Every classroom, on average, has a child with attention deficit hyperactivity disorder (ADHD). And today's teachers are expected to do more to help them.
Guidelines on managing such behaviour, published last week by the hugely influential National Institute for Health and Clinical Excellence (Nice), recommend that the use of Ritalin should be reined in and that teachers could help provide alternative solutions.
Methylphenidate, the stimulant sold as Ritalin, is still considered necessary in severe cases of the disorder, which is characterised by pupils being unable to sit still or concentrate for long periods - but doctors are being asked to cut back on its use where possible and use it in conjunction with other approaches, such as thorough education programmes for parents.
What should teachers do to help?
"Every teacher will have had a child like this at some point in their teaching career," said Dr Christine Merrell, of Durham University's Centre for Evaluation and Monitoring, who as an education specialist worked on the guidelines development group.
"You know ADHD when you see it. I remember when working in a middle school, one boy who would shout out. At the age of 10, children can put their hands up and wait, but he couldn't - he would blurt out the answers. He would arrive without an exercise book or pencil. I would lend him a pencil, but he'd have broken it by the end of the lesson. It's not bad behaviour, it's impulsivity."
Nice has now asked mental health trusts to ensure that specialist teams develop training programmes for people working with children and their families.
Dr Merrell wants to see the Department for Children, Schools and Families including more about the disorder in initial teacher training. There are basic teaching and learning techniques that are good not just for children with ADHD but for all pupils. Breaking long tasks into chunks, is one. Rather than asking children to write about robots for half an hour, give them just 10 minutes to write the beginning.
"They can't do boredom," said Fintan O'Regan, educational consultant with the national Attention Deficit Disorder Information and Support Service (Addiss) and author of several books on how to manage behaviour. "To get through school, you have to be able to do periods of boredom, and if you have ADHD you can't."
The solution, he said, is either to remove distractions or increase them, the theory being that by providing "proactive stimulations", children won't be so distracted by other goings-on.
"If I had a child working on a piece of maths for one hour, I would split it into five or six components, so every 10 minutes they could get up and drop the answer in the box; that's their seat break.
"I'd give them an egg-timer so they can work against it; and I may give them headphones so they can listen to music."
But he said teaching such children successfully, depended on the headteacher's backing.
"There are three types of staff when it comes to ADHD," he said. "About one third will quite like the children; they'll find them quirky, eccentric, they'll adapt to them. About one third of teachers don't do quirky; they find them annoying, disrupting lessons not allowing others to enjoy the subject. They are not bad teachers, they just don't like quirky kids. The other third are not decided.
"If you get two-thirds of your staff to like these children, then you're on your way.
"Leadership is the number one factor, without question. If the headteacher is progressive and finds ways to enthuse others, then that message will filter down.
"The second factor is having some well trained teachers - then you can make provision and enjoy quirky kids.
"The third factor is being open-minded to options available, including medication."
Children with the condition generally get poorer results and are excluded from school more, but if they are helped to manage the condition, the outlook can be positive. Michael Phelps, the American swimmer who won 11 gold medals in Beijing this summer, was diagnosed then given medication and behaviour modification at the age of nine. By 11, he managed the condition without drugs.
One anonymous personal story describes another hopeful outcome.
B remembers having the desire to do "really bad things" as a primary school child.
"By the time I entered secondary school," she said, "I had a reputation as being one of those bright but naughty kids, which is what I guess most kids with ADHD were called then."
She fell in with the wrong crowd, took drugs, became involved in crime and was imprisoned.
Then she saw psychiatrists, who helped to sort her out. She went to university to study English literature, got a masters degree, met her husband, and has a successful career and a child.
Dr Merrell said: "It is a continuum. Some pupils will need significant help to stop them falling further and further behind.
"But if you speak to people with ADHD, they like the feeling of being on the ball. It may even be advantageous for some people who are impulsive without the inattention difficulties."
CHARACTERISTICS OF ADHD
What is ADHD?
Attention deficit hyperactivity disorder is a mental condition which, typically, is observable before the age of seven. Cases range from mild to severe. Mild forms need not be impairing at all.
What are the symptoms?
Being unable to concentrate for very long or finish a task. Fidgety and unable to sit still. Impulsive: children speak and act without thinking of the consequences.
What causes it?
There is no single obvious cause. ADHD is diagnosed through behaviour, and the diagnosis need not imply a medical or neurological cause. There can also be a genetic influence. Some research links ADHD to damage to the development of the brain. There is also some link between additives and levels of hyperactivity.
How many children have it?
About 3 per cent of school-age children and young people in the UK and 2 per cent of adults worldwide.
What is Ritalin?
Ritalin is the brand name of methylphenidate, a stimulant. It has a short duration of action, of about four hours, although some delayed-release medications have also been developed. A methylphenidate patch, with the brand name Daytrana, is also available.
How many children are prescribed drugs?
It is thought as many as 55,000 have been prescribed drugs for ADHD, but no official figures exist.
What happens now?
The National Institute of Clinical Excellence (Nice) has said the drug should not be routinely prescribed and never to under-fives. It should be reserved for the 41 per cent with severe symptoms or for those with moderate levels of impairment who have refused non-drug interventions, or whose symptoms have not responded sufficiently to other approaches.
TRAINING AND TREATMENT
The National Institute for Health and Clinical Excellence recommends:
Mental health trusts should set up teams that can develop training programmes for professionals who have contact with people with ADHD.
Parent training programmes should be offered as first-line treatment.
Teachers who have received training about ADHD and its management should provide behavioural interventions in the classroom.
If the impairment is moderate, the parents should be offered referral to a group parent-training programme, either on its own or with a group treatment for the child.
In school-age children and young people with severe ADHD, drug treatment should be offered as the first-line treatment. Parents should also be offered a group-based parent training programme.
Drug treatment for children with ADHD should always be part of a treatment plan that includes psychological, behavioural and educational behaviours.