Although the symptoms of AD/HD have been recognized for over 100 years, the frequency of diagnosis, as well as the pharmacological treatment of it, have grown exponentially in recent years. At this point, there are some 2.5 million children in the U.S. alone who have been diagnosed with a condition that only a generation ago was almost unheard of. One has to wonder: To what we can attribute this meteoric rise in the AD/HD phenomenon? Is it due to an increased awareness on the part of diagnosticians? Is there perhaps a major shift in the environment in which children are growing up? Or is it yet another label that serves to isolate "problem" children from those better prepared to operate within our systems?

Regardless of the reason for this rise in the number of diagnosed cases of AD/HD, the use of medication, especially Ritalin, has thus far been the treatment of choice. In this issue, we sought the help of our guest editor, Stuart Copans, a child and adolescent psychiatrist who works with young people with AD/HD, to provide depth and balance to our exploration of treatments for AD/HD that do not involve drugs.

While we do not minimize the potential of stimulant medication to be helpful in the treatment of AD/HD, we do feel that such treatment has been given sufficient exposure. In fact, the primary therapeutic question for AD/HD cases has typically been: "What dose of medication leads to improvement in the child’s current functioning at school and at home?" While it is natural for families and schools to focus on relief for their immediate challenges by turning to medications, to focus only on the present is to treat these children inadequately. Moreover, legitimate questions have been raised as to whether stimulant medication may help only in producing positive short-term outcomes, while being far less effectual in the long term (see Frankenberger, this issue).

Therefore, it is important that both the school and family address not only the question of what helps now, but what interventions are likely to have a positive effect on the life course of the child. This issue of Reaching Today’s Youth is full of interventions that can have such a positive effect, as part of a comprehensive treatment with or without the use of psychostimulant medications. The articles included address:

• Educational accommodations and innovations in classroom (see Thomas Armstrong; Thomas Hartma Sandra Rief; Steven Forness and colleagues)

• Administrative accommodations (see Sandra Beyda Sydney Zentall)

• Parent training and involvement (see David Baker an Stewart Pisecco; Ten Toothman)

• Social skills training (see Linda Lantieri)

• Sports training (see William Pelham and Elizabeth Gnagy)

• School-based aerobic exercise (see Steve Putnam Stuart Copans)

• Behavioral interventions (see Gregory Greenberg; Terence Scott; Grad Flick)

All of these interventions lead to improved self-esteem, se control, and internal empowerment on the part of the child with AD/HD, rather than reliance on medication, rewards punishments, or other external control. However, there much more to success than a perfectly crafted blend accommodations and innovations. Most people who overcome adversity say there was one very important person their lives who served as a mentor and helped to focus attention on their strengths. In many cases, this person was teacher. While the interventions in this issue may indeed help children function better in the here and now, human contact with caring and consistent individuals still remains the sing most important factor for improving long-term outcomes for students with AD/HD.

Alan M. Blankstein, Co-Editor of Reaching Today’s Youth,’ President of the National Educational Service.

Lyndal M. Bullock, Co-Editor of Reaching Today’s Youth, Past President of the Council for Children with Behavior Disorders and the Regent’s Professor of Special Education at University of North Texas.

Stuart A. Copans, the Guest Editor of this issue of Reaching Today’s Youth, is an Associate Professor of Child Psychiatry at Dartmouth Medical School, and works with hospitalize adolescents at the Brattleboro Retreat. The authors wish thank Melissa Clark, Psychology Department, Vassar College for her contributions to the preparation of this editorial.