Duping some of what momtoalex had to say. My timing in finding this board (almost a year ago!) was very lucky and we have followed Pico's advice re building a village. We had already had difficult child thoroughly checked out by family physician for possible medical causes, had had a specialized psychologist do an emotional/developmental/educational assessment, and were seeing a psychiatrist at that point. This is what we've done, based on advice from this site and our treating professionals: 1) We have educated ourselves about many many disorders (some of which have since been discounted as NOT being part of difficult child's diagnosis), disabilities, 2) We have switched to a 2nd psychiatrist, at recommendation of 1st. We found #1 to be very helpful for parents/siblings but difficult child had never bonded with her, wouldn't talk or cooperate with her. #2 works out of Children's Hospital psychiatric dept's ADD/mood disorders clinic. That specialized knowledge and experience, gives her the "tools" which assisted difficult child (& husband, who has resisted suggestions of treatment for years, and who is now her patient as well) to bond with her. 3) We have become more specific in our instructions, as we now understand his inability to "follow instructions like his sister does" is not sheer ignorance but rather a reflection of his short-term memory difficulties. As per Kathy's illustrations, we can tell our easy child "get ready for bed", but we have to tell difficult child "get your jammies on, set out your clothes for tomorrow, brush your teeth, then come take your melatonin". And we can't tell him even those 4 things all at once, but max 2 things at a time. Otherwise he gets up to the stair landing, forgets why he's going upstairs and often ends up playing with the cat or reading in his room. 4) Evaluate who in the family needs to know, how much, about the child's treatment. Therapy is private, but obviously changes in attitude, permissions, etc. have to be transmitted to easy child so she knows some of the rules ahve changed. My dad isn't told anything, since he's of the "all he needs is discpline" or "omigod the kid is mentally ill that can't have come from OUR side of the family" depending on the day of the week. My mom, on the other hand, is genuinely interested and WILL FOLLOW INSTRUCTIONS in her interactions with difficult child, so she gets all the info the parents get. (My mom & dad are permanently separated, so this info dichotomy doesn't cause any difficulties) My sister with 2 extreme ADHD kids & an ADD husband gets bare bones cuz she doesn't need or care to know more. My other sister, with a possible difficult child (the child is only 3 so kinda hard to tell whether it's just the terrible twos hanging in there a while), gets almost everything cuz she wants to maintain control. In husband's family, everyone except one sister gets bare bones; that sister is a retired psychiatric nurse so she gets everything cuz she can understand it, plus she's our respite or ack-crisis caregiver. 5) We had to realize that we had to set the issue of his giftedness aside for a while, and work primarily on him being able to function in a classroom, before worrying about what he was doing academically. 6) As a result of #5, we placed him in a Social Learning (behaviour mod) classroom, in the public school district. We had initially rejected this placement as not being academically appropriate. There are 10 kids, gr 4-7, 1 teacher, 2 aides. Very structured, written communications between home/school each day, very big on natural consequences, very big on helping the kids become more self-aware & develop coping strategies. Is seen as a temporary placement, with eventual aim of gradually mainstreaming students back into regular classroom, but the mainstreaming isn't forced and "temporary" can stretch over 2 or more school years as needed. Class is located in a school in our district but not in our suburb, the board provides transportation by bus and ONLY the kids in this class are on this bus. First-year bus driver, keen to work with teacher, teacher has helped develop checklists/standards for bus behaviour, with consequences to follow in classroom for non-compliance. After extended period of general problems, an aide was assigned to ride the bus so the driver could concentrate on driving. Most suspensions are in-school, as the teacher sez, she "got tired of punishing the parents". My son is completing the bare-bones of the gr 4 curriculum this year to satisfy board requirements for placement, is able per IEP to spend as much time as possible on projects more to his liking/ability level. He is age-level in his math ability & that has caused huge frustration to him in the past as it is something he actually has to work to understand; he had developed many avoidance techniques & many of his worst school meltdowns were during/just prior to math work, however he is now doing grade-level math with little or no acting up. Ripping up worksheets doesn't work anymore, he just has to do them after taping them up. Forgetting his text doesn't work, teacher just faxes them to me at my office & I bring them home for him. Refusing to do homework means he'll have to join "The Homework Club" which means staying in at lunch the next day, even if the work only takes 10 mins to complete (it only took him a few days to learn that lesson). This school placement has also helped his self-esteem a bit, since he's not "the worst" in his class any more. (well, some days....) 7) Medications. We were absolutely positive we wouldn't "drug our child" into submission. We tried the herbal & foods route & they just didn't work - and yes, we did give them time. After monkeying around a bit, we've found that 100 mg Wellbutrin, 20 mg Paxil, 10 mg Dexedrine, taken in the morning, and 3 mg melatonin, taken about an hour before bedtime, work well together. Not much appetite, but he continues to thrive physically and wasn't much of an eater before either. Still gets by on much less sleep than we think someone his age needs, but he isn't cranky & is content to lay on his bed reading if he's still awake at 10:00 or so. Previously, he would be raging around the house, hitting and picking fights with me, waking up easy child, etc. Now he's just not sleepy. He seems to generally have more impulse control, and has none of the aggressive behaviour towards classmates that we were beginning to see after about 6 months on Ritalin. 8) Choose your battles. If he's not hungry, he doesn't have to sit at the table with us. A separate meal will not be prepared for him, but if he is hungry at another time he can fix himself a sandwich or have some fruit, milk or juice. husband in particular used to try to force this kid to eat, with the eventual outcome of said child learning to vomit at will, which ALWAYS ended the demands to eat. 9) Be consistent in what will NOT be tolerated. We don't have the lying or stealing that some of you deal with, our main problem is non-compliance and physical aggression. He hurts someone, then he will be spanked or - we've only done this once so far & it had a tremendous effect - we call the police. Non-compliance consequences are usually revoked privileges (i.e. he loves playing computer games & writing stories on computer, will tend to monopolize our home workstation, to extent of standing behind me or easy child when we are working on it, and keeping up a running negative commentary until we give up & go away). Disabling the computer so he doesn't have access is working for now (for some reason the ONE way we've found that he hasn't been able to figure out is simply turn the power bar off - confuses him no end as he sees that everything is still plugged in & connected, but he still can't get it to power up, and it isn't an inconvenience to the rest of us, who are simply discreet when we turn it on!). With the Nintendo we simply take the control paddles away - game unit & games aren't too useful without them. If he misbehaves on a certain outing, well then he can't go there again for a set period (hasn't been to Science World for a full year now, it was one of his fave places). 10) Adjust your expectations. We don't have a kid with a bad attitude, we have a special-needs child with emotional disorders. We aren't labelling our child, we're working towards a diagnosis while we treat the symptoms that are causing him a great amount of stress. He is well aware that he's not like other children, and deeply unhappy about that. 11) Get help for yourself and the rest of the family. It may "just" be respite, so you can have some time to yourself or with your spouse. I have learned that I have depression, and can now identify specific episodes in my life. A low dose of Prozac every morning, and I'm functioning much much better. husband has a different kind of depression, has some other challenges as well which he is (finally) accepting and getting help for. He has tried several medications and wasn't having lasting effects with anything, is currently off but still doing therapy. easy child is drug-free and problem-free (psychiatrically!) at the moment but is fully into the start of adolescent hormonal moodiness & is being watched quite carefully by us. We are a little concerned on her behalf, re peer-induced "stupidity" affecting her gifted academic work, and re possibility of anorexia due to several risk factors (she's taller than most of her friends due to genes and entering puberty earlier than many, and so heavier altho slim overall, has expressed anxiety re weight, body shape etc.; also a perfectionist, also a worrier, also has parents distracted by "problem" child, also has expressed perceived pressure within family to be "the good one", etc.). We continue to ensure she has one-on-one time with each of us during the week, which is something we've always done with our kids, even before we were aware of the level of problem we were dealing with, re difficult child. We have to continually reassure easy child that it's ok for her to be upset or angry with her brother's behaviour and treatment of her. We don't want her eating her anger and anxiety. 12) Pre-teach. Our difficult child has a lot of trouble with transitions and new settings. We'll talk about places or people we're going to visit, show pictures if possible, discuss what's going to happen & when. The more prepared he is, the better he handles these things. School takes the same approach. In short, try everything. Almost everything works for a while, and once in a while something sticks that you can keep doing.