'Hidden behind the forehead'

Linda Classen's passion is helping kids with Attention Deficit Hyperactivity Disorder (ADHD). She comes by the interest naturally: Two of her three now-adult sons struggled with it. She turned that personal interest into a 32-year career as a Texas classroom teacher, school social worker, and finally, as "504 coordinator" for the Austin Independent School District.

That "504" refers to the paragraph in the 1973 federal Rehabilitation Act that prohibits discrimination against kids with certain kinds of disabilities, including ADHD-and the job turned into a calling. "I truly believe I was called to do this as a ministry . . . to make something meaningful out of something so painful."

She's now into her third year of retirement from the district, but not from her passion. Several days a week she sees clients in one room of a suite of offices that houses a psychiatrist and psychologists who work with children and adolescents.

Mrs. Classen, 65, sits in a blue wing chair, one leg crossed boy-style over the other at the knee. Occasionally she shifts position, using her hands to help adjust her legs to a more comfortable position. She explains that a few years ago her childhood polio came back, leaving her lame and in great pain. She still walks with a limp, but regular treatments and the encouragement of nurses have helped: "All of these threads interweave to work for good for those who love the Lord."

Dressed in navy pants, white blouse, and striped overshirt, she combines both a grandmotherly and professional air as she counsels emotionally drained parents. A typical counselee has already spent hours in the principal's office at her child's school and huddled in conferences with her child's teachers. She has already learned to dread opening her morning e-mail because it is often filled with notes from teachers reporting another failure. She's had harried teachers rush to the carpool line to report her child's outrageous behavior.

Above all, such a mom has learned to keep her troubles to herself, because she's heard-and likely believes-the same thing other parents have heard: ADHD is a problem of lazy parents failing to discipline overactive children. ADHD = failure. ADHD = sin.

To those parents desperate for practical help, Ms. Classen appears as a sort of Glenda the Good Witch, radiating calm and good humor. Her clients don't have to be convinced that the "normal parenting strategies aren't working," and they don't know what to do: "Usually I find myself teaching and trying to correct some misconceptions about the disorder."

One misconception, she says, is that ADHD is only about hyperactivity or lack of focus in the classroom. While those traits are part of the description of the disorder, current brain research suggests that ADHD affects "executive function"-the ability to organize, inhibit impulses, think about consequences, and understand time. Kids with ADHD don't see much beyond the end of their noses, she says, so consequences and rewards have to be immediate. For example, telling a high-school student with ADHD that he cannot play sports unless he passes his courses every six weeks is ineffective because six weeks is an eternity for someone with the disorder.

Another misconception concerns the relative risks of stimulant medications, which have been studied extensively since they were first prescribed in 1957. Currently about 2.5 million children (that's 3 percent to 5 percent of the school-age population) take medication for ADHD. Parents worry that stimulants will turn their kids into addicts. (Actually, kids treated with stimulant medications are less likely than untreated kids to have substance-abuse problems.) Or they've read that stimulants may increase the risk of coronary problems, a concern currently under review by the National Institutes of Health.

They may also believe that ADHD is a matter of character. They often believe that if their kids would only apply themselves, they'd be fine-a belief shared by many teachers. With dismay Mrs. Classen recounts one teacher telling a struggling student, "You're smart and I know you're smart . . . but they are not going to put up with this in high school." She says no one seeing her polio-caused limp would tell her to get up and run laps, but well-meaning teachers pressure ADHD students because their disability is "hidden behind the forehead."

With her elfin grin and down-home manner, Mrs. Classen puts people at ease. Texisms roll off her tongue like syrup off a fork. "This is the thing that kicked my bucket over," she says. She often uses her own experience as a way to connect. "I love my child surely as much as you love yours," she says to parents worried about medication. "I would lie down in front of an 18-wheeler to protect him . . . so if you know something I don't know about the safety of these drugs, please tell me."

She comes by her empathy from experience. She was a stay-at-home mom, retired from teaching with three small children, when her husband abandoned her. She knew she'd have to go back to teaching to support herself: "It was the worst year of my life and it was the most important year." She learned that she was more interested in behavior than in curriculum and earned a master's degree by studying part-time and sometimes taking her children to class.

By the time Mrs. Classen received her master's degree, she had also discovered that her own kids had learning troubles and that little help was available: "My school social work program had no training; my colleagues had no training; pediatricians had no training." But the Austin school district hired her as a "visiting teacher," a social work position that she then held for 18 years. During that time she sat in on numerous staff meetings: "I was hearing the same litany about bright kids who weren't available for learning."

She became known as an expert on those kinds of kids: "I was passionately interested in this area. They knew I was spending my own money to go for in-service training." Other visiting teachers began to trade cases with her. Over time she learned which classroom techniques "were cruel and which ones hurt." Convinced that most teachers wanted to help their ADHD students, she was able to train them "when you do this, this is what happens. Do this; don't do that. Say this, don't say that."

Now Mrs. Classen more often accompanies parents to meetings at school: "I'm not there as an adversary of the staff . . . I'm one more person sitting around the table problem-solving for this child." She keeps prodding her teacher colleagues to understand and deal with a puzzling brain disorder that keeps smart kids who have been given "some pretty sour lemons" from making lemonade.

Drug war

Some conservatives vociferously criticize ADHD as a diagnosis and stimulants as a treatment. Phyllis Schafly once complained that "the old excuse of 'my dog ate my homework' has been replaced by 'I got an ADHD diagnosis,'" and Rush Limbaugh lectured parents, "You mask your own failings by doping up your children to calm them down."

But medical writer Michael Fumento, who quoted those critiques, also found conservatives on the other side-and they tended to be folks who had direct experience with a child suffering from ADHD. Columnist Mona Charen wrote, "I have two non-ADHD children, so it's not a matter of parenting technique. . . . People without such children have no idea what it's like. I can tell the difference between boyish high spirits and pathological hyperactivity. . . . These kids bounce off the walls. Their lives are chaos; their rooms are chaos. And nothing replaces the drugs. . . . I'm sure I would have been one of those smug conservatives saying it's a made-up disease . . . if I hadn't found out the hard way."

Mr. Fumento quotes Christina Hoff Sommers explaining that she originally planned to have a chapter attacking Ritalin in her best-selling book, The War Against Boys (2000), because "'it seemed to fit the thesis.' What stopped her was both her survey of the medical literature and her own empirical findings. Of one child she personally came to know she says, 'He was utterly miserable, as was everybody around him. The drugs saved his life.'"