Q. I have a 12 year old daughter who has been diagnosed with ADHD (Attention Deficit Hyperactivity Disorder), and a seizure disorder. She takes ritalin, lamictal for the seizures, and clonidine for the ADHD. Her behavior has always been a problem for the family. She is abusive (verbally) to her siblings and my husband and me. She is the oldest child. She is very demanding and manipulative. When she is told '"no" or cannot accept the limits put on her, she seems to become very out of control. She curses, becomes violent, throws herself around, and carries on, waiting for us to give in. It is very hard to stand our position. We are exhausted, both mentally and physically. A doctor has prescribed risperdal to use only in an emergency. But, I would like to prevent these episodes from even happening. Do you have any advice, given the medication she already takes?

A. I am not sure what to tell you about your daughter's medications. My simple rule of thumb is to change if things are not working. It does not sound as if things are working.

A diagnosis of ADHD is vague, and does not necessarily tell you how to treat. It just means she has trouble focusing. Likewise, a seizure disorder could exist, or she may have pseudoseizures. Each requires a different intervention if viewed as separate entities. My choice would be to try using an antidepressant, but I do not know enough about her medical history or emotional history to give a good answer. There are some dynamite child psychiatrists throughout the country treating patients like you daughter, and if you let me know where you live, I could offer a few suggestions where possible.

Medications are just part of the answer, and good behavioral therapy is also needed. You may want to touch base with a cognitive-behavioral therapist to maximize your daughter's chances of recovery.