Tough decisions. High stress. Many parents of ADHD children feel they've failed as parents.

With her oldest daughter already diagnosed with having mild attention problems, it was at least easier for Roxanne Salazar to notice that her son's behavior went beyond normal. At the age of five, he was kicked out of kindergarten for biting another child and spent his time at home "dancing off the walls," Salazar says. This behavior was later found to be the result of attention deficit hyperactivity disorder (ADHD).

Salazar was reluctant to treat her son with anything stronger than soda and candy. But after these alternate stimulants failed, along with vitamins and just about everything else she could try, Salazar heeded her doctor's advice and put him on a prescription stimulant medication. The difference, she says, is like night and day.

"His teacher says he's at the top of his class," Salazar adds, beaming.

Salazar's own life, however, is not about to return to normal anytime soon. Even with successful treatment, children with ADHD require almost constant attention. Salazar must juggle the special needs of her son with a full time job and a growing family. Her fourth child is due in December.

If she could offer one bit of advice to busy parents struggling with their own child who has ADHD, it would be this: "Have a lot of patience," she says.

The Scope of ADHD

As many as six percent of all American kids may suffer from severe attention problems, which can put extra strain on the already difficult work of raising a family. Children with ADHD develop more slowly in school, typically have fewer friends and may require special care even after they leave for college.

"Raising a child with ADHD is exponentially more difficult," says Dr. Arthur Robin, a professor of psychiatry and behavioral neurosciences at the Wayne State University School of Medicine in Michigan.

The pressure is compounded by the controversial nature of ADHD. As the diagnosis and treatment of this disorder continues to rise, pediatrician groups increasingly square off with critics who feel that ADHD has become a catch-all for hard to control but otherwise healthy kids.

Left in the middle are concerned parents, who must balance the needs of their child against the debate over ADHD. Few issues are more perplexing than the use of stimulant medications.

Drugs like Ritalin, Adderall and Concerta are low-dose versions of powerful amphetamines. This sets off alarm bells with parents, but Robin says that they are currently the most effective option for controlling problem behavior.

"It's the only thing that can directly change the way the mind is functioning," he says.

Robin is quick to add that children should also try other steps besides stimulant medications, such as behavioral therapy. As a psychologist, Robin teaches kids how to compensate in areas where they have trouble. When used together, drug and behavioral interventions help more than either alone, studies show.

Parents Need Help to Help Their Kids

Still, putting your own child on any medication is not an easy choice. Salazar told her doctor that she wanted to try her way first before allowing her son to take a stimulant. "I hate the idea of drugs," Salazar says, adding that she herself flinches at the use of antibiotics. Although the treatment has proven successful for her son, she can't help but think she did something wrong.

"You feel you've failed as a parent," she says.

Indeed, the stress and effort of raising a child with ADHD is enough to make parents need their own form of help. During her spare time, if it could be called that, Salazar runs an online discussion group for ADHD families who share their concerns and advice. Hospitals and medical organizations also hold local support groups for those who want to talk face-to-face.

Ultimately, being a strong parent is what kids most need to overcome attention problems. In one study published in 2002, researchers found that a firm and encouraging parenting style had a significant moderating effect on a child's behavior at home. Approaches that include clear, concise instructions and nurturing a child's talents can help improve behavior, studies suggest.

Kids are largely on their own at school, however, so parents should consistently check in with teachers to ensure that their child is up-to-speed and behaving well.

Stay Positive

Despite the frustration some parents may feel, children with ADHD require more coaxing than typical kids. Robins says moms and dads should take great care in making sure that they emphasize the positive over the negative.

"You need to be a cheerleader for your kid," says Robins. In addition, he says parents should give more immediate feedback, use incentives before punishment and enforce agreed-upon consequences for kids who fail to behave.

Salazar uses the five minute rule when her son gets out of hand. After two polite warnings to stop what he is doing wrong, a third warning signals that he has to remain still and silent for the next five minutes.

"What kid wants quiet time?" she asks. "It really works."

Yet, even with all the advice and research on how to be a better parent, there are times that Salazar feels at a breaking point. She takes a deep breath and composes herself.

"No matter what happens, stay strong," she says.

next: Tips For Parents of Children with ADHD As Well As ADHD Adults

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Reviewed: 02/2006