For one parent I've known for many years, the story began in kindergarten, when the teacher approached mom and dad about some behavior that didn't seem quite right. The little boy wasn't participating with the others, and when asked questions, he sometimes responded withed cartoon-character-type noises.
"We weren't sure it really was a problem," he said. "After all, this was kindergarten, and if a kid is a little bit immature, or slow to develop social skills, isn't that what that year is for, to let them get accustomed to what school is all about?"
But being good parents, they thought about it, and with this new possibility in mind, they looked back at the child's behavior, searching for clues.
"Unlike his brother, who had us read the same books to him over and over again, he'd stay in my lap for a few pages, then slide down and run away. And at family reunions, he'd stay with the crowd for about an hour, then retreat to his room, or to the bed of my pick-up, where he played by himself," he said.
Is this something he would grow out of, or something that would grow worse as the years went by? Would he develop friendships, or be the sort of child that everyone picked on or made fun of?
"We know how cruel kids can be, especially in the middle school years, so we decided to have some tests done," he said.
The tests included a a Magnetic Resonance Imaging test, which allows doctors to see abnormalities in the brain. The boy cried when they injected his leg with the sedative that would keep him immobile inside the MRI's cramped tube.
"You haven't lived until you've seen the outline of your child's head and the living brain inside it on a vdeo screen. It was fascinating and horrible at the same time," he said.
The usual treatment for ADD is a drug called Ritalin, which aids in concentration, but the boy's parents were scared that once they started down that road, some unanticipated side effect - manevolent and irreversible - might show up 20 years from now.
"It's like this laser surgery for your eyes. It sounds good, but 20 years from now, will something horrible happen to your eyesight as a result? We weren't sure which way to jump," he said.
The family considered biofeedback training available as an alternative to the drug, but the training center was in Tennessee and the course so long that one parent would have had to quit work to take it. With some misgivings, they agreed to the drug therapy.
That, and a specialized program of one-on-one instruction several times a week at the elementary school, seemed to work. Things were less successful at the middle school.
"We helped him keep his grades up by working with him every night, but he's still a loner, and they really had no idea of how to help him break out of that pattern," he said.
"I remember after one conference we had at the school, I got to the front door and remembered I'd left my umbrella in the conference room. I went back to get it and a counselor walked me and told a tale of her own forgetfulness. She and her husband had both arrived home one recent night and discovered that neither one had picked up their child from the day-care center. Maybe I'm making too much of it, but it didn't convince me that she would remember my child's needs," he said.
"Now it's time for high school, and the counselors have told us that they have hundreds of students to attend to, which I guess is meant to diminish our expectations of the service he'll get," he said.
"This is our dilemma: How hard do we push the school? If we don't do enough, will he miss some vital experience? Or if we do too much, will he be singled out as an oddball by his classmates? I just wish there was someone who could tell us for sure." he said.