If you believe a child in your class may have ADD, very likely you also feel like you've already tried everything and yet problems of underperformance or misbehavior persist.

Unless you've been teaching in a cave over the past decade, you've heard that ADD (Attention Deficit Disorder or ADHD to indicate hyperactivity) could be the cause of this child's problems. Yet be aware that ADD remains a heterogeneous multi-caused syndrome of underperformance, impulsivity and hyperactivity.

While popularly viewed as chemical imbalance within the child's brain, ADD may be described more accurately as living imbalance between what the child can deliver in terms of performance and behavior and the expectations and responses of the classroom and home environment. It is not so surprising, then, that there is so much ADD these days in America as demands on children's (and teachers') performance have increased while the social supports to children, their families and teachers have decreased.

The ADD candidate child's personality does tend toward an extreme compared to other children the same age. Critically, the ADD child finds it much more difficult to utilize the knowledge of time-delayed consequences to regulate his/her behavior. Most successful classroom and home management hinges on the caregivers recognizing this personality feature. Decreasing distractions is less important than providing immediate positive and negative reinforcements for desired behavior and performance.

The personality of the ADD child is explanation but not an excuse for poor performance or behavior. It is actually quite difficult to distinguish the difference between poor motivation and ADD based behavior. While a child should still be held responsible for his/her performance, some accommodations or adjustments to the reality of the ADD personality will be necessary. The expectation that if the ADD child knows the consequences of his/her actions he/she will perform appropriately is a common trap for teachers and parents. The ADD child, in order to perform successfully, will require more immediate attention and monitoring from the teacher and the family .

Immediate and tangible reinforcers are more effective than time-delayed, more intense or lengthier positive or negative consequences. Avoid lengthy, repetition of words, explanations, or appeals to conscience. Stars or tokens for prizes is more effective than a good report card grade. A minor immediate loss of privilege (Put your head down on the desk) is more useful than losing a chance to go on a field trip the next day. ADD misbehavior is not a matter of not knowing the right thing to do. Kind, firm, authoritative limit setting, especially early in the school year sets a good pattern and works best. Some conflict is unavoidable but effective standards to performance is the ultimate source of improved self-image.

Have the child sit in the front near you. Avoid placing him/her with friends. During unstructured recess/lunch, the child may do best if required to play within a ten yard perimeter of a supervising adult. Ideally there should also be situations where going bananas is permitted.

Communicate early with the family and get permission for firmness and immediacy in the classroom. A daily or weekly communication may be useful but punishment at home for misbehavior at school is too time-delayed to be useful. Rather parents can be encouraged to model teacher expectations and responses at home.

No child should be referred for a medical evaluation for ADD and Ritalin without first being screened for learning problems by the school's, Student Study Team, or its equivalent. Learning and attention problems occur frequently together and exacerbate each other. Let the parents know that you want to communicate with the doctor. ADD questionnaires are useful but direct comments especially about the child's strengths and the quality of the classroom and home environment are often not solicited.

Recognize Mission Impossible - teachers and schools are being asked to do everything from teaching reading to moral reasoning in the context of decreasing public funding for schools and an educational paranoia that expects every child to attain an advanced college degree in order to be successful in the 21st century. Ritalin cannot replace good teaching or parenting but when other interventions have been tried Ritalin can be a helpful component to a treatment plan.

Look for opportunities besides in academics to acknowledge and reward ADD children. Encourage the support of athletic, vocational or artistic activities for children at school.. Appreciate that the diversity of temperaments and talents enriches our society and culture and should be supported.