and let yourself be who you are.
    
    
12. Remember that what you have is a neurological condition. It is genetically transmitted. It is caused by biology, by how your brain is wired. It is NOT a disease of the will, nor a moral failing. It is NOT caused by a weakness in character, nor by a failure to mature. It's cure is not to be found in the power of the will, nor in punishment, nor in sacrifice, nor in pain. ALWAYS REMEMBER THIS. Try as they might, many people with ADD have great trouble accepting the syndrome as being rooted in biology rather than weakness of character.
    
    
13. Try to help others with ADD. You'll learn a lot about the condition in the process, as well as feel good to boot.

Performance Management

1. External structure. Structure is the hallmark of the non-pharmacological treatment of the ADD child. It can be like the walls of the bobsled slide, keeping the speedball sled from careening off the track. Make frequent use of:
   1) notes to self - 2) color coding - 3) rituals - 4) lists - 5) reminders - 6) files

2. Color coding. Mentioned above, color coding deserves emphasis. Many people with ADD are visually oriented. Take advantage of this by making things memorable with color: files, memoranda, texts, schedules, etc. Virtually anything in the black and white of type can be made more memorable, arresting, and therefore attention-getting with color.

3. Use pizzazz. In keeping with #15, try to make your environment as peppy as you want it to be without letting it boil over.

4. Set up your environment to reward rather than deflate. To understand what a deflating environment is, all most adult ADDers need do is think back to school. Now that you have the freedom of adulthood, try to set things up so that you will not constantly be reminded of your limitations.

5. Acknowledge and anticipate the inevitable collapse of x% of projects undertaken, relationships entered into obligations incurred.

6. Embrace challenges. ADD people thrive with many challenges. As long as you know they won't all pan out, as long as you don't get too perfectionistic and fussy, you'll get a lot done and stay out of trouble.

7. Make deadlines. Think of deadlines as motivational devices rather than echoes of doom. If it helps, call them lifelines, instead of deadlines. In any case, make them and stick to them.

8. Break down large tasks into small ones. Attach deadlines to the small parts. Then, like magic, the large task will get done. This is one of the simplest and most powerful of all structuring devices. Often a large task will feel overwhelming to the person with ADD. The mere thought of trying to perform the task makes one turn away. On the other hand, if the large task is broken down into small parts, each component may feel quite manageable.

9. Prioritize. Avoid procrastination. When things get busy, the adult ADD person loses perspective: paying an unpaid parking ticket can feel as pressing as putting out the fire that just got started in the wastebasket. Prioritize. Take a deep breath. Put first things first. Procrastination is one of the hallmarks of adult ADD. You have to really discipline yourself to watch out for it and avoid it.

10. Accept fear of things going too well, accept edginess when things are too easy, when there's no conflict. Don't gum things up, just to make them more stimulating.

11. Notice how and where you work best: in a noisy room, on the train, wrapped in three blankets, listening to music, whatever. Children and adults with ADD can do their best under rather odd conditions. Let yourself work under whatever conditions are best for you.

12. Know that it is O.K. to do two things at once: carry on a conversation and knit, or take a shower and do your best thinking, or jog and plan a business meeting. Often people with ADD need to be doing several things at once in order to get anything done at all.

13. Do what you're good at. Again, if it seems easy, that is O.K. There is no rule that says you can only do what you're bad at. Do what you're good at. Again, if it seems easy, that is O.K. There is no rule that says you can only do what you're bad at.

14. Leave time between engagements to gather your thoughts. Transitions are difficult for ADDers, and mini-breaks can help ease the transition.

15. Keep a notepad in your car, by your bed, and in your pocketbook or jacket. You never know when a good idea will hit you, or you'll want to remember something else.

16. Read with a pen in hand, not only for marginal notes or underlining, but for the inevitable cascade of "other" thoughts that will occur to you.

Mood Management:

1. Have structured "blow-out" time. Set aside some time in every week for just letting go. Whatever you like to do -- blasting yourself with loud music, taking a trip to the race track, having a feast -- pick some kind of activity from time to time where you can let loose in a safe way.

2. Recharge your batteries. Related to #30 most adults with ADD need feeling guilty about it. One guilt-free way to conceptualize it is to call it time to recharge your batteries. Take a nap, watch TV, meditate. Some-thing calm, restful, at ease.

3. Choose "good," helpful addictions such as exercise. Many adults with ADD have an addictive or compulsive personality such that they are always hooked on something. Try to make this something positive.

4. Understand mood changes and ways to manage these. Know that your moods will change willy-nilly, independent of what's going on in the external world. Don't waste your time ferreting out the reason why or looking for someone to blame. Focus rather on learning to tolerate a bad mood, knowing that it will pass, and learning strategies to make it pass sooner. Changing sets, i.e. getting involved with some new activity (preferably interactive) such as a conversation with a friend or a tennis game or reading a book will often help.

5. Related to #33, recognize the following cycle which is very common among adults with ADD: Something "startles" your psychological system, a change or transition, a disappointment or even a success. The precipitant may be quite trivia. b. This "startle" is followed by a mini-panic with a sudden loss of perspective, the world being set topsy-turvy. c. You try to deal with this panic by falling into a mode of obsessing and ruminating over one or another aspect of the situation. This can last for hours, days, even months.

6. Plan scenarios to deal with the inevitable blahs. Have a list of friends to call. Have a few videos that always engross you and get your mind off things. Have ready access to exercise. Have a punching bag or pillow handy if there's extra angry energy. Rehearse a few pep talks you can give yourself, like, ''You've been here before. These are the ADD blues. They will soon pass. You are OK."

7. Expect depression after success. People with ADD commonly complain of feeling depressed, paradoxically, after a big success. This is because the high stimulus of the chase or the challenge or the preparation is over. The deed is done. Win or lose, the adult with ADD misses the conflict, the high stimulus, and feels depressed.

8. Learn symbols, slogans, sayings as shorthand ways of labeling and quickly putting into perspective slip ups, mistakes, or mood swings. When you turn left instead of right and take your family on a 20-minute detour, it is better to be able to say, "There goes my ADD again," than to have a 6-hour fight over your unconscious desire to sabotage the whole trip. These are not excuses. You still have to take responsibility for your actions. It is just good to know where your actions are coming from and where they're not.

9. Use "time-outs" as with children. When you are upset or over stimulated, take a time-out. Go away. Calm down.

10. Learn how to advocate for yourself. Adults with ADD are so used to being criticized, they are often unnecessarily defensive in putting their own case forward. Learn to get off the defensive.

11. Avoid premature closure of a project, a conflict, a deal, or a conversation. Don't "cut to the chase'' too soon, even though you're itching to.

12. Try to let the successful moment last and be remembered, become sustaining over time. You'll have to consciously and deliberately train yourself to do this because you'll just as soon forget.

13. Remember that ADD usually includes a tendency to over focus or hyper focus at times. This hyper focusing can be used constructively or destructively. Be aware of its destructive use: a tendency to obsess or ruminate over some imagined problem without being able to let it go.

14. Exercise vigorously and regularly. You should schedule this into Your life and stick with it. Exercise is positively one of the best treatments for ADD. It helps work off excess energy and aggression in a positive way, it allows for noise-reduction within the mind, it stimulates the hormonal and neurochemical system in a most therapeutic way, and it soothes and calms the body. When you add all that to the well-known health bene- fits of exercise, you can see how important exercise is. Make it something fun so you can stick with it over the long haul, i.e. the rest of you life.

Interpersonal Life

1. Make a good choice in a significant other. Obviously this is good advice for anyone. But it is striking how the adult with ADD can thrive or flounder depending on the choice of mate.

2. Learn to joke with yourself and others about your various symptoms, from forgetfulness, to getting lost all the time, to being tactless or impulsive, whatever. If you can be relaxed about it all to have a sense of humor, others will forgive you much more.

3. Schedule activities with friends. Adhere to these schedules faithfully. It is crucial for you to keep connected to other people.

4. Find and join groups where you are liked, appreciated, understood, enjoyed. People with ADD take great strength from group support.

5. Reverse of #47. Don't stay too long where you aren't understood or appreciated. Just as people with ADD gain a great deal from supportive groups, they are particularly drained and by negative groups.

6. Pay compliments. Notice other people. In general, get social training, as from your coach.

7. Set social deadlines. Without deadlines and dates your social life can atrophy. Just as you will be helped by structuring your business week, so too you will benefit from keeping your social calendar organized. This will help you stay in touch with friends and get the kind of social support you need.

This educational material is made available, courtesy of the author and a non-profit organization based in Tacoma, WA. whose purpose is to educate adults, and the professionals who treat them, about Attention Deficit Disorder. We have numerous materials as well as a quarterly newsletter for sale. Our address is: ASW, PO Box 7804, Tacoma, WA. 98407-0804. Msg. Tel. 253-759-5085, email: addult@addult.org and web site: www.ADDult.org."

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come on now, smile :)

Every once and awhile, it's helpful to laugh at the situation you are in. After all, it's not your child's, or your fault. It just is.

You know you are the parent of an ADHD child when:

• You wake up in the morning and your heart sinks when you realize "this is not a bad dream."
• No less than 86% of your hair is completely gray...and you are only 27 years old.
• Everything in your house is either broke, or at least on it's last legs.
• You look ten years older than you actually are...through sheer exhaustion.
• You feel apprehensive eare nagging to stop at every McDonalds, garage, and sweet shop you pass. Incessantly, the chvery time you get in your car. The children are trying to climb out of the doors while the car is moving, the children keep trying to pull the handbrake on while you are driving, the childrenildren are crying again because you won't allow them to take the front dashboard off the car.
• When it gets to three p.m. - school time is over, you feel like your life has ended again for that day.
• You are often to be heard saying, "He must have picked it up in the playground," as your child demonstrates his knowledge of the latest swearword, very loudly in the middle of the shopping center.
• You know every crack in the ceiling and pattern on the walls of your child's headteacher's office because you have spent so long in there over the years.
• You know the ADHD diagnostic criteria by heart, and can recite it...backwards!

You know you are an ADD/ADHD sufferer when:

• You've lost your keys again, and that's the fifth time today!

• This is the third time this month that you've set the stove on fire because you keep forgetting you've started to cook.

• You have just read the same paragraph of the book you are reading seventeen times...and you still haven't got the gist of the story.

• You go into the other room to get something. "Now what was it ?!?!?"

• You have a cigarette in one hand and a double brandy in the other...often.

• Your TV remote handset is completely worn out from too much channel hopping.

• Waiting in this queue is driving you completely insane.

• You have just sent off your resume for a new job. The tenth new job in six months!

• You have just forgotten what you were going to say, a split second before you were going to say it.

• Your spouse tells you off again for distracting them from the telly with your finger- drumming or toe-waggling.

• You wish the person you are talking to would JUST GET TO THE POINT.

• Your darling husband asks "Was that OK for you?" and you reply "Was what OK?"

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from notes taken at a presentation by Dr. Ned Hallowell

"What's it like to have ADD? Some people say the so-called syndrome doesn't even exist, but believe me it does. Many metaphors come to mind to describe it. It's like driving in the rain with bad windshield wipers. Everything is smudged and blurred and you're speeding along, and it's frustrating and frightening not to be able to see what you're zooming past at sixty m.p.h. In other ways, it's like being supercharged all the time. You get one idea and you have to act on it, and then, what do you know, but you've got another idea before you've finished up with the first one, and so you go for that one, but of course a third idea intercepts the second, and you just have to follow that one, and pretty soon people are calling you disorganized and impulsive and all sons of impolite words that miss the point completely. Because you're trying really hard. It's just that children with ADD have all these invisible vectors pulling this way and that, which makes it really hard to stay on task."

"What is it like to have ADD? In ADD, time collapses. Someone once said, 'Time is the thinking that keeps everything from happening all at once.' Time parcels moments out into separate bits so that we can do one thing at a time. In ADD, this does not happen. Time becomes a black hole. To the person with ADD it feels as if everything is happening all at once. This creates a sense of inner turmoil or even panic. The child loses perspective and the ability to prioritize. He or she is always on the go, trying to keep the world from caving in on top."

"There is a very positive side to all this. Usually the positive doesn't get mentioned when people speak about ADD because there is a natural tendency to focus on what goes wrong or at least what has to somehow be controlled. But often once ADD has been diagnosed, and the child, with the help of teachers, parents, coaches, and even friends, has learned to cope with it, an untapped realm of the brain swims into view.

Suddenly the windshield is clear. And the child, who has been such a problem, such a general pain in the neck to himself and everybody else, that person starts doing things he'd never been able to do before. He surprises everyone around him, and he surprises himself" Dr. Hallowell uses the male pronoun, but it could just as easily be she.

Dr. Hallowell says "ADD people are highly imaginative and intuitive. They have a "feel" for things, a way of seeing right to the heart of matters while others have to reason their way along methodically. This is the child who can't explain how he thought of the solution, or where the idea for the story came from, or why suddenly he produced a painting, or how he knew the short cut to the answer, but all he can say is, he just knew it, he could feel it. This is the man or woman who makes million dollar deals in catnip and pulls them off the next day. This is the child who, having been reprimanded for blurting something out, is then praised for having blurted out something brilliant. These are the children who learn and know what to do and go by touch and feel."

"These people can feel a lot. In places where most of us are blind, they can, if not see the light, at least feel the light, and they can produce answers apparently out of the dark. It is important for others to be sensitive to this 'sixth sense' many ADD people have, and to nurture it. If the environment insists on rational, linear thinking and good behavior from these kids all the time, then they may never develop their intuitive style to the point where they can use it profitably. It can be exasperating to listen to these children talk. They can sound so vague and rambling. But if you take them seriously and grope along with them, often you will find they are on the brink of startling conclusions or surprising solutions."

"Their cognitive style is qualitatively different from most people's and what at first may seem impaired, with patience and encouragement may become gifted."

"The thing to remember is that if the diagnosis can be made, then most of the bad stuff associated with ADD can be avoided or contained. The diagnosis can be liberating, particularly for people (children) who have been stuck with labels like. 'lazy, stubborn, willful, disruptive, impossible, tyrannical, a spaceshot, stupid, or just plain bad.' Making the diagnosis of ADD can take the case from the court of moral judgment to the clinic of neuropsychiatric treatment."

"What is the treatment all about? Anything that turns down the noise. Just making the diagnosis helps turn down the noise of guilt and self-recrimination. Building certain kinds of structure into one's life can help a lot. Working in small spurts rather than long hauls; Breaking down tasks into smaller tasks; Getting extra help. Medication can help too, but it is far from the whole solution."

Hallowell spoke about ADD children having the ability to "hyper-focus" and actually be able to excel at tasks much of the time with the help of a patient person on their side. He spoke about growing up in Chatham on the Cape [Cod] with a special elementary school teacher, in the early 60's. "She took me by her side and kept my attention by being a 'good coach.' She gave me encouragement at every wrong turn." Hallowell has gone on to be on the staff at Harvard Medical School and he has a successful medical practice in Cambridge. MA.

Dr. Hallowell concluded with this thought: "We need your help and understanding. We make mess-piles wherever we go, but with your help, those mess-piles can be turned into realms of reason and art. So, if you know someone like me who's acting up and daydreaming and forgetting this or that and just not getting with the program, consider ADD before he starts believing all the bad things people are saying about him and it's too late."

Ed Note: This is a summary of a talk given by Ned Hallowell, M.D. of Harvard Medical School to a local chapter of CH.A.D.D (Children and Adults with ADD) in February of 1993. Many thanks to Carson Graves for preparing this transcription and permitting its distribution. This summary is taken from the newsletter of the Concord Special Education Parent Advisory Council which encourages readers to share its contents with others. Address: P.O. Box 274 Cocord, MA 01742

This article appeared in the Spring '97 GRADDA Newsletter. The Greater Rochester Attention Deficit Disorder Association. PO Box 23565, Rochester, New York 14692-3565. e-mail us at gradda@net2.netacc.net

Thanks to Dick Smith of GRADDA and the authors for permission to reproduce this article.

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We:

• Are highly motivated, persistent, and stimulated by many of the intellectual challenges, which are beyond the average person.

• Can be spontaneous, imaginative, creative, a little eccentric and able to express ourselves in the most unique ways.

• Make great scientists, artists, actors and entrepreneurs.

• Are often bursting with high energy and able to meet and beat challenges with zeal.

• Become stimulated by intrigue and inspired by the novelty involved in change.

• Can be keen observers, with an ability to find quick solutions to situations many mere mortals find complicated.

• Are very resourceful, and can devise ingenious means of accomplishing things.

• Think laterally and solve problems in very distinctive ways.

• Can juggle many balls in the air at once, and think about lots of different things at the same time.

• Are humorous, often with a keen wit and an ability or talent to make others laugh too.

• Can be extremely diligent with a never-say-die approach to life's problems.

• Are not afraid to take risks, often seeing risk-taking as a form of stimulation.

And our children, can be kind, thoughtful and often enjoy doing things for other people.

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It is generally believed now that there is a strong genetic connection of ADD and ADHD in families. Therefore, if one or more children are diagnosed in a family, then there is a good chance that at least one of the parents will exhibit symptoms also. With this connection in evidence it is inevitable that many adults (with ADD or ADHD) will find themselves raising a child who also suffers. Many of these ADD parents raising ADD kids were themselves brought up by one or more ADD parents! These grandparents and parents would more than likely have been undiagnosed and therefore treated.

Awareness of ADD and ADHD is only in the early stages, so for many children in Britain today, getting help and/or treatment is still a lottery. Unfortunately for us, because of the way ADD is perceived, many of our professionals are not yet taking on board that the cycle goes in both directions. It has been shown that ADD families have higher divorce rates, many ADD and ADHD children have been adopted, rates for domestic violence are higher, many of these children are taken into care for either abuse or perceived abuse and so on, so considering this long line of untreated ADD running through families, is it any wonder that many parents have difficulties?

So what can we do to improve things? First of all realize how our ADD affects our way of parenting. We know that these children do best in a structured environment .... which is totally the opposite to the way many of us live! This lack of structure does nothing to help the child who needs to know what he is supposed to be doing at all times. What an ADD adult may well regard as spontaneity, an ADD child may interpret as uncertainty or unpredictability. What about our impulsive natures? Do we often over react just like our children? Think about it. Perhaps your child may feel that he or she cannot depend on you for firm boundaries and consistent support.

Our ADD kids needs structure, structure and more structure, masses of support and a stable environment. Without these, they are being set up to fail, regardless of any medication they might be taking. The unfortunate thing is, that ADD adults often have difficulty providing this type of environment. How can we therefore parent these children in a more effective way? Well, for a start it is important to remember that the parent is the parent and the child is the child. As the adult in the relationship the responsibility must be with us at all times. We must keep control of situations, have the confidence to make (and enforce) rules and have the final say in discussion. Difficult I know - my son would argue the hind legs off a donkey. What often confuses issues is the fact that many situations which cause us difficulty as parents, are brought about by the child's reaction to something we have done and this unfortunately can turn some issues into chicken and egg situations which can escalate and escalate into total chaos and anarchy if the brakes aren't applied somewhere. This has to be our job, bearing in mind an understanding of our own possible ADD.

It often helps to reflect on what has worked and what hasn't in the past. Does shouting and screaming at an already wound up ADHD child really work? It is true, we may yell because we were yelled at as children, or we may have been driven to near distraction by the child's antics on a particular day, or because it is in our temperamental make up too. But if it has little or no effect on the child why continue to yell?

Sometimes, adding humor to a situation helps. I am confident enough by now, through knowing all about ADHD and by being able to understand how my son ticks, to turn difficult situations into jokes. Yes it is frustrating when your 12 year old sprinkles talcum all over YOUR bedroom floor, but getting him to vacuum it up (even after extended tantrumming) saying "This will stand you in good stead for when you get your own place son" wink, wink will make you feel better and also make him feel not as bad about his behavior.

So, simply put, often all that is needed is the belief in your own methods and the confidence to carry things out. This can be very difficult, especially if your parenting skills have been brought into question at any time, and your personality is such that you behave rather as your child does at times! But remember, parents of ADD and ADHD children do a more than excellent job under extremely difficult circumstances. Added to this may be the knock-on effects of their own ADD.

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Often parents have a difficult time getting an answer as to what is causing their children's inexplicable behavior. Over time, they may visit pediatricians, psychiatrists, clinical and educational psychologists and general practitioners. In many cases, parents find out through their own research, as I did, what is ailing their children. This is not the end of the road, however. Often it is the start of a new one. After all that, parents then have the difficult task of getting a firm diagnosis for their children.

Children who have displayed challenging behavior from a very young age could be suffering from Attention Deficit Hyperactivity Disorder (ADHD). On the other hand, it's important to keep in mind, your child may have a different disorder, for example, Asperger Syndrome, Conduct Disorder or Dyslexia. In any case, in order for these children to get the most appropriate medical, educational and managerial accommodations possible, they need some sort of diagnosis.

Here though, highlights the issue of whether or not to 'label' children who suffer from this range of childhood conditions. During my time manning the ADHD support group telephone helpline, I repeatedly encountered the frustration of parents whose children were left in diagnostic limbo, so to speak. Here in Britain, this was evident on a large scale.

Many was the time a parent would say to me that their specialist didn't want to 'put a label' on what was ailing their child (ren). Although one can see that labeling could bring into effect self-fulfilling prophesy in some cases, surely children who are obviously ill or disordered NEED a label (or diagnosis) to give a framework to the outside world of what would be expected of them.

Personally, I have had to fight tooth and nail to get 'labels' for my child. To have my child diagnosed the first time, I had to travel outside my community. However after coming back under the same authority recently, I have again had to cause waves to get in writing that my son also has Asperger syndrome (high-functioning autism). My specialists, in turn, have gotten frustrated with me because I HAVE to know what is the matter with my son, but I say this:

• Without a proper 'reason' for a child's difficulties, a parent cannot go through the necessary grieving process enabling them to come to terms and go forward.
• Diagnosed children get far more educational, medical and social accommodations that they are entitled to, than the child who does not have this so-called 'label'.
• Children without diagnoses, or with wrong ones, simply do not have their educational or medical assistance tailored exactly to their needs. What use is it for a child with Aspergers, whose most profound difficulty may be in comprehending everyday social situations, to have a statement of special needs which focuses mainly on his handwriting difficulties, when the help which is available would be much better utilized addressing the most acute presenting problems.
• A parent needs to KNOW, in order to move on. In simple terms, once a diagnosis has been made the parent can then educate him or herself all about the condition in question and how best to deal with situations which arise.

British professionals must somehow be made to see how this 'label' moves a situation on. In many other countries parents don't have this difficulty. Here parents often wait many, many years for such a label, which never comes. These are the parents whose children are excluded from school, who have dropped out of school because of underachievement, who are depressed, maybe unemployed, possibly abusing alcohol or substances...or even dead. So please, all you British professionals out there, never be afraid to label a child. You might just save their life.

So, what should a parent do if they are having difficulty getting a firm diagnosis? Well here are a few suggestions which might just help when you next see a specialist:

1. Go along and make it quite clear that you feel your child is suffering from ADD or ADHD. Try to get documentary evidence from school, in the form of report cards, behavior tick charts or letters, etc. If you have school reports outlining the particular difficulties, all the better.

2. If possible try to fill in a diagnostic criteria before you attend the appointment, otherwise you are wasting time. (Time your child hasn't got to waste). If you have any books or information leaflets referring to the behaviors your child shows, highlight them with a felt pen, and be insistent.

3. Make sure your specialist knows about these kinds of disorders. You need to be seeing a pediatrician or possibly a psychiatrist for initial diagnosis. It is no good if you have to wait months for your appointment if your child is going to be assessed by a drama therapist or practice nurse! (It does happen!) Before you agree to an appointment with this person find out what experience they have in ADD or ADHD. Ask which diagnostic tools they will be using.

4. If the secretary, or even the practitioner hasn't a clue what you are talking about, ask to be referred to someone who does. Be insistent. Also ask whether they are prepared to prescribe appropriate stimulant (or other appropriate) medication. Again, if not, ask to be referred to an experienced pediatrician who will. If they do not know of anyone to refer you to, ring your local Support Group who will be able to tell you the name of your nearest ADHD specialist.

5. Then, tell who you would have been seeing that you will be writing a letter to the health trust (or local medical board) voicing your concern about their lack of knowledge in dealing with the problem of ADD.

6. If you do get to see someone who does know a bit about ADD and ADHD, but who is reluctant to diagnose either way, ask IN WRITING why they think your child DOES NOT fulfill the criteria for ADD/ADHD.

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Teachers know what many professionals do not: that there is no one syndrome of ADD (Attention Deficit Disorder) but many; that ADD rarely occurs in "pure" form by itself, but rather it usually shows up entangled with several other problems such as learning disabilities or mood problems; that the face of ADD changes with the weather, inconstant and unpredictable; and that the treatment for ADD, despite what may be serenely elucidated in various texts, remains a task of hard work and devotion. There is no easy solution for the management of ADD in the classroom, or at home for that matter. after all is said and done, the effectiveness of any treatment for this disorder at school depends upon the knowledge and persistence of the school and the individual teacher.

Here are a few tips on the school management of the child with ADD. The following suggestions are intended for teachers in the classroom, teachers of children of all ages. Some suggestions will be obviously more appropriate for younger children, others for older, but the unifying themes of structure, education, and encouragement pertain to all.

1. First of all, make sure what you are dealing with really is ADD. It is definitely not up to the teacher to diagnose ADD,. but you can and should raise questions. Specifically, make sure someone has tested the child's hearing and vision recently, and make sure other medical problems have been ruled out. Make sure an adequate evaluation has been done. Keep questioning until you are convinced. The responsibility for seeing to all of this is the parents, not the teacher's but the teacher can support the process.

2. Second, build your support. Being a teacher in a classroom where there are two or three kids with ADD can be extremely tiring. Make sure you have the support of the school and the parents. Make sure there is a knowledgeable person with whom you can consult when you have a problem (learning specialist, child psychiatrist, social worker, school psychologist, pediatrician - the person's degree doesn't really matter. What matters is that he or she knows lots about ADD, has seen lots of kids with ADD, knows his or her way around a classroom, and can speak plainly.) Make sure the parents are working with you. Make sure your colleagues can help you out.

3. Third, know your limits. Don't be afraid to ask for help. You, as a teacher, cannot be expected to be an expert on ADD. You should feel comfortable in asking for help when you feel you need it.

4. ASK THE CHILD WHAT WILL HELP. These kids are often very intuitive. They can tell you how they can learn best if you ask them. They are often too embarrassed to volunteer the information because it can be rather eccentric. But try to sit down with the child individually and ask how he or she learns best. By far the best "expert" on the how the child learns best is the child himself or herself. It is amazing how often their opinions are ignored or not asked for. In addition, especially with older kids, make sure the child understands what ADD is. This will help both of you a lot.

Having taken 1 - 4 into account, try the following:

1. Remember that ADD kids need structure. They need their environment to structure externally what they can't structure internally on their own. Make lists. Children with ADD benefit greatly from having a table or list to refer back to when they get lost in what they're doing. They need reminders. They need previews. They need repetition. They need direction. They need limits. They need structure.
2. REMEMBER THE EMOTIONAL PART OF LEARNING. These children need special help in finding enjoyment in the classroom, mastery instead of failure and frustration, excitement instead of boredom or fear. It is essential to pay attention to the emotions involved in the learning process.
3. Post rules. Have them written down and in full view. The children will be reassured by knowing what is expected of them.
4. Repeat directions. Write down directions. Speak directions. Repeat directions. People with ADD need to hear things more than once.
5. Make frequent eye contact. You can "bring back" an ADD child with eye contact. Do it often. A glance can retrieve a child from a daydream or give permission to ask a question or just give silent reassurance.
6. Seat the ADD child near your desk or wherever you are most of the time. This helps stave off the drifting away that so bedevils these children.
7. Set limits, boundaries. This is containing and soothing, not punitive. Do it consistently, predictably, promptly, and plainly. DON'T get into complicated, lawyer-like discussions of fairness. These long discussions are just a diversion. Take charge.
8. Have as predictable a schedule as possible. Post it on the blackboard or the child's desk. Refer to it often. If you are going to vary it, as most interesting teachers do, give lots of warning and preparation. Transitions and unannounced changes are very difficult for these children. They become discombobulated around them. Take special care to prepare for transitions will in advance. Announce what is going to happen, then give repeat warnings as the time approaches.
9. Try to help the kids make their own schedules for after school in an effort to avoid one of the hallmarks of ADD: procrastination.
10. Eliminate or reduce frequency of times tests. There is no great educational value to timed tests, and they definitely do not allow many children with ADD to show what they know.
11. Allow for escape valve outlets such as leaving class for a moment. If this can be built into the rules of the classroom, it will allow the child to leave the room rather than "lose it," and in so doing begin to learn important tools of self-observation and self-modulation.
12. Go for quality rather than quantity of homework. Children with ADD often need a reduced load. As long as they are learning the concepts, they should be allowed this. They will put in the same amount of study time, just not bet buried under more than they can handle.
13. Monitor progress often. Children with ADD benefit greatly from frequent feedback. it helps keep them on track, lets them know what is expected of them and if they are meeting their goals, and can be very encouraging.

1. Break down large tasks into small tasks. This is one of the most crucial of all teaching techniques for children with ADD. Large tasks quickly overwhelm the child and he recoils with an emotional "I'll-NEVER-be-able-to-do-THAT" kind of response. By breaking the task down into manageable parts, each component looking small enough to be do-able, the child can sidestep the emotion of being overwhelmed. In general, these kids can do a lot more than they think they can. By breaking tasks down, the teacher can let the child prove this to himself or herself. With small children this can be extremely helpful in avoiding tantrums born of anticipatory frustration. And with older children it can help them avoid the defeatist attitude that so often gets in their way. And it helps in many other ways, too. You should do it all the time.
2. Let yourself be playful, have fun, be unconventional, be flamboyant. Introduce novelty into the day. People with ADD love novelty. They respond to it with enthusiasm. It helps keep attention - the kids' attention and yours as well. These children are full of life - they love to play. And above all they hate being bored. So much of their "treatment" involves boring stuff like structure, schedules, lists, and rules, you want to show them that those things do not have to go hand in hand with being a boring person, a boring teacher, or running a boring classroom. Every once in a while, if you can let yourself be a little bit silly, that will help a lot.
3. Still gain, watch out for overstimulation. Like a pot on the fire, ADD can boil over. You need to be able to reduce the heat in a hurry. The best way of dealing with chaos in the classroom is to prevent it in the first place.
4. Seek out and underscore success as much as possible. These kids live with so much failure, they need all the positive handling they can get. This point cannot be overemphasized: these children need and benefit from praise. They love encouragement. They drink it up and grow from it. And without it, they shrink and wither. Often the most devastating aspect of ADD is not the AD itself, but the secondary damage done to self-esteem. So water these children well with encouragement and praise.
5. Memory is often a problem with these kids. Teach them little tricks like mnemonics, flashcards, etc. They often have problems with what Mel Levine calls "active working memory", the space available on your minds table, so to speak. Any little tricks you can devise - cues, rhymes, codes and the like- can help a great deal to enhance memory.
6. Use outlines. Teach outlining. Teach underlining. These techniques do not come easily to children with ADD, but once they learn them the techniques can help a great deal in that they structure and shape what is being learned as it is being learned. This helps give the child a sense of mastery DURING THE LEARNING PROCESS, when he or she needs it most, rather than the dim sense of futility that is so often the defining emotion of these kids' learning process.
7. Announce what you are going to say before you say it. Say it. Then say what you have said. Since many ADD children learn better visually than by voice, if you can write what you're going to say as well as say it, that can be most helpful. This kind of structuring glues the ideas in place.
8. Simplify instructions. Simplify choices. Simplify scheduling. The simpler the verbiage the more likely it will be comprehended. And use colorful language. Like color coding, colorful language keeps attention.
9. Use feedback that helps the child become self-observant. Children with ADD tend to be poor self-observers. They often have no idea how they come across or how they have been behaving. Try to give them this information in a constructive way. Ask questions like, "Do you know what you just did?" or "How do you think you might have said that differently?" or "Why do you think that other girl looked sad when you said what you said?" Ask questions that promote self-observation.
10. Make expectations explicit.
11. A point system is a possibility as part of behavioral modification or reward system for younger children. Children with ADD respond well to rewards and incentives. Many are little entrepreneurs.
12. If the child seems has trouble reading social cues - body language, tone of voice, timing and the like - try discreetly to offer specific and explicit advice as a sort of social coaching. For example, say, "Before I tell your story, ask to hear the other person's first," or, "Look at the other person when he's talking." Many children with ADD are viewed as indifferent or selfish, when in fact they just haven't learned how to interact. This skill does not come naturally to all children, but it can be taught or coached.
13. Teach test-taking skills.
14. Make a game out of things. Motivation improves ADD.
15. Separate pairs and trios, whole clusters even, that don't do well together. You might have to try many arrangements.
16. Pay attention to connectedness. These kids need to feel engaged, connected. As long as they are engaged, they will feel motivated and be less likely to tune out.
17. Try a home-to-school home notebook. This can really help with the day-to-day parent-teacher communication and avoid the crisis meetings. It also helps with the frequent feedback these kids need.
18. Try to use daily progress reports.
19. Encourage and structure for self-reporting, self-monitoring. Brief exchanges at the end of class can help with this. Consider also timers, buzzers, etc.
20. Prepare for unstructured time. These kids need to know in advance what is going to happen so they can prepare for it internally. If the are suddenly given unstructured time, it can be over-stimulating.
21. Prepare for unstructured time. These kids need to know in advance what is going to happen so they can prepare for it internally. If they suddenly are given unstructured time, it can be over-stimulating.
22. Praise, stroke, approve, encourage, nourish.
23. With older kids, have then write little notes to themselves to remind them of their questions. In essence, they take notes not only on what is being said to them, but what they are thinking as well. This will help them listen better.
24. Handwriting is difficult for many of these children. Consider developing alternatives. Learn how to use a keyboard. Dictate. Give tests orally.
25. Be like the conductor of a symphony. Get the orchestra's attention before beginning (You may use silence, or the tapping of your baton to do this.) Keep the class "in time" , pointing to different parts of the room as you need their help.
26. When possible, arrange for student to have a "study buddy" in each subject, with phone number (adapted from Gary Smith).
27. Explain and normalize the treatment the child receives to avoid stigma.
28. Meet with parents often. Avoid pattern of just meeting around problems or crises.

1. Encourage reading aloud at home. Read aloud in class as much as possible. Use story-telling. Help the child built the skill of staying on one topic.
2. Repeat, repeat, repeat.
3. Exercise. One of the best treatments for ADD in both children and adults, is exercise, preferably vigorous exercise. Exercise helps work off excess energy, it helps focus attention, it stimulates certain hormones and neurochemicals that are beneficial, and it is fun. Make sure the exercise IS fun, so the child will continue to do it for the rest of his or her life.
4. With older children, stress preparation prior to coming into class. The better idea the child has of what will be discussed on any given day, the more likely the material will be mastered in class.
5. Always be on the lookout for sparking moments. These kids are far more talented and gifted than they often seem. They are full of creativity, play, spontaneity, and good cheer. They tend to be resilient, always bouncing back. They tend to be generous of spirit, and glad to help out. They usually have a "special something" that enhances whatever setting they're in. Remember, there is a melody inside that cacophony, a symphony yet to be written.

This article was among those given to GRADDA by Drs. Ned Hallowell and John Ratey as they were writing their now-published book, Driven To Distraction. They often appear on television, radio and at ADD conferences across the country. Dr. Ned was in Rochester as our Annual Conference speaker in 1994. Ed Note: In response to questions about developing different or separate teaching techniques for ADD children, Drs. Hallowell and Ratey note that the suggestions they've made serve ALL students although they are especially helpful for those with ADD. They do not support creation of "separate" approaches.

Thanks to Dick Smith of GRADDA and the authors for permission to reproduce this article.

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Is your family always the one at the restaurant whose little darling opens the salt shaker, spills the ketchup and trips the waiter, embarrassing you to the point that you would prefer to undergo root canal without anesthesia rather than be there? Does your tyke purposely pull out the bottom box of cereal in a supermarket display, causing you such intense embarrassment that you truly wish you could disappear? Is your precious dear always saying "NO!" to you, seemingly just to watch the color of your face change as you become increasingly enraged? Read on for some helpful information and hints.

Often, a parent contacts me frantic and exasperated. "Jill just seems to do the opposite of everything I say," or "Chris never listens. He pretends that he doesn't hear me and then does what he wants," they say. To my understanding, a "challenging" or "difficult" child is one who consistently fails to respond to or initiate an appropriately requested behavior within a few moments. While these children's behavior can indeed be difficult to deal with, it's important to keep in mind that it is the behavior and not the child, that needs to be changed. In many cases it is the parents' behavior that needs adjusting, for typically such behavioral problems arise as a result of less than ideal interactions between parent & child from an early age.

Let's take a look at what non-compliance means to different age groups. In young children (up to 10 years old), non-compliance is a way in which the child attempts to delimit interpersonal boundaries. In other words, the child is seeking to establish a sense of self as separate from those around him or her, especially the parents. What is most important is that the child perceive support for those independence-related behaviors that are appropriate. In addition, young children are testing the limits of their personal power to control their world. This is perfectly appropriate; it, too, is vital in the development of adequate self-esteem and sense of confidence.

For those older than 10 (and especially those pesky teenagers), the child begins to challenge authority, which is appropriate and further aids in the development of self identity and direction for the future. This is why teenagers may suddenly become vegetarians, become politically active, often in direct opposition to their parents' beliefs, and listen to "awful" music (unlike those of their parents who grew up listening to classical music, such as the Beatles, Rolling Stones and Led Zeppelin). What an adolescent requires is the reassurance, often implicit, that he or she will be loved no matter what their taste in music, clothes or boyfriends. Thus, non-compliance is often related to important life-stage issues that are critical to the development of personality and self-esteem. Often what appears "difficult" is actually a child's appropriate attempts at self- expression and learning. To reiterate, what is troublesome is not the child, but his or her behavior pattern, which becomes consistent.

Unfortunately, today's overworked parents often take little notice of positive behavior and instead only react when their child misbehaves. This sends a message that in order to be heard or acknowledged, children must do something negative in order to get their parent's attention. In addition, assuming that the developmental tasks described above are taking place, the child may be getting the wrong message -- that it is not acceptable to strive for independence, to test authority, to take risks. Also common is (in my opinion) the mistaken belief that punishment works, even when a child behaves age appropriately (though to his or her parent's dislike).

There are, of course, many ways to deal with behavior that appears troublesome. Parents may use intimidation, such as saying "Boy! Are you going to get it when your mother gets home!" or "You'd better do it, or Mommy won't love you anymore." Clearly these types of responses threaten the child's sense of self-esteem and even safety, if threats of physical intimidation or abuse are used.

Another common negative type of control is the use of guilt to coerce the child to do what the parent wants. Responses such as "I stayed up until three o'clock in the morning and this is the thanks I get?" or "You're driving me to an early grave," and my personal favorite "I carried you under my heart for nine months and this is how you treat me?" Such techniques of behavioral control teach the child manipulation and how to get what they want without taking responsibility and without regard to others' feelings.

On the other hand, an assertive but positive response by his or her parent teaches the child how to take responsibility for their own wishes while respecting other people. Statements such as "I realize that you'd like to go out and play without a coat, but it's cold outside and I want you to put one on" or I know that you'd like to stay up late tonight, but we agreed last week that 8 o'clock is your bedtime" demonstrate a variety of appropriate communication skills, such as taking responsibility for your own feelings ("I" statements) as well as disagreeing with other people without being disrespectful. In general such statements imply self-worth and bolster self-esteem, even though the child may be angry at the time.

Here are some other tips to help a parent take charge positively when their child becomes "challenging:"

• Use consequences - Consequences, positive as well as negative, should be discussed at a time when everyone is calm and be applied appropriately and immediately after your child exhibits particular behaviors.
• Use positive statements as often as possible.
• Use praise and encouragement as much as possible.
• Avoid labeling, comparisons and bullying.
• Ignore negative behavior as much as possible.
• Deny - Just say "NO" when your child demands something unreasonable, and stick to it.
• Demand - Insist, and say "Please DO THIS" when something of benefit to the child or others is necessary.
• Delegate - Communicate that it's alright for your child to assume greater freedom for his or her own life, but appropriately for their age and subject to parental discretion. Teach the child that along with greater freedom, which you are prepared to give, come greater responsibilities and consequences for their actions, both positive and negative.
• Encourage choices - Offer your child several choices, any of which is acceptable to you.
• Be consistent - Always follow through once you have made a decision and told your child. Successful and consistent follow-through communicates to your child that you are firmly and lovingly in control, reassuring him or her.

There are many more ways in which to you can change your child's troublesome behaviors into positive ones. In more troublesome cases, parents may need to contact a Psychologist. Above all respect, love and positive regard are the most important aspects in any relationship, particularly between parent and child. Allow your "challenging" child to be himself or herself and with some guidance they won't be "challenging" at all.

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Do you know what services your ADHD child is eligible for from the school district? You should!

Did you know that your child is eligible for services from the school district from birth? Did you know that you do not have to wait for a teacher or education professional to request special education testing and that you can request them yourself ?

Did you know that the school is responsible for providing services and accommodations to your ADHD child, even if they have to pay for them out-of-pocket? Did you know that laws state that schools can not use budget excuses as reasons not to provide services or accommodate your child's education?

You should know all of this and more! And you can have all of this information at your fingertips. Many local Protection (Social Services) and Advocacy agencies have manuals listing all this information and more.

CHADD has booklets available telling you about your rights and there are several places, right on the internet, where you can either purchase manuals detailing your rights or find most of that information for free! Make sure that any manuals or books you purchase are up-to- date, published in 2004 or later, to ensure that they include the latest updates to IDEA 2004 (Individuals with Disabilities Education Act).

The manual that I use, Special Education Rights and Responsibilities, is available at no charge right here on the net. You can read about the changes in IDEA 2004 and what they mean to ADHD children.

If your child doesn't qualify for special education, he/she still qualifies for services and accommodations under Section 504. Be sure you ask that a Section 504 representative for your district attends the IEP meeting in case you need to seek services under Section 504. For more information on Section 504 visit Council of Educators for Students with Disabilities.

Other sources I recommend to look for information would be:

• How to be an Advocate for your child.
• Wrightslaw: An excellent source of legal and education material regarding special education issues.
• Questions Dealing with IEP's

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An excuse for bad parenting

How many times in the course of trying to get help for our children do we come up against this old chestnut? Often, from the very people we have gone to for help!

In actual fact, parents of ADHD children are usually BETTER parents because of all the difficulties they have had to overcome. Our children challenge more rules, overstep more boundaries, get into more trouble at school than the average kid.

Many times though, it's not the challenging behavior which causes the greatest issues for us, it's the knock-on effects of the behavior. For example, having to go into school repeatedly to apologize for the child's difficulties, trouble with neighbors who sometimes just have these children down as 'bad uns.' Having psychologists and psychiatrists who we have gone to for help, doubt our word and listen, but not hear and understand what we tell them.

If bad parenting causes ADHD, what then accounts for the fact that often there are other children in the same family who are perfectly well-behaved and/or normal, who have never in their lives had any sort of behavioral difficulty?

An American fad

Although a lot of our information these days comes from The States, and much of the research into the causes of ADHD goes on there, ADHD is not "American." In fact, the symptoms were first outlined in Britain in the early part of this century by Professor George Still.

Although the actual name of the condition has changed many times since 1902, the condition has not, although our knowledge of ADHD has grown somewhat since then. In the UK, we are in the early stages of accepting, understanding and treating the condition, lagging somewhat behind other countries. Unfortunately, there are one or two professionals who were taught a certain way, many, many years ago, who are very resistant to change and staying up-to-date with modern ideas. Eventually though, as more people learn about the condition, more professionals will have the correct knowledge to diagnose and treat it.

An excuse for lazy, uncooperative children

How many times have we heard a teacher say to us, "Well, little Johnny did it yesterday, so he can do it today." No he can't!

One of the major factors of ADHD is inconsistency, and although frustrating for parents and teachers who don't really understand this disparity, it is also frustrating to the sufferer too. A child who cannot perform at the same level from hour-to-hour, never mind from day-to-day, can appear lazy or uncooperative, that's true. But unless the people working with children, like ours, understand that this is part of their make-up, the battles will continue to go on.

I once heard a S.N.A. say "He can concentrate when he wants to," but the word she left off the end of that sentence was ... SOMETIMES. Yes, these kids can concentrate when they want to-sometimes. Sometimes they can't. Only education will help these people work more successfully with our kids.

I'm not knocking all educational professionals, of course. The above are only isolated examples and there are some excellent teachers and special-needs workers out there. But if your school has entrenched ideas about how ALL children do/should perform, you need to bring them up to date on ADHD.

It's another name for a boisterous child

True, kids with ADHD tend to be on the boisterous side, but the cluster of problems which appear when the condition is present are so extreme that they cause considerable problems educationally, socially and in the home. Boisterous children do settle down over time and learn by experience as they develop. ADHD kids largely do not. If anything, if left undiagnosed and treated, over time they get worse.

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