The smart, dedicated mother of Jesse, a 9-year-old boy with Attention Deficit Hyperactivity Disorder, or ADHD, faces a jumble of wildly conflicting advice.

Jesse's teacher complains the boy disrupts the whole class; his psychiatrist says Ritalin will do the trick; his homeopathic doctor advises to avoid drugs and try soy cheese and spelt bread; and his father angrily demands that Jesse stay off drugs and just be allowed to be a boy.

Such is the chaotic life of Mama, the main character in "Distracted" by Lisa Loomer, which is being produced by TheatreWorks in Mountain View and opened April 1.

And such is the confusing predicament faced by countless parents in Palo Alto and elsewhere when they suspect their child has ADHD, according to psychologist Janet Dafoe, who runs a monthly support group for parents whose children are in the Palo Alto Unified School District.

The informational group currently has about 10 members, though at its peak it used to attract 40 to 50 parents monthly, Dafoe said.

For parents, a child with untreated ADHD can be a constant frustration, an embarrassment and a threat to family bonds.

For Mama in the TheatreWorks play, Jesse is all of these things.

After demanding candy for breakfast, the boy stalls at getting dressed and overflows his bowl of Cocoa Krispies with too much milk. Mama, who has just finished reading a book called "The Explosive Child," says all she wants at that moment is for "him to get to school without a tantrum."

After a psychiatrist recommends drugs to improve Jesse's behavior, Dad tells Mama: "If you continue to give my son drugs, I will divorce you, and I will fight for custody. My son is not crazy."

ADHD afflicts anywhere from 4 percent to 10 percent of the population, according to studies. Diagnosis has increased in recent years, Dafoe said, because much more is known about behavior and brain functioning, and better treatment is available. But overdiagnosis can be a problem because other conditions, including depression and anxiety, can be mistaken for ADHD.

Because the disorder remains widely misunderstood, many who have it are never identified, Dafoe said.

"People often think they're either oppositional or just lazy," Dafoe said. "These are two very common misconceptions, and it can look that way at school or at home.

"So, if they're not identified as having ADHD, they start getting labeled in ways that are inaccurate and they start feeling bad about themselves and it spirals out of control," she said. "The child finds a place where he feels less pain, and that might be drugs or a group of kids who are getting into trouble more. There are a disproportionate percentage of people with ADHD in jail and abusing all kinds of substances, especially if they were untreated."

Optimal treatment for the disorder is a combination of medication and educational and support therapy, according to Dafoe.
But the plight of the anguished Mama, in the TheatreWorks play -- facing conflicting advice from a plethora of professionals -- is all too common.

"It's because there aren't enough people who have a comprehensive understanding of this," Dafoe said. "It's a very complicated issue and each person has their own favorite pair of glasses to look at things through.

"Psychiatrists tend to want to medicate; homeopaths think their approach to medicine is preferable, and parents have their own preconceived notions of what their child should be like.

"Teachers often don't have training in ADHD, and classrooms are set up to work for a certain kind of kid -- and that is not an ADHD kid."

Or, as Mama puts it to her husband in the play: "Face it, honey, the school system is not going to smile on our child."

In a perfect world, an ADHD child would be properly diagnosed and get appropriate supports from home, school and medication.

"The best outcomes are for the kids who are able to maintain really good relationships with people who support them and love them no matter what," Dafoe said. "It's important for parents not to get into power struggles and homework struggles with the child. Let a tutor do that so you can be the supportive parent, where the child can go for refuge whenever they need it."

ADHD kids do best in a structured classroom with very clear expectations, written instructions and timelines, Dafoe said. But flexibility needs to be built in because these students tend to be impulsive and can make mistakes. Negative consequences don't work very well, she said.
Reward systems, with stronger levels of rewards than for other children, work better.

In addition to her work with the school district, Dafoe practices psychology at Morrissey/Compton Educational Center, Inc., where she has started a program called the ADHD School Success Center.
Information about the district's free ADHD parent support group is available by calling Dafoe at 650 322-5910.