Instilling a sense of discipline in children is something few parents feel very comfortable doing. “I just want them to have fun and be kids!” the guilty parent says. But discipline, whether you like it or not, is the cornerstone for understanding values and responsibility — things all kids will need to learn sooner or later.

Effective discipline comes from the following five C’s. Get these right, and you’ll have far less problems with your kids as they age, as they’ve learned the rules and what breaking them means.

1. CLARITY: Be clear when you set rights, rules and limits.

• Don’t assume your children know family rules until you’ve talked about them.
• Be sure your children understand why these rules are being made and the consequences for breaking the rules.
• Involve your children as much as possible in making the rules.
• Try writing out your family rules and posting them on the refrigerator.

2. CONSISTENCY: Be consistent in enforcing rules.

• Stick to the consequence that has been established for a broken rule.
• Discipline will be more effective if your children have been involved in establishing the rules.
• If a change needs to be made in a family rule, talk about it before the rule is broken.
• Be flexible — as your children grow, they’re ready for expanded rights and changes in rules and limits.

3. COMMUNICATION: Talk about rights, rules and limits often.

• Be willing to discuss the fairness of a rule and the reasons for it.
• Help your children learn to talk with you about feelings.
• Encourage your children to come to you when they need help.
• Express respect and faith in your child through your words, gestures and tone of voice.

4. CARING: Use encouragement and support, not just discipline for broken rules.

• Praise your children when they follow your family rules, especially when they do what’s expected of them without reminders from you.
• When a rule is broken, criticize the action and not your children.
• Follow up swiftly when a rule is broken; stay calm and carry out the consequences your children expect.
• Make sure the consequences are appropriate for the broken rule.
• Respect your children’s rights, such as the right to privacy.

5. CREATE: Instill a sense of social responsibility in your children.

• Let your children know you expect moral behavior, like honesty and fairness.
• Set an example of honesty, fairness and social responsibility for your children to follow.
• Promote your child’s sense of self-respect.

“Did you ever reach a point in your life,” he asks, “where you say to yourself, ‘This is the best I’m ever going to look, the best I’m ever going to feel, the best I’m ever going to do? And it ain’t that great?’”

That’s as good a description as any of what a midlife crisis is all about. Of course, Billy Crystal’s alter ego is far from the only hombre to ride nervously past the buzzards of Midlife Gulch. Ulysses, Dante, and Michelangelo have been there. So have Sigmund Freud and Carl Jung.

In his late thirties, Shakespeare switched from writing comedies to writing tragedies, producing in the process King Lear, Macbeth, Hamlet, and Othello — all tales of men who discover too late that their lives have gone seriously awry.

What is This Vague, Uncomfortable Feeling?

What, exactly, constitutes a midlife crisis? Experts agree there’s no single definition, although a pervasive sense of disappointment and a nagging feeling that time’s running out would be among the major characteristics. Larry Bumpass, Ph.D., a sociologist at the University of Wisconsin in Madison who directs the National Survey of Families and Households, says there’s “an array” of at least 40 events that commonly occur at midlife, from losing a job to the death of a parent, a flagging libido, divorce, or illness.

Midlife for men today is tougher than it’s ever been, says Ronald Levant, Ed.D., a psychologist who teaches at Harvard Medical School. The Ozzie and Harriet model of family life no longer prevails, he says, and new demands on men can exacerbate the confusion of midlife transition.

“It’s more of a crisis now than it might have been for our fathers because of the dynamic changes in the role of women and the structure of the American family,” Dr. Levant says. “Midlife men are now living with role expectations that are vastly different from when they grew up. The traditional masculine code has been broken.”

No Need to Panic

Many experts believe the word “crisis” overstates the degree of angst most middle-age men experience. These same experts also say that many of the stereotypes about men at midlife-such as their burning desire to hold onto youth by latching onto a younger woman-aren’t necessarily true. “Sure, we all know somebody who left his wife for his secretary when he was 45. But men leave their wives when they’re younger, too,” says Dr. Bumpass.

In fact, Dr. Bumpass’s research demonstrates quite clearly that the risk of divorce actually declines the longer people are married. Another study, conducted at the New England Research Institute by psychologist John B. McKinlay, Ph.D. showed that only 2 percent of over 1,700 middle age and older men surveyed reported having more than one current sexual partner, a far lower rate than the stereotypes would have us believe.

The word “crisis” applies more to how midlife transitions are handled than to the fact that transitions are taking place, says Leonard Felder, Ph.D., a psychologist in private practice in Los Angeles and an expert on midlife and career issues.

“Most people between the ages of 30 and 50 go through some major shifts in the way they see themselves and the way they feel about their lives,” he says. “That’s normal. It’s a crisis if men act impulsively during it. If they throw away their wives, kids, friends, then it’s a crisis. If they carefully think this through, it’s a fascinating transition.”

Take Stock of Your Life

That midlife regrets can serve as a potent catalyst for personal growth is a theme sounded repeatedly by experts from many disciplines. “I would go so far as to call it a midlife opportunity,” says Marsha Sinetar, Ph.D., an organizational psychologist and the author of Do What You Love; the Money Will Follow. “It’s time to look at questions like, Who am I? What do I believe? What do I really need? Those are issues worth examining. This means taking yourself seriously, perhaps for the first time.”

The first recommended step for getting the most out of your midlife agonies is to listen to them. Therapists say there’s a strong temptation to deny the questions that come up at midlife because the answers are sometimes threatening.

“Accept what’s happening,” says Dr. Sinetar. “Try to relax into the chaos. Trust that you’re going to find something wonderful in it.”

A parent who is being abused by their own child, whether it be a teen or even a younger child, may feel a sense of shame. As a mom or dad, you may think, “I should be able to handle this. Just because my child hits me or yells at me, I shouldn’t feel ashamed.”

But teenagers who are being abusive — hitting, threatening, intimidating, name-calling, shoving or more — need to understand the ramifications of their abusive behavior toward an adult. Just because that adult happens to be their parent doesn’t forgive or excuse the criminal behavior.

If you are suffering abuse at the hands of your son or daughter, it may be helpful to understand these tips:

Your safety is important

It is easy to believe that sacrificing yourself to protect your child is the “right thing” for a parent to do. But your safety is just as important and cannot be sacrificed to protect your child. If you’re seriously injured or, as the result of an accident, become hospitalized or worse, you will not be available to raise your child.

Make a safety plan and yes, call the police if necessary. It does not mean you don’t love your child. We all want to protect our children but that protection can not be traded against personal safety. Everyone has a right to feel both physically and emotionally safe.

You are not alone with this

Although the problem of parent abuse isn’t often talked about, it does exist and apparently is becoming increasingly common.

Rely on your inner strength and wisdom to guide you toward the best answer for your family. Consider all available resources to you. Some of these include: therapy or counseling, evaluation and medication, if appropriate; temporary respite, (BoysTown) drug/alcohol testing, if appropriate; mediation if your teen is willing to acknowledge that s/he is responsible for his/her own violence and the necessary steps to re-establish trust and safety in the home, anger management workshops, talking with trusted friends, etc.

Rely on yourself and your friends

Although you may want to keep this issue to yourself, that is the worse thing you can do. You need to rely not only on yourself, but also on your friends, family and support network. Although not everyone may understand or appreciate the seriousness of this issue, some of your friends and family will. Those are the ones you need to turn to at this time.

Do something. Anything. Marshaling your inner strength will help you do something; it might be learning more about parent abuse, interviewing therapists, finding a support group, etc. Just doing something can help you banish the feeling of powerlessness that often comes with parent abuse.

It will take time to fix this

Understand that turning the problem around will take time. As you experiment with different resources, allow time to determine if what you are trying is really for you. If not, why not? For example, what kind of therapist do you think would work best with your family? Is it someone that values a collaborative approach? Someone that has more traditional positions on family roles and responsibilities? It is important to look for a good fit that feels comfortable.

Present a united front

Parent must join together in a united front to successfully confront parent abuse. Parents and other care-givers can work together on solutions for managing the problem of parent abuse whether it is directed at one or both parties. Parents can only work together if they talk to one another to understand the full extent of the problem. Now is the time for trust, not accusation, especially if the parents are no longer together. Adults will do many things, but they won’t lie about something as serious as parent abuse at the hands of their own child.

Help your teen understand what you expect. Consider the use of behavior contracts and family meetings. Remove privileges when necessary and spend time together doing things you both enjoy.

For many parents, parent abuse feels like the outcome of a job not so well-done. Many parents feel like the abuse means they have failed themselves and their children. When you start beating yourself up about the way you are being treated by your teen, it may be helpful to remember that you are not your child’s only or sole influence. Your children encounter many people and experiences that happen completely outside of your relationship with them. Maybe you didn’t have a part in causing what is happening now, but you do have some power to direct how your relationship will be going forward. Choose to use it as best as the situation allows.

Much of our self-talk is reasonable — ‘I’d better do some preparation for that exam’, or ‘I’m really looking forward to that match’. However, some of our self-talk is negative, unrealistic or self-defeating — ‘I’m going to fail for sure’, or ‘I didn’t play well! I’m hopeless’.

Self-talk is often skewed towards the negative, and sometimes it’s just plain wrong. If you are experiencing depression, it is particularly likely that you interpret things negatively. That’s why it’s useful to keep an eye on the things you tell yourself, and challenge some of the negative aspects of your thinking.

You can test, challenge and change your self-talk. You can change some of the negative aspects of your thinking by challenging the irrational parts and replacing them with more reasonable thoughts.

With practice, you can learn to notice your own negative self-talk as it happens, and consciously choose to think about the situation in a more realistic and helpful way.

Challenging the Self-Talk

Disputing your self-talk means challenging the negative or unhelpful aspects. Doing this enables you to feel better and to respond to situations in a more helpful way.

Learning to dispute negative thoughts might take time and practice, but is worth the effort. Once you start looking at it, you’ll probably be surprised by how much of your thinking is inaccurate, exaggerated, or focused on the negatives of the situation.

Whenever you find yourself feeling depressed, angry, anxious or upset, use this as your signal to stop and become aware of your thoughts. Use your feelings as your cue to reflect on your thinking.

A good way to test the accuracy of your perceptions might be to ask yourself some challenging question. These questions will help you to check out your self-talk to see whether your current view is reasonable. This will also help you discover other ways of thinking about your situation.

There are four main types of challenging questions to ask yourself:

1. Reality testing

• What is my evidence for and against my thinking?
• Are my thoughts factual, or are they just my interpretations?
• Am I jumping to negative conclusions?
• How can I find out if my thoughts are actually true?

2. Look for alternative explanations

• Are there any other ways that I could look at this situation?
• What else could this mean?
• If I were being positive, how would I perceive this situation?

3. Putting it in perspective

• Is this situation as bad as I am making out to be?
• What is the worst thing that could happen? How likely is it?
• What is the best thing that could happen?
• What is most likely to happen?
• Is there anything good about this situation?
• Will this matter in five years time?

When you feel anxious, depressed or stressed-out your self-talk is likely to become extreme, you’ll be more likely to expect the worst and focus on the most negative aspects of your situation. So, it’s helpful to try and put things into their proper perspective.

4. Using goal-directed thinking

• Is thinking this way helping me to feel good or to achieve my goals?
• What can I do that will help me solve the problem?
• Is there something I can learn from this situation, to help me do it better next time?

Recognizing that your current way of thinking might be self-defeating (e.g., it doesn’t make you feel good or help you to get what you want) can sometimes motivate you to look at things from a different perspective.

You can conquer your negative self-talk today by challenging yourself with these questions every time you catch yourself thinking something negative to yourself.

• An Introduction to ADHD
• Symptoms of ADHD
• Problems Related to ADHD
• Causes of ADHD
• How is ADHD diagnosed?
• Treatment of ADHD
• Additional Treatments for ADHD
• ADHD in Adults
• Getting Help for ADHD
• Future Directions in ADHD
• Resources for ADHD

Online Resources

If you’re looking for additional online resources, support groups, and information about ADHD, we recommend our ADHD Library and our ADHD resource directory of other online resources reviewed and vetted by Psych Central.
We also have a thriving online support group for ADHD.

Other Groups & Resources

Attention Deficit Information Network (Ad-IN)
475 Hillside Avenue
Needham, MA 02194
(781) 455-9895

Provides up-to-date information on current research,
regional meetings. Offers aid in finding solutions to practical
problems faced by adults and children with an attention
disorder.

ADD Warehouse
300 NW 70th Avenue
Plantation, FL 33317
(800) 233-9273

Distributes books, tapes, videos, assessment on attention
deficit hyperactivity disorders. A central location for ordering
many of the books listed above. Call for catalog.

Center for Mental Health Services
Office of Consumer, Family, and Public Information
5600 Fishers Lane, Room 15-105

Rockville, MD 20857
(301) 443-2792

This national center, a component of the U.S. Public Health
Service, provides a range of information on mental health,
treatment, and support services.

Children and Adults with Attention Deficit Disorders
(CH.A.D.D.)
499 NW 70th Avenue, Suite 101
Plantation, FL 33317
(800) 233-4050

A major advocate and key information source for people
dealing with attention disorders. Sponsors support groups and
publishes two newsletters concerning attention disorders for
parents and professionals.

Council for Exceptional Children
11920 Association Drive
Reston, VA 22091
(703) 620-3660

Provides publications for educators. Can also provide
referral to ERIC (Educational Resource Information Center)
Clearinghouse for Handicapped and Gifted Children.

Federation of Families for Children’s Mental Health
1021 Prince Street

Alexandria, VA 22314
(703) 684-7710

Provides information, support, and referrals through
federation chapters throughout the country. This national
parent-run organization focuses on the needs of children with
broad mental health problems.

HEATH Resource Center
American Council on Education
1 Dupont Circle, Suite 800
Washington, DC 20036
(800) 544-3284

A national clearinghouse on post-high school education for
people with disabilities.

Learning Disabilities Association of America
4156 Library Road
Pittsburgh, PA 15234
(412) 341-8077

Provides information and referral to state chapters, parent
resources, and local support groups. Publishes news briefs
and a professional journal.

National Association of Private Schools

for Exceptional Children

1522 K Street, NW, Suite 1032
Washington, DC 20005

(202) 408-3338

Provides referrals to private special education programs.

National Center for Learning Disabilities
99 Park Avenue, 6th Floor
New York, NY 10016
(212) 687-7211

Provides referrals and resources. Publishes Their World
magazine describing true stories on ways children and adults cope
with LD.

National Clearinghouse for Alcohol and Drug Information
P.O. Box 2345
Rockville, MD 20847
(800) 729-6686

Provides information on the risks of alcohol during
pregnancy, and fetal alcohol syndrome.

National Information Center for Children

and Youth with Disabilities (NICHCY)

P.O. Box 1492
Washington, DC 20013
(800) 695-0285

Publishes free, fact-filled newsletters. Arranges
workshops. Advises parents on the laws entitling children with
disabilities to special education and other services.

Sibling Information Network
A.J. Pappanikou Center
1776 Ellington Road
South Windsor, CT 06074

(203) 648-1205

Publishes a newsletter for and about siblings of children
with special needs.

Tourette Syndrome Association
42-40 Bell Boulevard
Bayside, NY 11361
(718) 224-2999

State and local chapters provide national information,
advocacy, research, and support.

This article is based upon a brochure published by the National Institute of Mental Health.

• An Introduction to ADHD
• Symptoms of ADHD
• Problems Related to ADHD
• Causes of ADHD
• How is ADHD diagnosed?
• Treatment of ADHD
• Additional Treatments for ADHD
• ADHD in Adults
• Getting Help for ADHD
• Future Directions in ADHD
• Resources for ADHD

Although no immediate cure is in sight, a new understanding of attention deficit disorder (ADHD) may be forthcoming. Using a variety of research tools and methods, scientists are beginning to uncover new information on the role of the brain in ADHD and effective treatments for the disorder Such research will ultimately result in improving the personal fulfillment and productivity of people with ADHD.

For example, the use of new techniques like brain imaging to observe how the brain actually works is already providing new insights into the causes of ADHD. Other research is seeking to identify conditions of pregnancy and early childhood that may cause or contribute to these differences in the brain. As the body of knowledge grows, scientists may someday learn how to prevent these differences or at least how to treat them.

Researchers are also trying to determine if there are different varieties of attention deficit. With further study, researchers may find that ADHD actually covers a number of different disorders, each with its own cluster of symptoms and treatment requirements. For example, scientists are exploring whether there are any critical differences between children with ADHD who also have anxiety, depression, or conduct disorders and those who do not. Other researchers are studying slight physical differences that might distinguish one type of ADHD from another. If clusters of differences can be found, scientists can begin to distinguish the treatment each type needs.

Future ADHD Medications

A new drug with a nonstimulant mechanism of action may be approved in 2009 for the treatment of attention-deficit/hyperactivity disorder (ADHD). Intuniv (guanfacine extended-release tablets) is a selective alpha2A-agonist in development by Shire for the once-daily treatment of ADHD. The company submitted an NDA for monotherapy for the treatment of ADHD symptoms throughout the day in children aged 6 to 17 years and received an approvable letter from the FDA in June 2007.

The FDA requested additional information, and the company has been conducting additional clinical work related to the drug’s label.

Immediate-release guanfacine, a medication used to treat high blood pressure, also is used off-label in ADHD.

Anticipated advantages of Intuniv over guanfacine include FDA approval specifically for ADHD and maintenance of blood concentration in the therapeutic range, which is problematic with immediate-release formulations. Another potential advantage: Intuniv is not a controlled substance, and is not associated with any known mechanisms for potential abuse or dependence.

An estimated 30% of children with ADHD cannot tolerate stimulant drugs or do not benefit from currently available ADHD medications. Intuniv also might have applications in combination with stimulant drugs to reduce aggression and insomnia associated with stimulants and adult patients. Shire hopes to gain FDA approval and launch Intuniv in the second half of 2009.

Additional Research into ADHD

Additional research is examining the long-term outcome of ADHD. How do children with ADHD turn out, compared to brothers and sisters without the disorder? As adults, how do they handle their own children? Still other studies seek to better understand ADHD in adults. Such studies give insights into what types of treatment or services make a difference in helping an ADHD child grow into a caring parent and a well-functioning adult.

Animal studies are also adding to our knowledge of ADHD in humans. Animal subjects make it possible to study some of the possible causes of ADHD in ways that can’t be studied in people. In addition, animal research allows the safety and effectiveness of experimental new drugs to be tested long before they can be given to humans. One NIH-sponsored team of scientists is studying dogs to learn how new stimulant drugs that are similar to Ritalin act on the brain.

Piece by piece, through studies of humans and animals, scientists are beginning to understand the biological nature of attention disorders. New research is allowing us to better understand the inner workings of the brain as we continue to develop new medications and assess new forms of treatment.

This article is based upon a brochure published by the National Institute of Mental Health.

• An Introduction to ADHD
• Symptoms of ADHD
• Problems Related to ADHD
• Causes of ADHD
• How is ADHD diagnosed?
• Treatment of ADHD
• Additional Treatments for ADHD
• ADHD in Adults
• Getting Help for ADHD
• Future Directions in ADHD
• Resources for ADHD

Where does one turn when they suspect their child is suffering from attention deficit disorder (ADHD)?

Most families first turn to their family physician or pediatrician for help, which is often a good first step. However, a reliable diagnosis of ADHD is best made by a trained and experienced mental health professional who specializes in helping children with ADHD. Such professionals are usually child psychologists, child psychiatrists, as well as some developmental or behavioral pediatricians and behavioral neurologists. Clinical social workers may also have such training.

While some pediatricians may do the assessment themselves, parents should always ask for a referral to an appropriate mental health specialist. In addition, state and local agencies that serve families and children, as well as some of the volunteer organizations listed at the end of this document, can help identify appropriate specialists.

Knowing the differences in qualifications and services can help the family choose someone who can best meet their needs. There are several types of specialists qualified to diagnose and treat ADHD. Child psychiatrists are doctors who specialize in diagnosing and treating childhood mental and behavioral disorders. A psychiatrist can provide therapy and prescribe any needed medications. Child psychologists are also qualified to diagnose and treat ADHD. They can provide therapy for the child and help the family develop ways to deal with the disorder. But psychologists are not medical doctors and must rely on the child’s physician to do medical exams and prescribe medication. Neurologists, doctors who work with disorders of the brain and nervous system, can also diagnose ADHD and prescribe medicines. But unlike psychiatrists and psychologists, neurologists usually do not provide therapy for the emotional aspects of the disorder.

Within each specialty, individual doctors and mental health professionals differ in their experiences with ADHD. So in selecting a specialist, it’s important to find someone with specific training and experience in diagnosing and treating the disorder.

This article is based upon a brochure published by the National Institute of Mental Health.

• An Introduction to ADHD
• Symptoms of ADHD
• Problems Related to ADHD
• Causes of ADHD
• How is ADHD diagnosed?
• Treatment of ADHD
• Additional Treatments for ADHD
• ADHD in Adults
• Getting Help for ADHD
• Future Directions in ADHD
• Resources for ADHD

When people think about attention deficit disorder (ADHD), they usually consider it a childhood problem. However, a large proportion — between 30 and 70 percent — of children with the condition remain affected throughout adulthood.

In the late 1970s, the first studies were done into adult attention deficit disorder. Individuals were retrospectively diagnosed in their childhood through assessment by interview. As a result, standardized criteria were set down to help specialists diagnose ADHD in adults, called the Utah Criteria. These, and other newer tools such as the Conners Rating Scale and the Brown Attention Deficit Disorder Scale, combine data on personal history and current symptoms.

In general, adults with the condition will not have considered ADHD as an explanation for their problems, which may include poor organizational skills, bad time-keeping and lack of sustained attention. Their everyday lives can be full of challenges that are not experienced by adults without the disorder, so diagnosis can be a great relief.

ADHD Diagnosis in Adults

Because adults with ADHD do not usually believe they have the condition, it may take a specific event to trigger their suspicions. For example if their child is being assessed for or has been diagnosed with ADHD, or once the adult seeks medical advice for another issue such as anxiety, depression or an addiction.

For the diagnosis to be given to an adult, the individual must have symptoms which began in childhood and are ongoing up to the present. These may include distractibility, impulsivity and restlessness. Diagnosis must be accurate and is best undertaken by an expert in adult ADHD. It will include taking a personal history and often involve gathering information from one or more of the individual’s close relatives, friends or colleagues. The specialist will want to check for other undiagnosed conditions (such as learning disabilities, anxiety, or affective disorders), and may give a physical examination as well as the usual psychological tests.

Having been diagnosed with ADHD, an adult can start to make sense of the problems they may have suffered for a long time. It can help him let go of bad feelings about himself, and improve low self-esteem. It can also aid close relationships by giving others an explanation for unusual behaviors. To help face up to and overcome these issues, the individual may wish to begin psychotherapy or other counseling.

ADHD Treatment in Adults

Medical treatment for adult ADHD can be similar to that for children — many of the same stimulant drugs can be of benefit, including the newer drug Strattera (atomoxetine).

Another useful category of drugs for adults with ADHD are the antidepressants, either alongside or instead of stimulants. Antidepressants which target the brain chemicals dopamine and norepinephrine are the most effective. These include the older form of antidepressant known as the tricyclics. In addition, the newer antidepressant drug Venlafaxine (Effexor) may be helpful. The antidepressant Bupropion (Wellbutrin) has been found useful in trials of adult ADHD, and may also help reduce nicotine cravings.

The effects of drugs can be different in adults and children. This must be taken into account when treating adult attention deficit disorder, as must any other medications which will be taken at the same time for psychological or physical conditions, so that adverse interactions are avoided.

As well as drug treatment, adults with ADHD can benefit from education and psychotherapy. Learning about the condition is likely to give a sense of empowerment. With assistance, the patient can devise techniques to counter the effects of the disorder. It may be a good idea to set up systems involving well-planned calendars, diaries, lists, notes, and official locations for important items such as keys and wallets. Paperwork systems can help reduce the potential confusion of bills and other vital documents and correspondence. Such routines will give a sense of order and achievement.

Psychotherapy can provide an opportunity to explore emotions related to ADHD, such as anger that the problem was not diagnosed much earlier. It may boost self-esteem through improved self-awareness and compassion, and offer support during the changes brought about through medication and conscious efforts to alter behavior and limit any destructive consequences of ADHD.

The therapist can also help their patient see the beneficial effects of high energy levels, spontaneity and enthusiasm that ADHD can bring.

This article is based upon a brochure published by the National Institute of Mental Health.

• An Introduction to ADHD
• Symptoms of ADHD
• Problems Related to ADHD
• Causes of ADHD
• How is ADHD diagnosed?
• Treatment of ADHD
• Additional Treatments for ADHD
• ADHD in Adults
• Getting Help for ADHD
• Future Directions in ADHD
• Resources for ADHD

If you use only medication to try and treat attention deficit hyperactivity disorder (ADHD), you’re likely to only get a partial response that does little to help the child or adult with all of the effects of living with ADHD. Psychotherapy and other specific therapeutic interventions are not only important options to consider — they are mandatory in order to treat the long-term issues that go hand-in-hand with attention deficit disorder.

Once some of the behavior problems are under control, the child may be better able to understand the challenges they may have caused to the people around them. Everyone involved can benefit from techniques to manage the past and present consequences of ADHD behavior, and counseling the child and the family group may offer a solution.

Parenting training has been shown to be an effective and an important component of any treatment of ADHD in children. Parents who have a child with an attention deficit disorder should look into getting such training from an ADHD coach or therapist with experience in helping parents with ADHD. These parent training exercises help the parent learn to help their child who has attention deficit disorder, keep their behavior on-task, and correct it in a positive and reinforcing manner when needed. Think of the TV show, “Super Nanny” — except that the therapist helps the parents learn how to best help their child with ADHD.

Psychotherapy for ADHD

We have decades’ worth of research demonstrating the effectiveness of a wide range of psychotherapies for the treatment of ADHD in both children and adults. Some people turn to psychotherapy instead of medication, as it is an approach that does not rely on taking stimulant medications. Others use psychotherapy as an adjunct to medication treatment. Both approaches are clinically accepted.

In psychotherapy (commonly, cognitive-behavioral therapy for ADHD), the child can be helped to talk about upsetting thoughts and feelings, explore self-defeating patterns of behavior, learn alternative ways to handle emotions, feel better about him or herself despite the disorder, identify and build on their strengths, answer unhealthy or irrational thoughts, cope with daily problems, and control their attention and aggression. Such therapy can also help the family to better handle the disruptive behaviors, promote change, develop techniques for coping with and improving their child’s behavior.

Behavioral therapy is a specific type of psychotherapy that focuses more on ways to deal with immediate issues. It tackles thinking and coping patterns directly, without trying to understand their origins. The aim is behavior change, such as organizing tasks or schoolwork in a better way, or dealing with emotionally charged events when they occur. In behavior therapy, the child may be asked to monitor their actions and give themselves rewards for positive behavior such as stopping to think through the situation before reacting.

Psychotherapy will also help a person with attention deficit disorder to boost their self-esteem through improved self-awareness and compassion. Psychotherapy also offers support during the changes brought about through medication and conscious efforts to alter behavior, and can help limit any destructive consequences of ADHD.

Social Skills Training for ADHD

Social skills training teaches the behaviors necessary to develop and maintain good social relationships, such as waiting for a turn, sharing toys, asking for help, or certain ways of responding to teasing. These skills are usually not taught in the classroom or by parents — they are typically learned naturally by most children by watching and repeating other behaviors they see. But some children — especially those with attention deficit disorder — have a harder time learning these skills or using them appropriately.

Social skills training helps the child to learn and use these skills in a safe practice environment with the therapist (or parent).
Skills include learning how to have conversations with others, learning to see others’ perspective, listening, asking questions, the importance of eye contact, what body language and gestures are telling you.

Social skills training is done in a therapy office, or parents can learn them and teach them in the home. The therapist teaches the behaviors that are appropriate in different situations and then those new behaviors are practiced with the therapist. Clues that can be taken from people’s facial expressions and tone of voice may be discussed.

Support Groups for ADHD

Mutual self-help support groups can be very beneficial for parents and individuals with ADHD themselves. A sense of regular connection to others in the same boat leads to openness, problem-sharing, and sharing of advice. Concerns, fears and irritations can be released in a compassionate environment where members can safely let off steam and know that they are not alone.
As well as this type of support, the groups can invite experts to give lectures and answer specific questions. They can also help members to get referrals to reliable specialists.

Psych Central hosts two support groups online for people with attention deficit disorder: Psych Central ADHD support group and NeuroTalk’s ADHD support group.

• An Introduction to ADHD
• Symptoms of ADHD
• Problems Related to ADHD
• Causes of ADHD
• How is ADHD diagnosed?
• Treatment of ADHD
• Additional Treatments for ADHD
• ADHD in Adults
• Getting Help for ADHD
• Future Directions in ADHD
• Resources for ADHD

Treatment for attention deficit hyperactivity disorder (ADHD) has two important components — psychotherapy interventions (for both the child and the parents; or the adult with ADHD) and medications. There is a significant amount of research demonstrating that medication alone won’t really help address so many of the core issues a child (or adult) with ADHD has. So while a medication may help with immediate relief, the person with attention deficit disorder still often needs to learn the skills needed to be successful while living with the disorder.

This treatment article is divided into two major sections — medication treatments for ADHD are covered in the rest of this article, whicle psychotherapy and other treatments for ADHD are covered in the next section.

In the past, ADHD treatment has typically focused on medications. The specific class of medication most commonly prescribed for ADHD is stimulants. These stimulant medications — like Ritalin (methylphenidate) or Adderall (an amphetamine) — are commonly prescribed, well-tolerated, act quickly (usually soon after a person takes them), and in most people, have few side effects. These medications also have a robust research base supporting their effectiveness in treatment of attention deficit disorder.

Children vary a great deal in their response to medication treatments. Finding the combination with the highest efficacy and fewest side-effects is a challenge in every case. A child’s prescribing physician (preferably, a child psychiatrist rather than a general practitioner or pediatrician) will aim to discover the medication and dose that’s best for your child. If one medication doesn’t appear to be working after a few weeks of treatment, a doctor will often try another medication. This is normal and most people will switch medications to find the one that works best for them at least once.

The side effects of stimulants may include reduced appetite, headache, a “jittery” feeling, irritability, sleep difficulties, gastrointestinal upset, increased blood pressure, depression or anxiety, and/or psychosis or paranoia. If you experience any of these symptoms, you should talk to your doctor.

Many parents may be concerned about having stimulant medications prescribed to their child. This is a typical concern amongst parents, but such medications are not addicting, nor do they produce a “high” in a person with ADHD who takes them. Researchers are still unclear as to why stimulant medications do not “over-stimulate” people who take them, but it is hypothesized that people with ADHD have a problem with certain neurotransmitters in their brain that the medication helps correct. We do not yet know exactly why some drugs help some people, but not others, nor the exact mechanism that makes stimulants effective. We do know that they work in most people who take them, effectively treating the symptoms of attention deficit disorder.

Medications Used to Treat ADHD

Stimulant medications commonly prescribed for attention deficit disorder include methylphenidate (Ritalin, Concerta, Metadate, Methylin) and certain amphetamines (Dexedrine, Dextrostat, Adderall). Methylphenidate is a short acting drug, and in older forms, had to be taken multiple times a day. Longer-acting versions of the drug are now available for once-daily use. Although taking stimulants for treatment may seem risky, there is significant research that demonstrates that when taken as directed by your psychiatrist or physician, they are safe and effective in the treatment of adult ADHD.

Drug treatment for ADHD began decades ago. Some of the best results have been found with the stimulant drugs listed below. “Approved age” means that the drug has been tested and found safe and effective in children of that age.

Stimulant drugs are often beneficial in curbing hyperactivity and impulsivity, and helping the individual to focus, work, and learn. Sometimes the drugs will also help with coordination problems which may hinder sports and handwriting.

Under medical supervision, these stimulant drugs are quite safe and do not make the child feel “high”, although they may feel slightly different. To date, there is not convincing evidence that children risk becoming addicted to these drugs, when used for ADHD. In fact, a study at Massachusetts General Hospital and Harvard Medical School found that substance abuse rates were lower among teenagers with ADHD who stayed on their medication than those who stopped.

Many of the stimulant drugs come in short-term and long-term forms, and some are made as “sustained-release” — they are taken in the morning before school and are effective all day. The most suitable preparation for each child will be discussed by the parents and physician.

Even after adjusting the type and dosage of medications, about ten per cent of children will gain no benefit from stimulant drugs. In this case, other types of drug can be tried, such as antidepressants.

Occasionally a child may be prescribed a drug “off label”, meaning that its use in children, or for ADHD has not yet been approved by the FDA. This is common with newer drugs, many of which are given for ADHD. Later studies will produce better evidence on their safety and effectiveness.

Other, newer kinds of drugs, have also been approved for the treatment of attention deficit disorder. These non-stimulant medications include Strattera (atomoxetine, a selective norepinephrine reuptake inhibitor) and Vyvanse (lisdexamfetamine dimesylate). These drugs typically offer similar benefits to stimulants, but act in a different way on the brain. Some people may find they better tolerate these drugs.

Another useful category of drugs for adults with ADHD are the antidepressants, either alongside or instead of stimulants. Antidepressants which target the brain chemicals dopamine and norepinephrine are the most effective. These include the older form of antidepressant known as the tricyclics, as well as new antidepressants, such as Venlafaxine (Effexor). The antidepressant Bupropion (Wellbutrin) has been found useful in trials of adult ADHD, and may also help reduce nicotine cravings.

ADHD Drug Side-effects

The majority of side-effects are minor and do not result in stopping the medication. They may be alleviated by lowering the dosage, but you should always consult the prescribing physician before making any changes to you or your child’s medication.

For most medications prescribed for attention deficit disorder, the most commonly observed side-effects are:

• Decreased appetite – often low in the middle of the day and more normal by suppertime. Good nutrition is a priority
• Insomnia – may be relieved by taking the drug earlier in the day, or adding an antidepressant
• Increased anxiety and/or irritability
• Mild stomach aches or headaches
• Tics (more rare)

These medications only control ADHD symptoms on the day they are taken, so it’s important to remember that the disorder is not actually cured. While drugs can enable the child to use their skills more easily, an effort is still needed to improve schoolwork or knowledge in other areas.

As well as medication, behavioral therapy, emotional counseling, and practical support will also help children with ADHD cope with the disadvantages of the disorder.

Helpful Hints About Medication:

• ADHD drugs can help a child focus and improve behavior in many settings
• They may help reduce or avoid emotional problems or addictions
• Four out of five children with ADHD will still need medication as teenagers, and over half as adults
• Children who also have bipolar disorder, and are taking drugs such as lithium or Depakote, may or may not be suitable for ADHD medication as well. If so, it may be given at a lower dose.

Research References

One of the large-scale studies that examined medication treatment for ADHD is called the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (or MTA). The MTA included 579 elementary school boys and girls with ADHD. Four treatment four treatment programs were compared: (1) medication management alone; (2) behavioral treatment alone; (3) a combination of both; or (4) routine community care.

Treatment was given for 14 months, during which the children were regularly assessed for ADHD symptoms by specialists and teachers.

The children on medication were seen by the prescribing physician once a month. Those given behavioral treatment met with a behavior therapist up to 35 times and attended a special 8-week summer camp. The routine community care group saw a community-treatment doctor, selected by the parents, once or twice a year.

The best improvements were seen in the group given combined treatments, and the group on medication alone. Of these, combined treatment led to the biggest improvements in anxiety, academic performance, oppositionality, parent-child relations, and social skills. In addition, some children in the combined group could be successfully treated on lower does of medication than those on medication alone.

Another NIMH-funded study investigated drug treatments for pre-schoolers with ADHD. The Treatment of Attention Deficit Hyperactivity Disorder in Preschool-Age Children (PATS) study included 165 children, aged 3 to 5.5 years. It examined the safety and efficacy of a stimulant drug called methylphenidate, which has been widely given to children under the age of 6, despite a lack of evidence on safety and efficacy.
The children appeared to benefit from low doses of methylphenidate, but 11 per cent stopped using the drug because of side-effects. The drug was effective at doses from 7.5 to 30 mg/day, with a mean optimal dose of 14.22 mg/day. (Average adult daily dosage is between 20 mg and 30 mg).

The researchers said that more children taking the drug showed a decrease of ADHD symptoms than did those on placebo. They suggest that preschoolers be started at low doses, and that further studies are needed to test higher doses.

Overall, 30 per cent of parents reported adverse events in their children, including emotional outbursts, difficulty falling asleep, repetitive behaviors/thoughts, irritability, and decreased appetite. But these may have been due as much to lack of medication efficacy as to the action of the drug, said the researchers.

Nevertheless, due to fears over side-effects, preschoolers with ADHD on methylphenidate treatment need to be carefully monitored, they concluded.

This article contains information from a brochure published by the National Institute of Mental Health.

• An Introduction to ADHD
• Symptoms of ADHD
• Problems Related to ADHD
• Causes of ADHD
• How is ADHD diagnosed?
• Treatment of ADHD
• Additional Treatments for ADHD
• ADHD in Adults
• Getting Help for ADHD
• Future Directions in ADHD
• Resources for ADHD

While the symptoms of attention deficit disorder (ADHD) may appear commonplace in many people’s behavior (as many symptoms for mental disorders are), there are a set of specific diagnostic criteria used by trained mental health professionals to make the diagnosis.

The official diagnostic criteria for ADHD state that the symptoms must occur beyond the extent that is normal for the person’s age, and must occur in a variety of different situations (e.g., not just school). For a diagnosis of ADHD, the symptoms must also have appeared before the age of 7 (for childhood ADHD), and have continued for at least 6 months.

Impairments due to the symptoms of ADHD must also have been observed in at least two different settings, such as at school, at work, in the community, at social events, or at home. For example, a child who is overly active in the playground but has no problems concentrating on their schoolwork may not be appropriate for a diagnosis of ADHD.

So the critical questions to consider before an ADHD diagnosis is made are whether the symptoms are: (a) excessive compared with what would be expected; (b) longer-term rather than in response to a recent change; and (c) pervasive rather than limited to one environment.

ADHD Diagnosed in Children

The signs of possible attention deficit disorder may first be noticed long before the child begins school. Their lack of attention, hyperactivity, and impulsivity may be seen when these lose interest in playing a game or watching a TV show, or if the child runs around and seems completely out of control. Parents may feel it is necessary to contact a pediatrician or a child psychologist to undergo an assessment of whether or not their child’s behavior is appropriate for their age. Often they will be reassured that the child is behaving within normal limits and is just unusually exuberant or a little immature for their developmental stage.

Sometimes it’s another adult who first suspects that a child may have attention deficit disorder, such as a babysitter or teacher. Teachers with experience of the disorder are particularly well-placed to identify the symptoms of ADHD, especially as the symptoms are particularly evident in the school environment when teachers have come to know how children “typically” behave. The inattentive form of ADHD may be missed for some time in pupils who are seemingly cooperative.

Once a specialist is consulted, the professional will begin to gather information on the child’s unusual behavior and rule out possible causes other than ADHD, for example:

• A sudden change in the child’s life, such as death of a close relative, divorce, or a parent’s job loss
• Previously undetected seizures
• Middle ear infection, which can cause hearing problems
• Other types of medical disorder that may be affecting the child’s brain
• Learning disability
• Anxiety and/or depression

These factors can usually be ruled out with help from the parents and school, but tests may be necessary. Alongside this information, the specialist will find out how the child’s behavior is currently being handled, and look into the nature of the child’s home and school to find out if they are unusually stressful or chaotic.

The child will then be assessed directly, and their behavioral symptoms will be observed in a range of environments and compared against those set out in the diagnostic manual. The specialist will give special attention to the child’s behavior during situations which call for the most self-control, and noisy or unstructured situations such as parties. Their response to during needing sustained attention (reading, working math problems, or playing a board game) will be observed.

This data will allow the specialist to pieces together a profile of the child, finding out which specific ADHD symptoms the child shows, how often, and in which situations. Children with ADHD will vary on their age when symptoms began, the pattern of symptoms – whether they are chronic or come and go in phases, and the extent to which they interfere with aspects of the child’s life such as friendships, school activities, home life, and community activities.

Other related problems, if they exist, may also be identified during diagnosis.

The assessment will include speaking with teachers who have taught the child since they began school. Standard evaluation forms — known as behavior rating scales — are filled in by the teachers, rating their observations of the child’s behavior. Results are then compared with what would be considered “normal”.

Interviews also take place with the child’s teachers, parents, and possibly other adults who know the child well. They will be questioned on how the child behaves in many settings, and may be given a rating scale to mark the severity and frequency of the behavior.

Further tests that are often given include: social adjustment, mental health, intelligence, and learning achievement.

• An Introduction to ADHD
• Symptoms of ADHD
• Problems Related to ADHD
• Causes of ADHD
• How is ADHD diagnosed?
• Treatment of ADHD
• Additional Treatments for ADHD
• ADHD in Adults
• Getting Help for ADHD
• Future Directions in ADHD
• Resources for ADHD

As with all mental disorders, the exact cause of attention deficit disorder (ADHD) is unknown, so parents should not blame themselves for this problem. It is likely that many factors play a role in each case of ADHD, very little of which has to do with specific parenting or child rearing skills.

Inevitably, parents will ask themselves “What did I do to cause this?” or “How could I have prevented it?”, but most of the evidence points to genetic factors, environmental facts or brain damage.

Instead, parents should focus on how best to help their child with ADHD. Experts hope that someday, understanding the causes of the condition will lead to effective therapies, and evidence is building on the side of genetic causes for ADHD rather than elements of the home environment. Certain aspects of a child’s environment may, however, affect the symptom severity of ADHD once it is established.

Possible causes of ADHD include:

Genes

ADHD has a strong genetic basis in the majority of cases, as a child with ADHD is four times as likely to have had a relative who was also diagnosed with attention deficit disorder. At the moment, researchers are investigating many different genes, particularly ones involved with the brain chemical dopamine. People with ADHD seem to have lower levels of dopamine in the brain.

Children with ADHD who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. Research into this gene has showed that the difference are not permanent, however. As children with this gene grow up, their brains developed to a normal level of thickness and most ADHD symptoms subsided.

Nutrition and Food

Certain components of the diet, including food additives and sugar, can have clear effects on behavior. Some experts believe that food additives may exacerbate ADHD. And a popular belief is that refined sugar may be to blame for a range of abnormal behaviors.

However, the belief that sugar is one of the primary causes of attention deficit disorder does not have strong support in the research data. While some older studies did suggest a link, more recent research does not show a link between ADHD and sugar. While the jury is still out on whether sugar can contribute to ADHD symptoms, most experts now believe that the link is not a strong one. Simply removing sugar from a child’s diet is unlikely to significantly impact their ADHD behavior.

Some studies also suggest that a lack of omega-3 fatty acids is linked to ADHD symptoms. These fats are important for brain development and function, and there is plenty of evidence suggesting that a deficiency may contribute to developmental disorders including ADHD. Fish oil supplements appear to alleviate ADHD symptoms, at least in some children, and may even boost their performance at school.

The Environment

There may be a link between ADHD and maternal smoking. However, women who suffer from ADHD themselves are more likely to smoke, so a genetic explanation cannot be ruled out. Nevertheless, nicotine can cause hypoxia (lack of oxygen) in utero.

Lead exposure has also been suggested as a contributor to ADHD. Although paint no longer contains lead, it is possible that preschool children who live in older buildings may be exposed to toxic levels of lead from old paint or plumbing that has not been replaced.

Brain Injury

Brain injury may also be a cause of attention deficit disorder in some very small minority of children. This can come about following exposure to toxins or physical injury, either before or after birth. Experts say that head injuries can cause ADHD-like symptoms in previously unaffected people, perhaps due to frontal lobe damage.

Other Possible Causes

ADHD researchers are currently investigating the frontal lobes of the brain — the areas controlling problem-solving, planning, understanding other people’s behavior, and restraining our impulses.

The brain is divided into two halves, and the two frontal lobes communicate through a bundle of nerve fibers called the corpus callosum. These areas, and nearby brain cells, are being examined by ADHD researchers. Using brain imaging methods, the experts can get an idea of the location of the psychological deficits of ADHD.

A 2002 study found that children with ADHD had 3-4 percent smaller brain volumes in all the brain regions measured. But children on ADHD medication had similar brain volumes to unaffected children, in some of the areas measured.

One big difference was the amount of “white matter” — long-distance connections between brain regions that normally become stronger as a child grows up. Children with ADHD who had never taken medication had an abnormally small volume of white matter.

This article is based upon a brochure published by the National Institute of Mental Health.

• An Introduction to ADHD
• Symptoms of ADHD
• Problems Related to ADHD
• Causes of ADHD
• How is ADHD diagnosed?
• Treatment of ADHD
• Additional Treatments for ADHD
• ADHD in Adults
• Getting Help for ADHD
• Future Directions in ADHD
• Resources for ADHD

ADHD is often present alongside other mental health problems, such as a learning disability or oppositional defiant disorder. When the individual is affected by such disorders, these should be treated in conjunction with ADHD, by a well-qualified mental health professional or team of specifically-trained professionals.

Some of the disorders often linked with ADHD:

Learning Disabilities

About 20 to 30 percent of children with ADHD also have a learning disability (LD). This is a problem that is unexpected given the child’s general intelligence In preschool children, this often appears as a difficulty understanding certain sounds or words and/or difficulty in expressing oneself in words. In school age children, reading or spelling disabilities, problems writing, and arithmetic disorders may appear. One specific type of reading disorder, dyslexia, is quite common. Reading disabilities affect up to eight percent of elementary school children.

A child with ADHD may struggle with learning, but he or she can often learn adequately once successfully treated for the ADHD, whereas a learning disability will need specific treatment.

Tourette Syndrome

Occasionally people with ADHD have an inherited neurological disorder called Tourette syndrome. This usually appears in childhood, and is characterized by multiple physical (motor) tics and at least one vocal (phonic) tic. These nervous tics and repetitive mannerisms may include eye blinks, facial twitches, grimacing, clearing the throats frequently, snorting, sniffing, or barking out words. These symptoms can be controlled with medication. Although this syndrome is rare, it is common for people with Tourette syndrome to have ADHD. Both disorders will require treatment that may include medications.

Oppositional Defiant Disorder

Oppositional Defiant Disorder is defined as an ongoing pattern of disobedient, hostile, and defiant behavior toward authority figures that goes beyond the bounds of normal childhood behavior. It affects up to half of all children with ADHD, particularly boys. To meet this diagnosis, the child’s defiance must interfere with their ability to function in school, home, or the community and have been happening for at least six months.
These children tend to act in ways that are stubborn and non-compliant, and may lose their temper, arguing with adults and refusing to obey rules. They may deliberately annoy people, blame others for their mistakes, be resentful, spiteful, or even vengeful.

Conduct Disorder

Conduct disorder is a more serious pattern of antisocial behavior which may eventually develop in 20 to 40 percent of children with ADHD. It is defined as a pattern of behavior in which the rights of others or the social norms are violated. Symptoms include over-aggressive behavior, bullying, physical aggression, cruel behavior toward people and pets, destruction of property, lying, truancy, vandalism, and stealing.

These children are at a high risk of getting into trouble at school or with the police. They are also at high risk for experimenting with drugs, and later dependence and abuse. They need immediate help, otherwise the conduct disorder may develop into antisocial personality disorder.

Anxiety and Depression

Children with ADHD can also struggle with anxiety and/or depression. Treatment for these problems can help the child to handle their ADHD more effectively. This works the other way too – effective treatment of ADHD can reduce the child’s anxiety or depression through improved confidence and ability to concentrate.

Bipolar Disorder

Because there are some symptoms which can be present both in ADHD and bipolar disorder, it is often difficult to differentiate between the two conditions. For this reason, there are no accurate statistics on how many children with ADHD also have bipolar disorder.

Bipolar disorder is a condition defined by extreme moods, occurring on a spectrum from debilitating depression to unbridled mania. Between these states, the individual can experience a normal range of moods.

However, bipolar disorder in children often involves a faster cycling of the extreme mood states, even within one hour. Children may also experience the symptoms of mania and depression simultaneously. Experts describe this pattern as a chronic mood dysregulation, including irritability.

The symptoms which can overlap between ADHD and bipolar disorder include high levels of energy and a reduced need for sleep. But elated mood and grandiosity – an inflated sense of superiority — are distinctive signs of bipolar disorder.

The Right to Ask Questions

Many elements of treatment vary from patient to patient. You should know how they apply to you specifically. Following are some questions you may want to ask about your individual treatment and choices:

1. What are the benefits and risks of my treatment?
2. Are there alternative treatments?
3. How likely is my treatment to be successful?
4. If I am unhappy with my therapy or with you, what do I do about it?

Where do I Turn for Help?

Before therapy begins. you also should discuss the logistics of your treatment. Misunderstandings about costs and arrangements can be a potential source of trouble, so make sure you understand everything from the beginning. Discuss what the time and length of your appointments will be, and agree about what will happen if you miss one or want to schedule an extra appointment.

The Right to Satisfaction

You always have the right to ask your therapist questions, whether these are about how the therapy will operate or about your therapist’s own credentials and training. Remember, if you are not satisfied with the therapy, you can end it at any time.

Be sure, however, that you’re not terminating simply because you’re feeling bad—that’s to be expected as your therapy does its work. On the other hand, if you find you are always uncomfortable with a therapist, try to figure out why so you can decide whether to continue or to terminate. You don’t have to love your therapist for your treatment to work, but you do need to trust him or her.

The Right to Confidentiality

You are protected by confidentiality in your discussions with your therapist. This means that, in general, your therapist is legally prohibited from revealing any information about your visits, including that you are in therapy in the first place.

Like any rule, however, this one has exceptions. If one of these exceptions applies to your therapy, and your therapist needs to break your confidentiality, it may seem to you like a violation of trust. For this reason, it is important that you know about these exceptions before your therapy begins.

About 2,000 new titles a year move on and off bookstore shelves — books that promise to help you stop grieving, to take away your pain, and to bring you hope if you feel hopeless. Are these books really helpful or are they only hype?

Clinical psychologist Joseph C. Kobos, who chairs the American Psychological Association’s (APA) Board of Professional Affairs, says, if a particular book has made the top 10 lists, it’s probably got some substance.” Kobos notes that M. Scott Peck’s book, “The Road Less Traveled,” has been on the best-seller list for 10 years. “I think people must be getting some value out of it to keep it there.”

The APA has no guidelines for the production of self-help books or on how to use them with patients, Kobos says. The association’s ethical standards urge psychologists who produce materials for the public to “present the material fairly and accurately, avoiding misrepresentation through sensationalism, exaggeration or superficiality. ”

Responsible Marketing?

But some say that psychologists largely have failed to develop and market their self-help books responsibly, says Gerald M. Rosen, Ph.D., a clinical associate professor in the departments of psychology and psychiatry at the University of Washington. “What I’m against is psychologists making exaggerated and untested claims,” he says.

Rosen, himself the author of “Don’t Be Afraid,” a self-help book on reducing fear, is the first to say that the promotional blurb on the jacket of his book is “exaggerated.” It reads: “In as little as six to eight weeks, without the expense of professional counseling, and in the privacy of your own home, you can learn to master those situations that now make you nervous or afraid.” Rosen complains it doesn’t mention that research findings “suggest that only 50 percent of people succeed at self-administered treatment.”

It’s difficult to test self-help approaches because they are hard to define. Does minimal contact with a therapist, such as weekly phone calls, take the “self’ out of “self-administered?” Does it matter that self-administered materials often are used to treat such limited problems as addictive behaviors? How often do self-help therapies that don’t work get written about?

For some self-help areas anyway, the outcome appears to be the same as those of treatments conducted by a therapist, according to “Psychological Science”. Another study found that most self-help consumers are satisfied with the results they receive from their reading. But for every study that appears to support the effectiveness of self-administered treatment, there’s another that denies it.

Books for Transitions

Self-help books that guide you through a life transition, such as pregnancy or divorce, may be particularly helpful, says Alan B. Siegel, Ph.D

“Transition books provide a kind of map of developmental transition,” he says. “Transitions have somewhat expectable stages, and there are different emotional reactions and developmental tasks associated with them. And they frequently are not known to people in general, and they may not be known to the therapist either.”

Siegel, author of the book, “Dreams that Can Change your Life: Navigating Life’s Passages through Turning Point Dreams” (Berkley Books, 1992), says transition books can help the therapist help you identify issues that wouldn’t have come up otherwise.

Self-help books may in fact be helpful, but don’t expect them to work magic. Books also may be helpful in combination with therapy. One approach may be to think of them as homework to be discussed with your therapist. Ask your therapist for suggestions of what books are best for you.