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In Irvine, California, James Swanson has tried to create the ideal setting for teaching kids with ADHD. The Child Development Center, an elementary school that serves 45 kids with the disorder, is a kind of experiment in progress. The emphasis is on behavior modification: throughout the day students earn points -- and are relentlessly cheered on -- for good behavior. High scorers are rewarded with special privileges at the end of the day, but each morning kids start afresh with another shot at the rewards. Special classes also drill in social skills: sharing, being a good sport, ignoring annoyances rather than striking out in anger. Only 35% of the kids at the center are on stimulant drugs, less than half the national rate for ADHD kids.
Elsewhere around the country, enterprising parents have struggled to find their own answers to attention deficit. Bonnie and Neil Fell of Skokie, Illinois, have three sons, all of whom have been diagnosed with ADD. They have "required more structure and consistency than other kids," says Bonnie. "We had to break down activities into clear time slots." To help their sons, who take Ritalin, the Fells have employed tutors, psychotherapists and a speech and language specialist. None of this comes cheap: they estimate their current annual ADD-related expenses at $15,000. "Our goal is to get them through school with their self-esteem intact," says Bonnie.
The efforts seem to be paying off. Dan, the eldest at 15, has become an outgoing A student, a wrestling star and a writer for the school paper. "ADD gives you energy and creativity," he says. "I've learned to cope. I've become strong." On the other hand, he is acutely aware of his disability. "What people don't realize is that I have to work harder than everyone else. I start studying for finals a month before other people do."
COPING
Adults can also train themselves to compensate for ADHD. Therapists working with them typically emphasize organizational skills, time management, stress reduction and ways to monitor their own distractibility and stay focused.
In her office in White Plains, Tomaino has a miniature Zen garden, a meditative sculpture and all sorts of other items to help tense patients relax. Since many people with ADHD also have learning disabilities, she tests each patient and then often uses computer programs to strengthen weak areas. But most important is helping people define their goals and take orderly steps to reach them. Whether working with a stockbroker or a homemaker, she says, "I teach adults basic rewards and goals. For instance, you can't go out to lunch until you've cleaned the kitchen."
Tomaino tells of one very hyperactive and articulate young man who got all the way through college without incident, thanks in good measure to a large and tolerant extended family. Then he flunked out of law school three times. Diagnosed with ADHD, the patient took stock of his goals and decided to enter the family restaurant business, where, Tomaino says, he is a raging success. "ADHD was a deficit if he wanted to be a lawyer, but it's an advantage in the restaurant business. He gets to go around to meet and greet."