OK - now I have defined ADHD/ADD (I use the terms interchangeably in this instance) as not being a "disease" but rather a personality type that causes problems in academic and/or social settings. 

http://www.healthvoices.com/blog/dr_rob_lamberts/2006/03/06/add_adhd_disease

Now, what can be done for this problem?  Should we just say "that's just the way the child is, so there is nothing to do for it"?  Or, should the child be put on medication automatically since they don't conform to what we think a student should look like?  I do not think either are proper responses. 

When I see a child first for ADD, my first question is "is it a problem?"  I am looking to see some way in which their behavior is interfering with their ability to succeed.  Some parents come to me wondering if a child has ADD and the child is doing fine in school, poses only average parenting difficulties, and is generally doing OK socially.  In this case, the diagnosis of ADD, while it may be clinically correct, is moot.  The sole reason for treating a condition is to change something for the better.  If everything is OK, there is no strong reason to treat - in fact, I think treating with medication will do more harm than good.  I do, however, recommend that parents understand ways to optimize the child's potential by understanding what areas require more attention.  I remember as a high school student deciding to sit in the front of the classroom because I noticed I did a lot better in the class when I did.  Understanding this diagnosis and how to compensate for the weaknesses associated with it is very important for both the child and the parents.

So when it has been determined that there are areas which are causing significant problems, the next step is to make sure that there is not some other pathology going on.  Depressed and anxious children may become either hyperactive or lose focus.  It is very important to not assume that all distraction is due to the nature of the child - it may also come from the environment the child comes from.  Since ADD is often inherited, the households many of these children grow up in are very disorganized.  This makes it more difficult for a child to follow through on tasks such as homework and may also result in lax discipline at home.  Improving these things may actually improve the child more than medication.  Since I take care of both adults and children, I have on occasion noted that the parent may be the more severely affected ADD patient and have suggested they be treated before the child.  Depressed or chronically ill parents may also result in an environment where focus is all the more difficult.  Oh yes, and then there are the teachers who just don't gel with the student.  If a child is generally doing well and then suddenly one year has an off year, it may simply be that the teacher is not communicating well with the child.

Once these things are addressed, I then turn to the option of medication.  The goal of medication is to fit a "square peg into a round hole."  In other words, a child that has trouble focusing and is doing badly in school (academically or behaviorally) who needs to focus to succeed can often be much more successful with medication.  It is remarkable to see the looks on the faces of parents when they come back after we first start medications on the child - they are so relieved that the child can do well in school and marvel at the difference medication makes.  The child is usually happier too, not getting in trouble at school nearly as often and making better grades.

The hardest situation is where I feel a child may get better just with improved parental input, but the chance of improving the parents is small.  Do you penalize the child for the sake of the parent?  I can lecture the parents about structure and discipline, but if they are unwilling, I may end up treating the child anyway.

Another difficult question is "how good is good enough?"  If a child is getting B's, do you medicate them so they can get A's?  My advice is to focus on behavior rather than results.  If the child is acting reasonably, the final grades should be accepted as they are.  If a child is constantly forgetting things, missing homework assignments, and/or getting in trouble at school, then a B student may be treated.  Each case needs to be taken individually.

It must be remembered that all medications have risk, and the ADD medications carry significant downsides at times.  The suppression of appetite and problems with sleep are the main problems we encounter.  When you think of it, we are really suppressing a destructive part of the child's personality when we treat them - this should not be taken lightly.  We should use medications as a tool to accomplish a greater good for the child.  If the benefit is small, then the risk should not be taken.  If, however, there is significant disability caused by the ADD, medication can greatly enhance the life of a child and improve the outlook for his/her future.  Studies have shown that a child treated with medications for ADD is 7 times less likely to use drugs as an adolescent compared to a child with ADD who is not treated.  Why?  Kids turn to drugs out of a need to escape.  If they are a failure at school and never meeting the expectations of their parents, they despair, and that despair can lead to them turning to drugs.

I don't think that blanket statements about medications and ADD are worthy of attention (sorry Tom).  ADD medication should never be taken lightly, but proper use of them (along with proper counsel on strategies for parents and children on coping with the problem) can greatly reduce the chance of problems down the road.