So you have just returned home from your third meeting with your child's teacher. She tells you that your child is not getting his work done, he cannot sit still, and he is simply not going to have any success in school unless something changes. She suggests that you talk to someone to see if he has ADHD. What do you do next?

This can certainly be a difficult time in any family, so we would not want you to be uninformed as you take the next important steps. Here are the things that we recommend if you have a child that ought to be looked at for possible Attention Deficit Hyperactivity Disorder.

First, there should be an "adequate" physical exam by the child's pediatrician or family practice doctor. This doesn't have to be an extensive, expensive exam, but should be able to rule out possible problems like Mononucleosis, Thyroid problems, lead poisoning (if it is common in your area), and potential attention problems caused by medications, such as allergy medications. Then, with a clean bill of health, we move on to step two.

Second, get an evaluation for attention deficit hyperactivity disorder. Usually a psychologist or other mental health professional will do this evaluation for ADD ADHD. But please, only get counseling or therapy from professionals who have a lot of experience treating attention deficit hyperactivity disorder. Therapists who do not have a lot of experience with ADD ADHD will just take your money and then probably blame you, the parents, for the child's disorder. Find experts on attention deficit hyperactivity disorder in your area. Ask around at your local CHADD chapter. Call you local Psychiatric Hospital and ask for the Child or Adolescent Unit. Then ask for the "Charge Nurse." Ask the Charge Nurse who the best psychiatrists and therapists in your town are. They know.

The Evaluation

When you get an evaluation for attention deficit hyperactivity disorder, there should be a good parent interview. It's absolutely essential that somebody sits down with the parents and spends 45 minutes to an hour with them. The psychologist or therapist needs to find out what's going on now, why did the parents pick up the phone and call now instead of last week, and so on. A good developmental history on the child must also be taken. Important questions are:

ADHD as a Risk Factor for Alcoholism

Its really no surprise for those in the field, working with ADHD children and teens, but two new studies show that children with ADHD are more likely than other children to abuse alcohol in their teen years, and maybe beyond.

In one study, researchers found that 15- to 17-years olds with childhood ADHD reported being drunk an average of about 15 times during the previous year, compared to about 2 times for adolescents without ADHD.

Fourteen percent of the ADHD group was classified as alcohol abusers or alcohol dependent, but none of the youths in the non-ADHD group were. Before age 15, kids with ADHD didn't abuse alcohol any more than did other kids.

The study looked at 364 children with ADHD -- attention deficit hyperactivity disorder -- enrolled in the Pittsburgh ADHD Longitudinal Study.

Dexedrine (d-amphetamine)

Dexedrine is not prescribed very often for the treatment of ADHD out here in California, but those patients that we've seen on it have done well. Typically it is prescribed to patients who have not responded to Ritalin very well. It has the advantage of having a very nice long-lasting product (one dose per day). Usually it will not be prescribed to teenagers, or to individuals with a history of substance abuse. It can have retail value in the high school parking lot, and can be misused and abused.

Cylert (Sodium Pemoline)

Cylert seems to be prescribed most by neurologists and by the few pediatricians who are afraid to prescribe Ritalin. We don't recommend Cylert at all, and wonder why anyone actually prescribes it at all any more. It only works about half the time with patients, and can have very serious side-effects. We have been told that it causes hepatitis in 1/1000 of patients. We cannot verify this, but it's good enough for us to not recommend it to patients anyway. Even the manufacturer recommends against it as the first medication tried in treating Attention Deficit Disorder.

Besides Attend works as well or better and is much healthier and safer, so why mess with a medication that can cause such serious problems?