Father-Son Bonding: Learning to Love Your Child's ADHD

by Wendi Nelson

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My son came into the world without a sound. He seemed perfect from the start, with bright, curious eyes that scanned the room, absorbing every detail. My wife and I named him Drew - meaning "intelligent," according to our baby name book - because we sensed he was a smart one. As I held him for the first time, I felt lucky to be the father of this perfect little boy.

Years passed, and I watched with dismay as Drew changed from that perfect child in the delivery room into a boy with significant developmental delays.

He would hit his friends to let them know he was happy, no matter how many times we told him not to. When he entered school, we noticed that he was slower than his peers at understanding abstract ideas.

I vividly recall the evening my wife, Wendi, patiently explained the concept of death to Drew. When she finished, she asked if he had any questions. "Yes," he replied. "Did you ever die?"

Still, Wendi and I wouldn't admit to ourselves the severity of his delays until we finally heard a doctor say, "He's years behind where he should be." I went from wondering how I was going to pay for a Harvard education to watching Drew climb aboard the special-ed bus each morning. There was no denying that Drew was different from other kids, but I was convinced that if I tried hard enough, I could make him "normal."

At age six, Drew joined a T-ball league. But he seemed to spend most of his time picking dandelions in the outfield. He couldn't understand why his teammates were running all over the place to catch a ball when there were so many beautiful flowers to gather.

Drew moved on to soccer, but he proved less interested in chasing the ball than in playing with the drinking fountain at the edge of the field. In karate class, he spent most of his time putting the other kids in headlocks - something his instructor frowned upon. Nothing really engaged him except building Lego masterpieces.

At age seven, Drew was diagnosed with attention deficit disorder (ADD ADHD). His odd behavior continued. Still, I was determined to find something he could do like any other little boy. So I signed him up for Boy Scouts, volunteering to be the troop leader.

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This article comes from the October/November 2005 issue of ADDitude.

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We started off with a series of weekend hikes. Halfway through each outing, I found myself carrying Drew's backpack, along with my own, as he kept stopping to examine anthills or use a stick to trace pictures in the dirt.

By the time we made it to the campsite, the other kids had long since pitched their tents and were gathered around the campfire. My co-leader would optimistically remark on how great Drew was doing. I felt like screaming but comforted myself with the belief that scouting was helping Drew have a happy childhood.

Still, I was really looking forward to our next outing: a 30-mile canoe trip down the Colorado River. The first day was magnificent, perfect weather for a float trip. But Drew wasn't much of a paddler. He didn't so much stroke as he simply stirred the water. Despite my best efforts at teaching Drew how to paddle correctly, we fell far behind the other canoes. It was a long first day.

When we finally reached our campsite, I lost my footing getting out of the canoe and toppled into the water. Drew ran off without a word - he hadn't even noticed. Exhausted and cold, I quickly inhaled some food and said goodnight to Drew, who seemed captivated by the moths circling our lantern.

The next morning, I felt re-energized. If I paddled harder, I reasoned, Drew and I would be able to keep up with the other canoes. But, once again, we fell behind, losing contact with the nearest canoe barely two hours into the trip. Drew and I were alone on the river.

As I sat there in the blazing sun, I felt more frustrated than ever. Drew, oblivious to my disappointment, was peering into the water, looking for fish. Why me, I wondered. Why couldn't Drew be like any other boy who could paddle a canoe, kick a goal, or hit a home run?

Then I began to wonder: What in the world was I doing? Why was I obsessed with having a son like everyone else's? Drew pointed at a butterfly that had perched atop his shoe and gave me a big smile. And there it was, right in front of me: It didn't matter that Drew had no interest in hitting a home run or being the fastest down the river. He was too busy discovering the world around him. No, this wasn't the little boy I'd had such hopes for in the hospital so long ago. But he was happy.

In camp that evening, Drew watched as a pair of dragonflies danced above his head. He turned to me and said, "This is the best trip ever." In that moment, for the first time in a very long while, I felt lucky to be Drew's dad.

ADHD Parenting Advice from Michael Phelps' Mom

by Judy Dutton

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“We worked as a team to overcome ADD”

Debbie Phelps, middle-school principal in Towson, Maryland, and mother of Olympic swimmer Michael Phelps

No doubt about it, Michael Phelps has made waves in his chosen sport. In 2004, at the age of 18, he swam his way to eight medals (six of them gold) at the summer Olympics in Athens. Now 21, he holds 13 world records, including the 200-meter butterfly and the 4 x 100-meter freestyle relay.

Yet Michael might not have loved swimming at all, were it not for the ingenuity of his mother, Debbie Phelps. “At age seven, he hated getting his face wet,” says Debbie. “We flipped him over and taught him the backstroke.”

Michael showed swimming prowess on his back, then on his front, side, and every way in between. But in the classroom, he floundered. An inability to concentrate was his biggest problem.

“I was told by one of his teachers that he couldn’t focus on anything,” says Debbie. She consulted a doctor, and nine-year-old Michael was diagnosed with ADHD.

“That just hit my heart,” says Debbie. “It made me want to prove everyone wrong. I knew that, if I collaborated with Michael, he could achieve anything he set his mind to.”

Debbie, who had taught middle school for more than two decades, began working closely with Michael’s school to get him the extra attention he needed. “Whenever a teacher would say, ‘Michael can’t do this,’ I’d counter with, ‘Well, what are you doing to help him?’” she recalls.

After Michael kept grabbing a classmate’s paper, Debbie suggested that he be seated at his own table. When he moaned about how much he hated reading, she started handing him the sports section of the paper or books about sports. Noticing that Michael’s attention strayed during math, she hired a tutor and encouraged him to use word problems tailored to Michael’s interests: “How long would it take to swim 500 meters if you swim three meters per second?”

At swim meets, Debbie helped Michael stay focused by reminding him to consider the consequences of his behavior. She recalls the time when 10-year-old Michael came in second and got so upset that he ripped off his goggles and threw them angrily onto the pool deck.

During their drive home, she told him that sportsmanship counted as much as winning. “We came up with a signal I could give him from the stands,” she says. “I’d form a ‘C’ with my hand, which stood for ‘compose yourself.’ Every time I saw him getting frustrated, I’d give him the sign. Once, he gave me the ‘C’ when I got stressed while making dinner. You never know what’s sinking in until the tables are turned!”

Debbie used various strategies to keep Michael in line. Over time, as his love of swimming grew, she was delighted to see that he was developing self-discipline. “For the past 10 years, at least, he’s never missed a practice,” she says. “Even on Christmas, the pool is the first place we go, and he’s happy to be there.”

Debbie also made sure to listen to her son. In the sixth grade, he told her he wanted to stop taking his stimulant medication. Despite serious misgivings, she agreed to let him stop — and he did fine. Michael’s busy schedule of practices and meets imposed so much structure on his life that he was able to stay focused without medication.

Debbie and Michael didn’t see eye to eye on every challenge that came his way, but he always understood the role she played in his swimming success. Immediately after being awarded his first gold medal at Athens, he stepped off the winner’s platform and walked to the stands, to hand Debbie a bouquet and the garland that crowned his head. That moment is vivid in Debbie’s memory. “I was so happy, I was in tears,” she recalls.

Michael now attends the University of Michigan, where he’s majoring in sports marketing, while training for the 2008 Olympics. Debbie has become the principal of Windsor Mill middle school in Baltimore, Maryland. She applies what she learned raising Michael to all of her students, whether or not they have ADHD. “All kids can fail us at times,” she says. “But if you work with them, nine times out of 10, they’ll make you proud.”

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This article comes from the April/May 2007 issue of ADDitude.

To read this issue of ADDitude in full, purchase the back issue and SUBSCRIBE NOW to ensure you don't miss a single issue.

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What does it take to succeed despite attention deficit disorder (ADD ADHD)?

It takes hard work, for starters — a willingness to meet challenges head-on. It takes support from family members, teachers, therapists, and coaches. And, of course, it’s hard to overstate the benefits of ADHD medication.

But, of all the ingredients needed to make a happy, successful life, nothing is more important than good parenting. Behind almost every ADHD success story is a devoted parent (or two). In honor of mothers, let’s give credit where credit is due — and heed their ADHD parenting advice.

The three mothers profiled here helped their sons and daughters achieve great things — more than they could have imagined. Steadfast and resourceful, they saw strength where others saw weakness, and kept looking for ways to help their children after others were ready to give up. Let their stories inspire you!

Study First to Link TV Sex To Real Teen Pregnancies

By Rob Stein
Washington Post Staff Writer
Monday, November 3, 2008; A01

Teenagers who watch a lot of television featuring flirting, necking, discussion of sex and sex scenes are much more likely than their peers to get pregnant or get a partner pregnant, according to the first study to directly link steamy programming to teen pregnancy.

The study, which tracked more than 700 12-to-17-year-olds for three years, found that those who viewed the most sexual content on TV were about twice as likely to be involved in a pregnancy as those who saw the least.

"Watching this kind of sexual content on television is a powerful factor in increasing the likelihood of a teen pregnancy," said lead researcher Anita Chandra. "We found a strong association." The study is being published today in Pediatrics, the journal of the American Academy of Pediatrics.

There is rising concern about teen pregnancy rates, which after decades of decline may have started inching up again, fueling an intense debate about what factors are to blame. Although TV viewing is unlikely to entirely explain the possible uptick in teen pregnancies, Chandra and others said, the study provides the first direct evidence that it could be playing a significant role.

"Sexual content on television has doubled in the last few years, especially during the period of our research," said Chandra, a researcher at the nonpartisan Rand Corp.

Studies have found a link between watching television shows with sexual content and becoming sexually active earlier, and between sexually explicit music videos and an increased risk of sexually transmitted diseases. And many studies have shown that TV violence seems to make children more aggressive. But the new research is the first to show an association between TV watching and pregnancy among teens.

The study did not examine how different approaches to sex education factor into the effects of TV viewing on sexual behavior and pregnancy rates. Proponents of comprehensive sex education as well as programs that focus on abstinence said the findings illustrate the need to educate children better about the risks of sex and about how to protect themselves, although they disagree about which approach works best.

"We have a highly sexualized culture that glamorizes sex," said Valerie Huber of the National Abstinence Education Association. "We really need to encourage schools to make abstinence-centered programs a priority."

But others said there is no evidence that abstinence-centered programs work.

"This finding underscores the importance of evidence-based sex education that helps young people delay sex and use prevention when they become sexually active," said James Wagoner of Advocates for Youth. "The absolutely last thing we should do in response is bury our heads in the sand and promote failed abstinence-only programs."

Chandra and her colleagues surveyed more than 2,000 adolescents ages 12 to 17 three times by telephone from 2001 to 2004 to gather information about a variety of behavioral and demographic factors, including television viewing habits. Based on a detailed analysis of the sexual content of 23 shows in the 2000-2001 TV season, the researchers calculated how often the teens saw characters kissing, touching, having sex, and discussing past or future sexual activity.

Among the 718 youths who reported being sexually active during the study, the likelihood of getting pregnant or getting someone else pregnant increased steadily with the amount of sexual content they watched on TV, the researchers found. About 25 percent of those who watched the most were involved in a pregnancy, compared with about 12 percent of those who watched the least. The researchers took into account other factors such as having only one parent, wanting to have a baby and engaging in other risky behaviors.

Fifty-eight girls reported getting pregnant and 33 boys reported being responsible for getting a girl pregnant during the study period. The increased risk emerged regardless of whether teens watched only one or two shows that were explicit or surfed many shows that had occasional sexual content, Chandra said.

"It could be a child wasn't watching that much TV per week but was watching shows that got a pretty high rating on sexual content, or it could be a kid who was watching a lot of hours but on average was getting just moderate amounts of sexual content from each show," Chandra said.

Among the shows the teens watched were "Sex and the City," "Friends" and "That '70s Show." Chandra would not identify the others but stressed that they included dramas, comedies, reality shows and even animated programs on broadcast and cable networks.

"We don't want to single out any individual programs," Chandra said.

The researchers recommended that parents spend more time monitoring what their children watch and discussing what they see, including pointing out the possible negative consequences of early sexual activity. Programmers should also include more-realistic portrayals of the risks of sex, such as sexually transmitted diseases and pregnancy, the researchers said.

"Unfortunately, that continues to be relatively rare compared to the portrayals of the positive aspects," Chandra said.

Critics of television programming and experts on teen pregnancy said the research provided powerful new evidence about the role of TV in youth behavior.

"This is very significant," said Melissa Henson of the Parents Television Council, a watchdog group. "It gives us plenty of reason for concern."

Kelleen Kaye of the National Campaign to Prevent Teen and Unplanned Pregnancy praised the study but stressed that the causes of teen pregnancy are complex.

"We need to be cautious about overreaching in our expectations about the role the media can play in our effort to prevent teen pregnancy," she said. "We don't want to assume this is the whole story."

Several experts questioned whether the study had established a causal relationship.

"It may be the kids who have an interest in sex watch shows with sexual content," said Laura Lindberg of the Guttmacher Institute. "I'm concerned this makes it seem like if we just shut off the TV we'd dramatically reduce the teen pregnancy rate."

Chandra acknowledged that other factors might play a role but said the findings are compelling because the researchers were able to track the teens over time and found such a striking relationship.

"The magnitude of the association we did see was very strong," she said.

Study Links Violent Video Games, Hostility

Research in U.S., Japan Shows Aggression Increased for Months After Play

By Donna St. George
Washington Post Staff Writer
Monday, November 3, 2008; A18

Children and teenagers who play violent video games show increased physical aggression months afterward, according to new research that adds another layer of evidence to the continuing debate over the video-game habits of the youngest generation.

The research, published today in the journal Pediatrics, brings together three longitudinal studies, one from the United States and two from Japan, examining the content of games, how often they are played and aggressive behaviors later in a school year.

The U.S. research was the first in the nation to look at the effects of violent video games over time, said lead author Craig A. Anderson, a psychology professor at Iowa State University and director of its Center for the Study of Violence.

Anderson said the collaboration with Japanese researchers was particularly telling because video games are popular there and crime and aggression are less prevalent. Some gamers have cited Japan's example as evidence that violent games are not harmful.

Yet the studies produced similar findings in both countries, Anderson said. "When you find consistent effects across two very different cultures, you're looking at a pretty powerful phenomenon," he said. "One can no longer claim this is somehow a uniquely American phenomenon. This is a general phenomenon that occurs across cultures."

The study in the United States showed an increased likelihood of getting into a fight at school or being identified by a teacher or peer as being physically aggressive five to six months later in the same school year. It focused on 364 children ages 9 to 12 in Minnesota and was first included in a 2007 book, "Violent Video Game Effects on Children and Adolescents."

Japanese researchers studied more than 1,200 Japanese youths ages 12 to 18. In all three studies, researchers accounted for gender and previous aggressiveness.

"We now have conclusive evidence that playing violent video games has harmful effects on children and adolescents," Anderson said.

The American Academy of Pediatrics, which publishes the journal in which the study appears this month, is in the process of revising its recommendations on media violence, and expects to issue a new statement in four to six months, a spokeswoman said. The academy now recognizes violence in media as a significant health risk to children and adolescents and recommends limiting screen time including television, computers and video games to one to two hours a day.

For many parents, the latest research was unsettling, though not surprising.

Patricia Daumas, 50, a single mother of two in Reston, said she sometimes wonders about her decision to allow her sons, ages 8 and 11, to play war games. But like many parents, she sees the issue as complex. She does not allow her sons to play games rated "mature."

"I don't think the games are good for them," she said, "but what I'm seeing in my own children is that they're still very gentle, that they're very caring, and they have absolutely no behavior problems at school."

Daumas noted that many of her sons' friends play the games. "It's a tough balancing act," she said.

Tracey Goldman, 42, a mother of two in Takoma Park, said she enforces time limits on video-game playing and does not allow violent content. Her fourth-grader plays Lego Star Wars, she said, but otherwise, "I just feel very uneasy about letting him play those kinds of games."

Still, she said, monitoring game-time can require vigilance because children can find games on Internet sites. She recalled looking over her son's shoulder as he played at a computer, asking: "Wait a minute. Is that shooting people?"

Parents have debated the potentially harmful effects of video-game violence for most of the last two decades, as the games have become more popular and more graphic. In the new research, games were deemed violent when one character harmed or killed another.

Still, not all video games are violent or associated with such negative effects, said Joseph Kahne of Mills College in Oakland, Calif., coauthor of a recent video-gaming study by the Pew Internet & American Life Project.

The Pew study, based on a poll of 1,102 youths ages 12 to 17, found that most teenagers play many different kinds of games and that some types of play -- such as making decisions about how to run a city -- are correlated with more political or civic involvement.

Overall, Kahne said, "it's important to pay attention to the nature of the games and the sense that kids make of the experience."

Although the longitudinal studies reported in Anderson's study showed that frequent playing of violent video games leads to greater aggression, Anderson also said this message should be understood in the larger context of a child's life.

"A healthy, normal, nonviolent child or adolescent who has no other risk factors for high aggression or violence is not going to become a school shooter simply because they play five hours or 10 hours a week of these violent video games," he said.

Extreme forms of violence, Anderson said, "almost always occur when there is a convergence of multiple risk factors."

A U.S. surgeon general report in 2001 identified an array of those risk factors, including gang involvement, antisocial parents and peers, substance abuse, poverty and media violence. Males are more at risk.

The new study noted that video games are played in 90 percent of American homes with children ages 8 to 16 and that the U.S. average playing time of four hours a week in the late 1980s is now up to 13 hours a week, with boys averaging 16 to 18 hours a week.

Help Your ADHD Teenager Find His Passion

Parenting ADHD children: How to help your teenager find his unique talents and skills.

by Patricia Berry

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Teens hear it constantly — find your passion. It’s as if one or two talents or skills are the magic pills for success, in school and in life. High-school guidance counselors suggest that a worthwhile hobby is just the ticket for getting into a good college.

The truth is, it can be. A special interest is fulfilling, it may impress admissions officers, and it could lead to success in college and beyond. But for teens with ADHD, finding that one special thing can be a challenge. Where do they begin? How can they pick just one activity when they enjoy so many?

“The busy ADD mind has a great capacity for dabbling in a variety of activities, and not going deep in any one area,” says Theresa L. Maitland, Ph.D., coordinator of the Academic Success Program for Students with LD and ADHD at the University of North Carolina. ADD kids have trouble selecting one or two standout pursuits. The quiet reflection needed to shorten the list of possibilities — what Maitland calls “being still with oneself” — does not come easy for them.

Filling a teen’s days with tutors and life coaches certainly doesn’t help. “We focus too much on our teens’ weaknesses, and not enough on uncovering talent or passion,” says Maitland. “We are all naturally good at something.”

Giving teens time and space to think about what makes them feel good about themselves is one way parents can nurture the process. Another is helping them discover clues about what their passions may be. Your teen has to do the hard work of finding and cultivating her talents, but your support — and the good sense to back off at times — will keep your teen on task.

Rate His Interests

“Each person has unique talents and gifts — it’s just a matter of teasing them out,” says Maitland, who specializes in helping high school and college students stay on track with their academic and extracurricular pursuits. She often refers students to Richard Chang’s book, The Passion Plan: A Step-by-Step Guide to Discovering, Developing, and Living Your Passion (Jossey-Bass), to help them mine their talents.

Tips for Teens

Chang suggests asking your teen to make a list of “passion candidates.” Have him think about the things he likes to do. Hobbies or objects he’s chosen for his room may spark ideas. Is there a guitar leaning in the corner, reminding him of a love for music, for instance? Or a museum poster that reflects a liking for painting or art? If so, encourage him to imagine participating in these pursuits. What do his heart and body tell him when he thinks about each activity? When is he alive, exhilarated, enthusiastic, energetic? When is he bored?

Have your teen rate each interest—say, from 1 to 10—and then rank those on his list. Some interests or passions likely will reflect current pursuits. Others may suggest careers—a useful list for the student contemplating college or vocational school. Maitland suggests that a teen talk to people other than Mom and Dad, who know her too well. Getting the reaction of a grandparent, a family friend, or a beloved teacher to your teen’s passion list will inform the exercise. For example, an aunt may recall the puppets your daughter made for her cousins one year, and the hours she put in assembling each one. Such memories may deepen your teenager’s thinking about a particular pursuit.

Key into His Personality

The things teens get in trouble for can be clues to their passion. The teen who talks too much in class, or who bosses his teacher and classmates around, may be a born organizer, well suited to starting a high school club or leading a management team. The teen who neglects her schoolwork to play outdoors may prefer nature to being at a desk. Such feelings are not talents, but they could be the foundation of a passion.

“Look at the things kids gravitate to and ask, ‘Could those be the seeds of life passions?’” says Maitland. If you saved your teen’s elementary-school report cards, dig them up for clues. Comments from teachers can point out patterns. For instance, a student’s doodling throughout the day back in second grade may be the beginnings of his cartooning for the school paper. Perhaps he’d enjoy drawing classes, to hone his skill.

Think Beyond Oneself

Knowing what you love isn’t the full answer. An athlete, for instance, may love track, and discover it’s not the running he enjoys, but being part of a team and having the structure of practices. “Passion frequently lies in being a part of something bigger than oneself,” says Maitland.

Maitland counsels a college student who “discovered that she felt most alive when she was traveling to foreign countries and meeting people of different backgrounds.” She has decided to take her love for other cultures into the business world, to help company managers cultivate diversity among personnel.

Search for Talent

Passion and talent don’t always go hand in hand, but they evolve together. Nineteen-year-old Morgan Miller, who has ADD, grew up without a specific talent, not unlike many kids with her condition. “I was mediocre at most things,” says the Montclair, New Jersey, native. “I wasn’t a really good dancer. I wasn’t the best softball player.

“I needed to find something I could feel confident about,” she says. Eventually, it came to her: “I realized I love working with kids,” Miller says. “And it was something I knew I was good at. It was my passion. You work at your passion, and it becomes your talent.” Now the Goucher College sophomore is intent on pursuing a career in children’s television. So momentous was this self-discovery that Miller chose passion as the topic of her college application essay.

Keep an Eye on the Prize

When passions begin shaping students’ goals, other pursuits will start to seem like burdens. Maitland works with a student who wants to work for Doctors Without Borders. While he enjoys the science classes that he needs to get into medical school, he hates history, which seems irrelevant to his goal.

Maitland encourages the student to keep his internal dialogue—what she calls “self-talk”—focused on the positive. “He uses self-talk to stay on track with the required courses he doesn’t care for,” she says. This ongoing conversation helps the student get past the frustration of history class —what he sees as a waste of his time—and use it as a stepping stone to accomplishing his goal. He plasters images from Doctors Without Borders brochures on his history notebook, as a reminder of his objective.

Maitland says her teen clients teach her a lot about living their life. “Some people with ADD are incredible at doing only what they love. They could be my tutors,” she says. She understands why students don’t want to take required courses that have nothing to do with their major or their life goals.

“They tell me, ‘I don’t have much time on earth. I only want to do what I’m passionate about.’” Who can blame them?

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This article comes from the Spring 2008 issue of ADDitude.

Listening to clients...no, really listening! Studies show a 65% improvement in outcome

from Scott Miller, PhD (www.talkingcure.com)

Evidence-based practice is, as you know, "all the rage." Like bell-bottoms and skinny ties, listening to clients in therapy is out of fashion. Treatment manuals and fidelity measures are "in." Most of the push for field-wide adoption of specific treatments for specific disorders comes from the top. Government funders, policy think tanks and professional organizations are promoting evidence-based practice as the cure-all for what ails the field--namely, a continuing lack of respect and lingering perception of mental health as the "soft" of science. Here we consider a different idea for addressing the call for accountability in mental health: "practice-based evidence"--that is, using data generated during treatment to inform the process and outcome of treatment. A number of researchers have, over the last decade, been using the client's rating of the therapeutic alliance and progress in treatment as a way of improving retention and outcome in treatment. Interestingly, such research shows that providing therapists with real-time feedback regarding the client's experience of the therapeutic alliance and outcome cuts attrition rates in half and improves outcome by as much as 65%. By the way, such results were achieved without training therapists in any new treatment procedures or limiting the sample diagnostically. As you know, most randomized clinical trials exclude subjects that do not meet narrow inclusion criteria thereby making the applicability of any study findings to real-world clinical settings exceptionally questionable. Bottom line: therapists were encouraged to listen--especially when what they were doing wasn't working or did not fit for the individual client--and the hoped for improvements in retention and outcome followed.

Teen drivers with ADD a problem on the road

By Judy Fortin
CNN Medical Correspondent

It was hard to miss the bright yellow Student Driver bumper sticker on the back of the car driven by Tosha Mulligan. Tosha Mullgian, 19, has attention deficit disorder. She says her mind wanders when she drives. Getting a driver's license is a rite of passage for many teenagers, but the process was a bit more challenging for 19-year-old Mulligan of Acworth, Georgia. When she gets behind the wheel, she said, "Sometimes my mind wanders off." She's not alone. Researchers reported driving can be a serious problem for teens with ADD and attention deficit hyperactivity disorder. Motor vehicle accidents already are the leading cause of death among teenagers in the U.S., according to the National Highway Traffic Safety Administration. Experts such as Russell Barkley say ADD and ADHD compound the problem.

Barkley, a psychiatry professor at the Medical University of South Carolina, is a widely recognized expert on ADD and driving. He has investigated the topic for 15 years and conducted a half-dozen studies, some of which have been published in peer-reviewed journals. Teen drivers with ADD or ADHD "are impulsive, highly distractible and clumsy, can't pay attention to the roadway and they get bored easily," he said.

Mulligan's driving instructor, Jerry Thielemann of Freedom and Mobility Driver Training and Evaluation in Marietta, Georgia, experienced that firsthand. He works with teenagers with ADD three to four times a week. "A person with ADD pays attention to someone walking down the street rather than a car coming toward them," Mulligan said. "They don't know what to focus on." Barkley sees speeding as a key problem. "In general, people with ADHD speed four times more often than those without ADHD," he said. His research shows that those with ADD or ADHD are two to three times more likely to have an auto accident, three times more likely in the first five to eight years of driving to have their licenses revoked and five times more likely to get a parking ticket. In all three instances, Barkley pointed to the impatient and impulsive nature that is common among people with ADD or ADHD.

Chris Zeigler Dendy, author of "Teenagers with ADD and ADHD," raised a son and a stepson with the condition. "We were worried sick about our kids when they started driving because both had ADHD," Dendy recalled. "They both started getting speeding tickets and having car wrecks. One of them even had his license suspended." That was nearly 20 years ago. Today, Dendy said, she understands what was behind their troubles. "I think the good news is that parents today are so much better informed than we were, plus laws have tightened up so you get one ticket or step out of line and your license is gone," she said. Dendy credited proper medication with helping get her sons back on track. "Research tells us that with medication they are more likely to pay attention to road signs and less likely to have road rage," Dendy explained. She worried about parents who may not be as vigilant when it comes to monitoring their teen's driving behavior, especially during high-risk times. "One is after school from 3 to 6 and the other is on weekend evenings," she said. She mentioned those are often the hours when medication starts to wear off or when teens may be more likely to skip a dosage.

Barkley acknowledged the parents who decline to medicate their children who have ADD or ADHD, but he believes "Medication is more effective than any other treatment." Barkley also cautioned that people with ADD are more sensitive to the effects of alcohol and are unable to drive safely after drinking. He told teens to put away their cell phones, MP3 players and other items that might distract them while driving. Barkley suggested parents closely monitor their teenagers and provide sign-in and sign-out sheets in the garage to track their whereabouts.

Dendy eventually drew up a contract with her children, spelling out specific rules and expectations for driving the family car. Dendy and Barkley both recommended that teenagers with ADD or ADHD stay in a learner's permit program longer, at least a year, and put off getting their license until they have more experience behind the wheel. That's what Tosha Mulligan did. She finished her last driving lesson the day before she left for her freshman year in college. She passed her driver's test on the first try and got her license. She said waiting to get her license made a big difference. She said "It kept me focused." She reported no wrecks, no tickets and no problems so far.