There are three main types of attention deficit disorder, including the Predominantly Inattentive Type, in which children have six or more of the following symptoms:

• Fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
• Has difficulty sustaining attention in tasks or play activities.
• Does not seem to listen when spoken to directly
• Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace.
• Has difficulty organizing tasks and activities
• Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort, such as schoolwork or homework.
• Loses things necessary for tasks or activities, such as toys, school assignments, pencils, books or tools.
• Is easily distracted by extraneous stimuli.
• Is forgetful in daily activities.

Other children have a Predominantly Hyperactive Type of ADHD, and have six or more of the following symptoms:

• Fidgets with hands or feet or squirms in seat.
• Leaves seat in classroom or in other situations in which remaining seated is expected.
• Runs about or climbs excessively in situations in which it is inappropriate.
• Has difficulty playing or engaging in leisure activities quietly.
• Is often 'on the go' or often acts as if 'driven by a motor'
• Often talks excessively.
• Blurts out answers before questions have been completed.
• Has difficulty awaiting turn.
• Interrupts or intrudes on others.

Children may also have a Combined Type of ADHD, having six or more symptoms of inattention and six or more symptoms of hyperactivity and impulsivity.

There is no test available that will easily tell us if your child has attention deficit disorder, and your pediatrician must have as much information as possible to complete the evaluation. The evaluation will probably include having the parents and school teachers fill out ADHD ratings scales to see if your child has the symptoms described above. Be as detailed and descriptive as possible in filling out and describing your child's symptoms and ask the school to enclose copies of report cards, achievement tests, and results of any testing that has already been done. Also obtain copies of testing for attention deficit disorder or learning disabilities that have already been completed by other doctors.

The American Academy of Pediatrics recently published a Clinical Practice Guideline on the 'Diagnosis and Evaluation of the Child With Attention-Deficit/Hyperactivity Disorder.' This guideline recommends that the diagnosis of attention deficit disorder requires that a child meet DSM-IV criteria (described above), that the evaluation include evidence of these symptoms obtained from the child's caregivers and classroom teachers, that other coexisting conditions also be looked for (such as conduct disorder, oppositional defiant disorder, anxiety, and/or depression), and that other diagnostic testing, such as blood tests, brain imaging tests, or continuos performance tests.

Many new reports have shown that children with sleep problems, especially obstructive sleep apnea, may have symptoms that are similiar to ADHD, including problems paying attention and with hyperactivity. Other symptoms of a sleep disturbance might include snoring and daytime sleepiness.

ADHD is now thought to occur in 3-5% of school-age children and is more common in boys. It is not yet known what causes attention deficit disorder, but there does seem to be a genetic influence.

The mainstays of therapy for ADHD are medication when appropriate, behavior modification and educational remediation as needed.

The medicines that we most commonly use to treat attention deficit disorder are the stimulants, which include Ritalin (methylphenidate) and Adderall. These are quick acting (they begin working within 30-60 minutes), but also short acting (they only last 2-4 hours). Most children take a dose in the morning and another at noon to help control their symptoms at school. Some also require a third dose after school. Concerta is a newer long acting form of methylphenidate that just has to be given once a day.

These medicines are controlled substances and a new prescription will need to be picked up each month and will expire within seven days. Your physician can not call these medicines in to the pharmacy or give you a refill, so you will either need an appointment or just a visit to your doctor's office each month to pick up a new prescription.

These medicines are generally safe with few long-term side effects. The most common side effects are having a poor appetite/growth, insomnia, mild headaches and stomachaches. Some children do better if they take their medicine after a meal, or by having 'drug holidays' on weekends or during summer, during which their growth can rebound. Also, a mid-afternoon snack may be helpful for those children with a poor appetite at lunch. The effect on appetite and growth seems to be worst during their first year on the medicines and they do not appear to permanently suppress a child's growth and should have no effect on their final adult height.

Your physician will probably begin a low starting dose, either twice a day or just in the morning. It would probably be best to start it on a weekend, so that you can note any side effects that occur. Your physician will then slowly increase the dose every few days or weeks until there is improvement in your child's symptoms. Please talk with your child's teacher and let your physician know how the medicine is working and when it appears to be wearing off.

Many physicians recommend taking the medicine every day at first, including weekends, until you find the right dose of medicine. If your child has benefited from medication and is not having side effects, then you may then allow him to take it everyday, including weekends and holidays. You may, however, be able to give your child a holiday from the medication on weekends and/or holidays if you wish, but discuss it with your physician first.

Sometimes the generic form of Ritalin does not seem to work as well as the brand name form, and your docotr may try switching forms if the medicine does not seem to be working well. About 70-80% of children with attention deficit disorder will respond to one of the stimulant medicine, but there are some children that do not respond to the first medicine that is started, and your physician may then change your child to another or try a different type of medicine altogether, such as an antidepressant, which also seem to help control the symptoms of ADHD.

Not all children with attention deficit disorder need to take medicine for the rest of their lives. It is now thought that adolescents and adults don't grow out of their ADHD, but rather learn better coping mechanisms to deal with it and some may not need to continue their medication.

Children with attention deficit disorder are at great risk for doing poorly in school and for having emotional and behavioral problems. It is very important to intervene as soon as possible if your child is showing any signs of depression, poor self esteem, or severe behavioral problems. Remember that many discipline techniques that work well with children who do not have ADHD may not work as well in your child with attention deficit disorder. He may benefit from individual and family therapy/counseling from a child psychologist who specializes in the care of these types of children.

Among the most important non-medical interventions are behavior modification to help your child to control their impulsiveness; setting clearly defined expectations and limits; trying to reward, praise and reinforce desired behaviors rather than the use of negative reinforcement and punishment for undersized behaviors; using token and reward systems; using simple (one-step) commands (especially for chores: don't tell them to clean their room, instead break it down into steps like making the bed, picking up toys, putting clothes away, etc.); using more immediate consequences for undesired behaviors (for example, it will probably not be an effective punishment to tell your child that he can't go to the movies the following week for doing something undesirable today, instead, restrict an activity, such as watching TV or playing videogames that same day). Other discipline techniques that may be effective include allowing your child to see the natural consequences of his actions (if he breaks a toy, then he can't play with it), logical consequences (if he doesn't put his toys away, then you will put them away and he can't play with them all day), withholding privileges (find things that your child enjoys, for example, playing Nintendo, renting movies, etc. and take them away when he misbehaves) and time out. Always remember to be firm, consistent, calm and loving in whatever discipline methods you choose.

Many children with ADHD have trouble making and keeping friends. This is often because they may talk too much, try to take charge of activities, are too intrusive and impulsive and don't always follow the rules. You can help your child make and keep his friends by observing and trying to improve bad behaviors, role-play or coach them through different scenarios, structure activities with only one or two other children, and intervene early if things are not going well.

Also, try to establish structure and organization by the use of lists, notes, reminders, and calendars and teaching them to break down large tasks into smaller ones; encouraging participation in extracurricular activities; and using social skills training. Try to prepare your child in advance for any changes that may occur in their routine, such as a family member visiting, a vacation or trip, etc., and learn to anticipate in what settings your child may have problems, such as shopping or going out to eat, and discuss a plan of action beforehand (including what the punishment will be for not complying).

You will not be able to change all of your child's behaviors and you should pick your battles to try to help them change the most bothersome or disruptive and try to ignore the more trivial ones. If they have a lot of trouble getting ready in the morning, for example, you can try to use a chart or schedule that lists all of the steps that they need to do to get ready, including getting up, washing, getting dressed, eating breakfast, taking their medicine, etc. and let them check off each activity as they do them. They can then be offered rewards or privileges for doing it correctly and on time for a certain number of days in a row.

There are also many interventions that can be used in the classroom and you can discuss these with your child's teacher. They include sitting close to the teachers desk and away from distractions; the use of written and oral instructions for assignments; giving only one assignment at a time; allowing more time for tests or taking untimed tests; the use of oral testing; shorter assignments; and the use of another student as a 'study-buddy' to help remind your child of assignments and what books to take home. Your child may also need specialized tutoring.

It can also be helpful to have a school-to-home notebook that will allow you and the teacher to discuss concerns you may have about your child, assignments and homework that is due, upcoming tests, and allow you to get feedback on how your child is doing, including daily or weekly school behavior report cards that report how well your child pays attention, follows directions, completes assignments and gets along with others, etc.

It is important for you to tell the school of the diagnosis of attention deficit disorder, because it is considered a disability under the Individuals with Disabilities Act and Section 504 of the Rehabilitation Act of 1973 for which public schools must make accommodations and other special services. Ask the school what special education services your child qualifies for.

• Children's Attention Deficit Disorder Resources: Resources and information for parents of children with attention deficit hyperactivity disorder (ADHD).
• Attention Deficit Disorder in Children: Attention deficit disorder can cause children to have inattention and/or impulsiveness and hyperactivity. Learn about how adhd is diagnosed and treatmented, including the use of ritalin and adderall.
• About Attention Deficit Disorder: The ADHD website written about, for and by people who have ADHD. Everything you ever wanted to know about attention deficit disorder but could never remember to ask.
• Attention Deficit Disorder: National Institue of Mental Health article on ADHD, with info on the symptoms of ADHD, causes and treatments.
• Children and Adults with Attention Deficit Disorder: CHADD – the national non-profit organization representing children and adults with attention deficit disorder. CHADD works to improve the lives of people with attention deficit disorder througheducation, advocacy and support. Working closely with leaders in the field of ADHD research, diagnosis and treatment, CHADD offers its members and the public information they can trust.
• Clinical Trials for Attention Deficit Disorder: ClinicalTrials.gov - Linking Patients to Medical Research about Attention Deficit Disorder with Hyperactivity.
• Diagnosis and Evaluation of the Child With Attention Deficit Disorder: This clinical practice guideline from the American Academy of Pediatrics provides recommendations for the assessment and diagnosis of school-aged children with attention deficit disorder (ADHD). This guideline, the first of 2 sets of guidelines to provide recommendations on this condition, is intended for use by primary care clinicians working in primary care settings. The second set of guidelines will address the issue of treatment of children with ADHD.
• National Attention Deficit Disorder Association: National nonprofit organization focused on the needs of people with Attention Deficit Disorder, particularly adults and young adults.
• Top Ten Things I Wish Students With ADHD Knew About Their Medications: A Top 10 list. These are the things that I wish all college students with ADHD knew about their medications when they arrived on campus.
• What is Attention Deficit Disorder?: Attention deficit disorder (ADHD) is a common childhood behavioral disorder, but it can be difficult to diagnose and even harder to understand. Read this article for imformation about what to do if your child has ADHD.
• The ADHD e-BOOK: An electronic book about ADHD that you can read online. Written by a Pediatric Neurologist, it includes lists of symptoms, treatments and other resources.
• ADHD - A Place to Start: "I'm a mom who struggles to help my ADHD/ADD child.  In this regard, I’ve spent a considerable amount of time searching for answers  –  only part of which you’ll find referenced in this letter.  It’s my hope that by sharing this information it will raise public awareness as well as be instrumental in lending a helping hand toward finding “a place to start.”  There's something here for everybody. "

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