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'Hidden behind the forehead'

Medicine | For years conservatives have expressed skepticism about the existence of ADHD and worried about the overuse of powerful stimulants like Ritalin. Yet many parents, teachers, and counselors don't doubt ADHD's existence. In Austin, Texas, Linda Classen has devoted her adult life to helping parents and teachers better understand "children like ours"

Issue: "Faculty follies," April 29, 2006

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.

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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."

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