When I worked in special ed about 15 years ago, the school could recommend seeing a GP for a referral for diagnosis, but could not go as far as to suggest that a child had a disorder. The first course of action was always counseling and behavior modification. Often times more 1 on 1 attention was enough to turn a child around. The catch was, under NYS education law, there had to be an IEP, which required a clinical diagnosis and coding. With children under 10, typically clinicians would tend to stay away from meds unless the child was beyond normal behavior modification. With kids in 1st or 2nd grade what we would see was a vague diagnosis of OHI (other handicapping impairment) just so that they would qualify for services, like a 1:1 aide. Meds should be a last resort. They change the brain chemistry such that they become necessary for the child to reach baseline. Many children "outgrow" ADHD/ADD, but it is nearly impossible to do if the brain is altered during periods of time when it is developing. If the brain doesn't "learn" to produce essential levels of dopamine, serotonin, acetylcholine, and other essential neurotransmitters, the child will be forever dependent upon chemical substances to function, concentrate, and avoid depression.