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" Kathy Price* knew when her daughter was a toddler that something wasn&amp;#039;t quite right. &amp;quot;Every day, Ally hit the ground running and never stopped,&amp;quot; says Price, 48, who works in real estate in Glastonbury, CT. &amp;quot;And she had zero tolerance for frustration.&amp;quot; By the time Ally entered first grade, her behavior was spinning out of control. &amp;quot;She couldn&amp;#039;t stifle her impulses; she would dart from one thing to the next. She wasn&amp;#039;t able to do her schoolwork because she couldn&amp;#039;t pay attention long enough to hear and follow directions,&amp;quot; says Price.  Still, when doctors diagnosed Ally with attention deficit/hyperactivity disorder (ADHD) later that year and prescribed Ritalin, Price balked. &amp;quot;I carried the bottle around in my purse for a month because I was so conflicted about giving Ally a drug,&amp;quot; she recalls. But Ally continued to struggle, and Price relented. &amp;quot;I&amp;#039;ll never forget the first day she took it: She was just 6, and she came to me and said, &amp;#039;I like this medicine. It makes me feel better.&amp;#039;&amp;quot;  The decision to start a child on a medication like Ritalin can be wrenching, particularly since ADHD is sometimes painted as a wastebasket diagnosis being used to drug a whole generation of kids into submission. True, ADHD \u2014 which is characterized by hyperactivity, impulsivity, and inattention \u2014 often feels like the kids&amp;#039; disorder du jour: Some 6.5 percent of all school-age kids have been diagnosed with ADHD, making it one of the most commonly diagnosed behavioral disorders of childhood, according to the Centers for Disease Control and Prevention. And as the disorder has gained recognition, the percentage of kids nationwide being treated with ADHD drugs has risen \u2014 to about 3 percent, compared with 1 percent 20 years ago. The rise is due in part to changes in the way ADHD is defined: In 1994, the American Psychiatric Association began associating attention problems without hyperactivity with the disorder, which contributed to increased prevalence rates.  But although experts acknowledge that a small percentage of kids being treated for ADHD may not have it, many more with the disorder who could benefit from drugs are going untreated, says Richard D. Todd, M.D., an ADHD researcher at the Washington University School of Medicine in St. Louis. &amp;quot;According to our research, more than a third of boys and more than half of girls with full-blown symptoms have never tried any medication,&amp;quot; says Todd.  Surprised? We were too. Read on for more straight talk you can trust about ADHD risk factors, ramifications, and treatments.  * Some names have been changed. What does ADHD look like? There are three distinct types of ADHD: predominantly inattentive, predominantly hyperactive-impulsive, or combined type (an amalgam of the first two). Kids who are predominantly inattentive have great difficulty focusing on details: They&amp;#039;re disorganized and forgetful; they lose things and make careless mistakes; they&amp;#039;re easily distracted and have trouble following directions.  A child who&amp;#039;s predominantly hyperactive-impulsive is always on the go: He fidgets and squirms; he runs and climbs when and where it isn&amp;#039;t appropriate; he has difficulty playing quietly, blurts out answers, interrupts others, and has trouble taking turns.  Of course, all kids exhibit some of these symptoms some of the time. But a child with ADHD displays most of these symptoms most of the time, in many different settings, beginning before age 7, and in ways that are age-inappropriate and socially and academically debilitating.  Still, not all ADHD is easy to spot: Girls, in particular, tend to suffer from the inattentive subtype. &amp;quot;They appear as though they&amp;#039;re daydreaming,&amp;quot; notes Todd. &amp;quot;Since they don&amp;#039;t cause disruptions, they more often go undiagnosed.&amp;quot; Nor are children with ADHD always unfocused. &amp;quot;I don&amp;#039;t know a single ADHD kid who can&amp;#039;t focus on a stimulating video game,&amp;quot; adds Todd. &amp;quot;But the true test is, can they focus when doing the mundane, uninteresting things? Which, let&amp;#039;s face it, is a large part of school life.&amp;quot; Who&amp;#039;s at risk? Although any child can develop ADHD, those with a family history are at highest risk. &amp;quot;Genes play a role in about 75 percent of ADHD cases, which means it&amp;#039;s about as heritable as height,&amp;quot; says Desiree Murray, Ph.D., associate director of the Duke University Medical Center ADHD program. Gender also matters, with boys being two to three times as likely as girls to have ADHD, though experts don&amp;#039;t fully understand why. Other associations include prenatal exposure to cigarette smoke, insufficient oxygen during birth, lead poisoning, low socioeconomic status, or having a parent with depression or other mental-health issues.  Scientists are still unsure how these factors may affect the brain in ways that contribute to ADHD. They do know that the frontal lobe \u2014 a brain region involved in part with planning and problem solving \u2014 is 10 percent smaller in individuals with ADHD than in those without. &amp;quot;And ADHD sufferers appear to have lower activity in the brain regions associated with inhibition and attention,&amp;quot; says Murray. Could it be something else? Many other conditions can look like ADHD, so it&amp;#039;s vital that your child be thoroughly evaluated before you accept a diagnosis (see &amp;quot;Diagnosing ADHD: What to Expect,&amp;quot; later in this article). For instance, kids who are chronically sleep deprived due to sleep apnea or other nighttime issues are reported to have higher levels of inattention and hyperactivity. So are those who have had frequent ear infections, a common cause of correctable hearing loss that can lead to ADHD-like inattentive or disruptive behaviors, or those who have a visual problem called convergence insufficiency, which literally makes it hard for the child to focus.  If the pediatrician rules out the above physical factors, experts recommend a psychological evaluation as the next step: Roughly half of all kids with ADHD have at least one other behavior disorder that requires attention, and many common culprits \u2014 such as anxiety or a learning disability \u2014 are easy to mistake for ADHD. While most pediatricians and family doctors today can diagnose textbook ADHD, it may take a child psychologist or psychiatrist to pinpoint and treat these other mental-health concerns. What are the treatment options? Some parents of kids with ADHD find that incorporating certain lifestyle changes can help manage symptoms. But only two treatments are proved to work in studies: stimulant medication and behavioral therapy.    STIMULANTS: For up to 80 percent of kids with ADHD, these drugs are effective. They work by &amp;quot;turning on&amp;quot; brain areas involved in attention span and impulse control. Though generally safe, stimulants work differently for different children, so finding the right one is often a matter of careful trials. For instance, short-acting formulas (e.g., Ritalin and Dexedrine) can wear off between doses, so many parents prefer newer longer-acting forms like Concerta and Adderall XR. Another option is the Daytrana patch. &amp;quot;You can remove the patch at any time to stop the medication, and the patch can be a real plus if your child dislikes taking pills or has trouble absorbing the medication,&amp;quot; says Steven Pliszka, M.D., chief of child and adolescent psychiatry at the University of Texas Health Science Center in San Antonio. Stimulants can also cause headaches and irritability, and they may raise the risk for sudden cardiac death or psychotic episodes in children with preexisting heart conditions or psychotic disorders. For kids who can&amp;#039;t take stimulants, there&amp;#039;s Strattera, the only non-stimulant ADHD medication approved by the FDA. But it doesn&amp;#039;t seem to be as effective as the stimulants, and in very rare cases, Strattera may trigger suicidal thoughts.    BEHAVIOR THERAPY (BT):  BT hinges on teaching parents, in training sessions, how to use rewards and consequences to effectively set limits for their children and encourage positive behaviors. &amp;quot;Kids with ADHD have almost superparenting needs \u2014 they require strategies and skills that most parents wouldn&amp;#039;t come by naturally,&amp;quot; says Murray. While research indicates that BT alone may not be as effective for treating core symptoms of ADHD as medication alone, some kids \u2014 particularly those who also have anxiety \u2014 seem to respond equally well to behavioral and drug treatments. Studies suggest, however, that the optimal treatment for all children with ADHD is a combination of BT and drugs. &amp;quot;This is particularly true for children who are under intense pressure at home or school, or those who are dealing with a coexisting condition such as depression or anxiety that can&amp;#039;t be addressed with drugs alone,&amp;quot; says Peter S. Jensen, M.D., director of REACH (The Resource for Advancing Children&amp;#039;s Health) in New York City.   Diagnosing ADHD: What to Expect There is no concrete test for ADHD, so getting a diagnosis is a multistep process requiring time and patience. Your pediatrician (or a child psychiatrist or psychologist) will start by taking a medical history and may perform a physical exam of your child. She&amp;#039;ll collect information about your child&amp;#039;s behavior from you, your child&amp;#039;s teachers, and any other primary caregivers. In addition, your doctor will interview your child and may have him take tests to assess for any learning disabilities.  Based on the results, your doctor may refer you to another specialist (such as a neurologist, ophthalmologist, or audiologist) to rule out or treat any other health concerns. If your child is diagnosed with ADHD, your doctor will work with your family to develop a treatment plan.  Your ADHD Daily Survival Guide Living with ADHD or other attention problems is a daily challenge for children and their loved ones. The following tactics can help alleviate stress for the entire family:     Praise specific behaviors that you&amp;#039;d like repeated For example: &amp;quot;You did a great job putting your Pok\u00E9mon cards away.&amp;quot; Children with ADHD tend to receive less positive reinforcement, yet it&amp;#039;s a more effective motivator than criticism.     Look your child in the eye and deliver step-by-step directions.  This way, you&amp;#039;ll know that your child is listening, which may keep you from having to repeat yourself endlessly \u2014 a habit that only encourages your child to tune you out.     Reward good behaviors \u2014 and punish bad ones \u2014 immediately.  Kids with ADHD quickly lose the connection between their actions and delayed consequences.    Provide concrete incentives.  Children with ADHD may want to do well because it feels good, but they&amp;#039;re easily distracted by external temptation. Offer more tangible motivation, such as the promise of extra Game Boy time, to keep them on track.     Keep to a structured routine. Kids with ADHD can&amp;#039;t organize themselves, so the more predictable your child&amp;#039;s world, the more predictable his behavior will likely be.    How Real Kids Respond to ADHD Treatment &amp;quot;Our 11-year-old, Ariella, has been on Concerta for about three years and has done very well. Before she was diagnosed, she couldn&amp;#039;t store the numbers one and two in her head long enough to add them together. But by last year she was doing sixth grade math in fifth grade. One reason we keep her on the drug is because of what it has done for her self-esteem. Ariella used to think she couldn&amp;#039;t do the work, but now she knows she can, and it&amp;#039;s been such a confidence boost for her.&amp;quot;  \u2014Ilana Knab, 44, Bethesda, MD &amp;quot;Our 7-year-old son started on Concerta, but it triggered serious appetite and sleep issues. Next we tried Adderall, which worked well for about a year, but then just stopped having an effect. Now he&amp;#039;s taking Strattera, which seems to help take the edge off his hyperactivity and impulsivity, and his sleep and appetite have improved. We&amp;#039;ve also tried behavioral strategies, but not much has helped. He&amp;#039;s very bright and knows how he should act. He just can&amp;#039;t control his impulsive tendencies.&amp;quot;  \u2014Claire Kendall, 38, Hartford, CT &amp;quot;We tried our 10th grader on stimulants, but he has a mild case of Tourette&amp;#039;s syndrome, and stimulants exacerbated the tics. We tried [the non-stimulant] Strattera, but it made him depressed. Now he takes the antidepressant Wellbutrin, which is supposed to help with ADHD, though I think it only modestly improves his attention. He has also learned some cognitive behavioral approaches, which help him some. But what works best is positive reinforcement: Say to him, &amp;#039;You are really trying hard, thank you,&amp;#039; and he will do everything he can to contain his behavior and stay on task.&amp;quot;  \u2014Richard Giannini, 56, Berwyn, PA "^^<http://www.w3.org/2001/XMLSchema#string>
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