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If you want to start a fight at a PTA meeting, just say ADHD. Some parents insist attention deficit hyperactivity disorder is a phony diagnosis, that it's a way to medicate a kid who's just wild or spacey. Others are convinced it is a real problem that requires medication.

Now some light from the American Academy of Child and Adolescent Psychiatry. It has issued guidelines for diagnosis and treatment.

And joining us now to talk about those guidelines and treatment options, our resident medical expert, Dr. Sydney Spiesel. He is a pediatrician and he's also a professor at the Yale Medical School and he writes for the online magazine Slate.

Hi, Syd.

Dr. SYDNEY SPIESEL (Yale Medical School): Hi, Madeleine.

BRAND: So, Syd, ADHD, in your medical opinion, is it a real disease, something that needs to be treated?

Dr. SPIESEL: There is no doubt in my mind that it's very, very real.

BRAND: Well, what are the guidelines? If you see a child you think may have ADHD, what should you be looking for?

Dr. SPIESEL: You're going to laugh when I say this because all of these things - everything on the list are things that we see in every child to a greater or lesser extent. The question is, for these kids, is it much more common and much more active and much more of a problem? Does a child have difficulty in organizing tasks, for instance? Do they lose things? Are they easily distracted? Are they forgetful? Do they fidget? Do they sort of blurt out answers? These are the kinds of questions which we need to know. First of all, how often do these occur? And how many of these behaviors occur in any one child?

BRAND: You know, Syd, a lot of people I've talked to, a lot of parents I've talked to, have said, you know, if I were a child now, I would have been on medication because I was such a hyper child and I couldn't sit still in class. And look at me, I'm fine. I didn't need to be medicated.

Dr. SPIESEL: Well, I probably would have said the same thing about myself, although when I was a kid, which was a long time ago, there was no such diagnosis and no idea of treatment. In a certain way, maybe I became a pediatrician because I suffered a lot. And I don't want kids to be miserable. I want kids to have happy and productive lives. And I think that some of the kids are going to get through it okay and are going to do okay.

But other kids are really damaged by their poor function and by what is a consequence of their poor function in school and in life. And I think that if we can prevent that from happening, if we can help kids, we really should be doing it.

BRAND: And by doing it, you mean giving them Ritalin or some other drug to calm them down?

Dr. SPIESEL: No. I think that that's only treatment. Many kids respond very well to the stimulant medications or some other medications. I think that sometimes you can do very well with psychotherapy or just changing focus on kids. If I had my druthers, which the world doesn't seem to have given me, I would - one intervention that I would do is I would go and change the schools. But nobody seems to want me to do that.

BRAND: You mean to make them less rigid and more open to different personality types?

Dr. SPIESEL: Exactly right. And make them more adaptable to not to try and have a single curriculum in a single seating style and everything else that is good for everybody.

BRAND: You know, Syd, it's often the kids who are the brightest, who are the most creative, who are, you know, marching to a different drummer, if you will, who have a very vibrant interior life, who are the ones who are diagnosed with this. And I'm wondering if it's a problem that you see, if they're taking drugs, that that might kill their intellectual spark or their creativity or their differentness.

Dr. SPIESEL: Well, you know, I think that there is a class of kids - subset of kids in my own practice, especially, who are very bright and creative and whose inner theater is so much more interesting than what's going on in the classroom that they turn off the classroom. And the problem is that they suddenly discover that they've missed stuff that other kids have gotten, and it makes them doubt their own capacity. And it gives them a sense of anxiety about themselves, and that anxiety really interferes with their ability to focus.

I think if medication is judiciously used, that it doesn't interfere with their creativity, actually. And in any case, these kids seem to need it not for a very long time. I think it actually may enhance their creativity by enhancing their ability to be effective in the world.

BRAND: That's opinion from Dr. Sydney Spiesel. He is a practicing pediatrician. And you can read Syd's Medical Examiner column at

Thanks again, Syd.

Dr. SPIESEL: Thank you.

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