1. Get an accurate diagnosis.

This is the starting point of all treatment for ADD.

2. Educate the family.

All members of the family need to learn the facts about ADD as the first step in the treatment. Many problems will take care of themselves once all family members understand what is going on. The education process should take place in the entire family, if possible. Each member of the family will have questions. Make sure these questions get answers!

3. Try to change the family "reputation" of the person with ADD.

Reputations within families, just like reputations in the outside world, keep a person in one set or mold. By changing the reputation of the person with ADD, you will set up higher and brighter expectations. If you are expected to screw up, you probably will; if you are expected to succeed, you just might. It might be hard to believe at first, but having ADD can be more of a gift than a curse. Try to see and develop the positive aspects of the person with ADD, and try to change his or her family reputation to accentuate these positive aspects. Remember, this person usually brings a special something to the family–special energies, special creativity, special humor. He or she has lots to give, and the family–more than any group of people–can help him or her reach full potential.

4. Make it clear that ADD is nobody's fault.

It is extremely important that this is understood and believed by all members of the family. Lingering feelings that ADD is just an excuse for irresponsible behavior or that ADD is caused by laziness will sabotage any treatment.

5. Also make it clear that ADD is a family issue.

Unlike some medical problems, ADD touches everybody in the family in a daily, significant way. It affects early-morning behavior, dinnertable behavior, vacations, and quiet time. Let each member of the family become part of the solution.

6. Give everyone in the family a chance to be heard.

ADD affects everyone in the family, some silently. Try to let those who are in silence speak.

7. Pay attention to boundaries and control within the family.

People with ADD often step over boundaries without meaning to. It is important that each member of the family know and feel that he or she is an individual, and not always subject to the collective will of the family. In addition, the presence of one or another parent becomes a little tyrant, fanatically insisting on control over things all the time. ***This makes no sense — needs to be reworked *** Such a hyper-controlling attitude raises the tension level within the family and makes everybody want to rebel. It also makes it difficult for family members to develop the sense of independence they need to have in order to function effectively outside the family.

8. Everyone should have a clear responsibility in the family.

Everybody needs to know what is expected of him or her. Everybody needs to know what the rules are, and what the consequences are of not following those rules.

9. Have family brainstorming sessions.

When a crisis is not occurring, talk to each other about how a problem area might be dealt with. Be willing to try anything once to see if it works. Approach problems as a team with a positive, can-do attitude.

10. ADD can drain a family.

ADD can turn a family upside down and make everybody angry at everybody else. Treatment can take a long while to be effective. Sometimes the key to success in treatment is just to persist and to keep a sense of humor. Although it is hard not to get discouraged if things just seem to get worse and worse, remember that the treatment of ADD often seems ineffective for prolonged periods. Get a second consultation, get additional help, but don't give up.

11. Consider seeing a family therapist.

If negotiations bog down at home, a therapist will be the professional you need with experience in helping families listen to each other and reach a consensus. Since families can be explosive, it can be helpful to have a professional around to keep the explosions under control. You can also buy books to help in negotiations.

12. Pay attention to the "balance of attention" within the family.

Try to correct any imbalance. Often, when one child has ADD, siblings get less attention. The attention may be negative, but the child with ADD often gets more than his or her fair share of parents' time and attention day in and day out. This imbalance of attention can create resentment among siblings, as well as deprive them of what they need. Bear in mind that being the sibling of a child with ADD carries its own burdens. Siblings need a chance to voice their concerns, worries, resentments, and fears about what is going on. Siblings need to be allowed to get angry as well as to help out. Be careful not to let the attention in the family become so imbalanced that the person with ADD is dominating the family scene.

13. Try to avoid the "big struggle."

The "big struggle" pits the child with ADD against his or her parents, or the adult with ADD against his or her spouse, in a daily struggle of wills. The negativity that comes from the big struggle eats away at the whole family. It will eventually define (and consume) the ADD-affected family.

14. Disengage from the big struggle.

If you sense that the big struggle is beginning, try to back away. Once it has begun, it is very hard to get out of. The best way to stop it, on a day-to-day basis, is not to join it in the first place. Beware of the struggle becoming an irresistible force.

15. Negotiate a deal.

Have the whole family sit down together and negotiate your way toward a "game plan" that everyone in the family can buy into. To avoid the family gridlock of the big struggle, it is wise to get into the habit of negotiation. This can take a lot of work but, over time, some sort of settlement can usually be reached. The terms of any settlement should be made explicit; at best, they should be put into writing so they can be referred to as needed. They should include concrete agreements by all parties as to what is promised, with contingency plans for meeting and not meeting the goals.

16. Break any negative process and turn it into a positive one.

Applaud and encourage success when it happens. Try to get everyone pointed toward positive goals, rather than gloomily assuming the inevitability of negative outcomes. One of the most difficult tasks a family faces in dealing with ADD is getting onto a positive track. However, once this is done, the results can be fantastic. Just focus on building positive approaches to each other and to the problem.

17. Role-play situations.

This process can help members of the family show each other how they see others. People with ADD can be very poor observers, and watching others role-play them can vividly demonstrate behavior they may be unaware of. Videotaping can also help in this regard.

18. Avoid the pattern of loving the child one day and hating him or her the next.

One day, he or she delights you and you praise and love him or her. The next day, he or she exasperates you and you dole out punishment, rejecting the child. It is true of all children, but particularly true of those with ADD, that they can be little demons one day and jewels of enchantment the next. Try to keep on an even keel in response to these wide fluctuations. If you fluctuate as much as the child, the family system becomes very turbulent and unpredictable.

19. Make a united front with your spouse.

Make time to confer with each other. The less you can be manipulated, the better. Consistency helps in the treatment of ADD.

20. Don't keep ADD a secret.

ADD is nothing to be ashamed of, and the more family and friends know about what is going on, the more help they can be.

21. Make use of feedback from outside sources.

Sometimes a person won't listen to or believe something someone in the family says, but will listen if it comes from the outside–teachers, pediatricians, therapists, or other parents and children.

22. Try to target problem areas.

Typical problem areas include study time, morning time, bedtime, dinnertime, times of transition, and vacations. Once the problem area has been explicitly identified, everyone can approach it more constructively. Negotiate with each other as to how to make it better. Ask each other for specific suggestions.

23. Try to accept ADD.

Accept ADD just as you would accept any other condition and normalize it in the eyes of all family members as much as possible. Acclimate to it as you might a family member's special talents or interests, like musical or athletic skills, whose development would affect family routines. Acclimate to it, but try not to let it dominate your family. In times of crisis, this may not seem possible, but remember that the worst of times do not last forever.

24. Never worry alone.

Try to cultivate as much support as possible. Make use of whatever support you can find. It is amazing how group support can turn a mammoth obstacle into a solvable problem, and how it can help you keep perspective. You'll find yourself saying, "You mean we're not the only family with this problem?" Even if this doesn't solve the problem, it will make it feel more manageable, less strange, and less threatening.

25. Keep up hope.

Hope is a cornerstone in the treatment of ADD. Have someone in mind you can call to lean on and also someone who can pick up your spirits. Always bear in mind the positive aspects of ADD–energy, creativity, intuition, good-heartedness–and also bear in mind that many, many people with ADD do very well in life. When ADD seems to be sinking you and your family, remember things will get better.