Sexual intercourse between a man and a woman starts with them both getting sexually excited. This is sometimes referred to as foreplay, and might involve kissing and cuddling, touching each other and other sexual activities. Foreplay is important as it means a woman’s vagina begins to get moist and a man gets an erection. If the woman’s vagina does not get moist enough, then having sexual intercourse could be difficult or painful for her.

If a man and woman are having sexual intercourse, then using a contraceptive properly, every time, will prevent the woman becoming pregnant. There is more information on the contraceptive page.

If two people have sex (sexual intercourse) and one of them has a sexually transmitted disease (STD) then they could pass it on to the other person. Using a condom is the best way to prevent any infection from being passed from one person to the other.

If a couple are going to use a condom for protection against pregnancy or infections, they should put it on the man’s penis as soon as he gets an erection. Some men say they worry about using condoms in case they lose their erection or have difficulty putting the condom on. You could get some condoms and practice beforehand. Condoms come with instructions in words and pictures which show exactly how to use them.

After the condom is on, the man or woman can guide his penis into her vagina. The couple then move their bodies so that his penis moves up and down inside her vagina. This usually rubs the penis and makes the man sexually excited so that he has an orgasm. The movement might also rub the woman’s clitoris (or sensitive areas inside her vagina) so she can have an orgasm. But this depends on the position the couple are in when they have sexual intercourse.

Does having sex hurt?

The best way to ensure pain free sex is for both partners to relax and take their time.

Having sex does not usually hurt, though first time sex may be a bit uncomfortable for a woman because her hymen (a thin layer of skin that partially covers the entrance to the vagina) may be stretched or torn. This may cause a little bleeding, but it does not usually last long. Sex is not usually painful for a man.

After the first time, sex should become more comfortable. The vagina is very stretchy and will usually accommodate a penis (even a large one) with ease. However, a woman may experience pain when having sexual intercourse if her vagina does not produce enough natural lubrication. Extra vaginal fluids are usually produced when a woman becomes sexually excited to allow the penis to enter the vagina easily. If a woman is tense or rushing when she has sex, her vagina may not become moist enough to allow the penis to move in and out smoothly. Stress can also cause the muscles in the vagina to involuntarily tense up, making penetration difficult and painful. The best way to ensure pain free sex is for both partners to relax and take their time.

Extra lubrication might also help, and can be bought from many chemists and some supermarkets. When using a condom, it is very important that a water-based lubricant (like KY jelly) is used, as oil-based lubricants like Vaseline can cause the condom to disintegrate.

What ‘counts’ as losing your virginity?

Different people have different opinions on this, and some say there are different types of virginity. But most people generally agree that if a man has had penetrative sex, that is sexual intercourse, with a woman then he (or she) is no longer a virgin.

Which position is best for having sex?

There are quite a lot of different positions for sexual intercourse. One of the most common is the missionary position, where a woman lies on her back and a man lies on top of her. A man and woman might also lie on their sides, the woman may sit on top of the man, or she may kneel on all fours while the man puts his penis into her vagina from behind. If a couple are in a position where the woman’s clitoris is not being stimulated, they can do this with their fingers.

Can a woman become pregnant even if she doesn’t have sexual intercourse?

Yes. Pre-ejaculate (pre-come), the lubricating fluid that leaks out of a man’s penis when he’s sexually excited, can sometimes contain sperm. If pre-come or semen (come) get inside or around the entrance to the vagina, this can lead to pregnancy. They can also pass on a sexually transmitted infection.

Semen and pre-come can be transferred to the vagina on fingers or sex toys, so it’s important to make sure they’re clean and washed before they go anyway near a woman’s vagina.

What does sex feel like?

Similar things happen to most people’s bodies when they have sex – they get sensitive and warm and excited and may have an orgasm. Enjoying sexual activities with another person is possible whether you have an orgasm or not. Not being able to have an orgasm with another person doesn’t mean that you don’t fancy them or love them. Your emotions might be different each time you have a sexual experience, depending on the circumstances. Having sex can be one of the most intense and pleasurable physical and emotional experiences a person can have. But it won’t always be wonderful.

How do you have an orgasm?

When sexual excitement builds up and reaches a peak a person might experience an orgasm, also called a climax, or ‘coming’. The sexual excitement might start from someone masturbating on their own, or through kissing, masturbating or having sex with another person.

Sexual excitement usually grows gradually and a person feels more and more pleasure and a kind of exciting tension. All the feelings of tension then disappear when the orgasm happens, and the person experiences feelings of intense pleasure. The feeling can be so strong that a person might not be able to see, or hear or think about anything for a moment. They might even groan and call out with the pleasure. Orgasms usually last only a few seconds but the feelings might last a lot longer.

When a man has an orgasm he ejaculates. This means that sperm mixed with semen comes out of the end of his penis in a sticky white fluid. After a man has ejaculated he loses his erection and usually needs to stop for a while. When a woman has an orgasm, her vagina often becomes very wet, but she can continue being sexually aroused as long as she likes. Some women can experience more than one orgasm without stopping.

If a person doesn’t have an orgasm, it doesn’t mean anything is wrong. In fact, worrying about reaching an orgasm or being nervous is quite likely to make it hard for a person to relax enough to have one.

What is anal sex?

Anal sex (also known as anal intercourse) is when a man puts his penis into the anus and rectum of another man or woman.

Some people might have strong objections, especially religious or moral objections to anal sex. Others may feel uncomfortable about the idea of anal sex simply because it’s not something they think they will find enjoyable or want to try. For others however, anal intercourse is a very enjoyable way to have sex.

If a couple do decide to have anal sex, they should think about using a water-based lubricant, like KY Jelly, and a good quality condom.

Anal sex is often portrayed as something that only gay men do. This is not true. Many straight couples engage in anal sex, while many gay men have never tried it.

Anyone wanting to try anal sex should make sure that their partner really wants to do it. If one person wants to try it but the other doesn’t, it is better to stick to other forms of sex that both partners enjoy.

If a couple do decide to have anal sex, they should think about using a water-based lubricant, like KY Jelly, and a good quality condom. They should also take it slowly. The lining of the rectum is delicate and easily damaged during vigorous thrusting, particularly if the receiving partner is not relaxed.

There is a popular misconception that anal intercourse between a woman and man is a good way to avoid pregnancy. Anal sex does carry a lower risk of pregnancy than vaginal sex, but pregnancy can still occur if any semen leaks out of the anus and into the vagina. Using condoms is a more reliable way of preventing pregnancy, and they will also protect against sexually transmitted infections.

How long does sex last?

It depends what you mean by sex! The time people devote to doing sexual things can last from a few minutes, to several hours, or even a whole day! The actual act of sexual intercourse will often last until a man has an orgasm (ejaculates or comes), although there’s nothing wrong with stopping before this point.

A man might find he comes very quickly the first time he has sexual intercourse. Usually sexual intercourse lasts longer as people get more experienced and know what to expect. But with a new partner it can take time for people to get used to each other. Sex will usually be different every time – it depends on how a couple feel and what they want.

Is sex noisy?

Only if you want it to be! Some people do make noises when they having sex. They might moan or groan with pleasure or even cry out. Some people talk to each other. Others don’t speak or make any noises. But your body might make noises that you can’t help – squelching and squishing. These might be embarrassing or funny, but they are perfectly normal.

How often do people have sex?

Sexual appetite is entirely a matter of personal taste. Some people have sex once or twice a day and others once a month. It probably varies for most people depending on whether they are in a relationship, how busy they are and how they feel. Most people think about sex far more often than they do it.

How do you have oral sex?

Oral sex is when one person licks or sucks another person’s penis or vagina. When oral sex is done to a man it is sometimes called a blow job. When it is done to a woman it is sometimes called licking out. If two people have oral sex with each other at the same time it is sometimes called a 69 because of the shape their bodies make. A woman cannot get pregnant from giving oral sex to a man, even if she swallows his sperm.

Oral sex can be a very intense and intimate experience. Some people enjoy giving oral sex or having it. Other people feel uncomfortable about the idea and don’t want to do it. Sometimes people feel pressure to have oral sex when they don’t want to. It is very important to think about what the other person really wants if you want to have oral sex. Some sexually transmitted infections can be passed on through oral sex. There are flavoured condoms available that you can use when having oral sex. These are to stop any infections which might be passed on.

How do you masturbate?

A woman usually masturbates by rubbing, stroking or squeezing her clitoris. The clitoris is the most sensitive sexual part of a woman. She might also touch her breasts and other sensitive areas of her body. A man usually masturbates by stroking, rubbing or ‘pumping’ his penis, and may concentrate particularly on the tip, which is the most sensitive part. Masturbation is sometimes referred to as playing with yourself, or, especially with men, jerking off, a hand job, or wanking.

There is no physical reason why you should or shouldn’t masturbate. It is not true that you’ll go blind if you masturbate.

People don’t necessarily begin masturbating when they reach puberty. Some people hardly ever masturbate, and others masturbate a lot. It varies according to how a person feels. Many people masturbate even when they are in a relationship with someone. Masturbation can last as long as you want, but generally people masturbate for between a few minutes and half an hour.

There is no physical reason why you should or shouldn’t masturbate. It is not true that you’ll go blind if you masturbate, or that you will become weak or lose your health. It is not possible to masturbate too much, though you should stop if you start to make yourself feel sore. Some people think that if a man doesn’t masturbate his testes will fill up with sperm. This is not true; the sperm are just absorbed into his body. It is also not true that women who think about sex or masturbate are ‘easy’.

There are many ways to determine baby gender so that miss buying of baby goods can be avoided. The main option is for women who are having ultrasounds to see the gender via the photo picture which generally does an accurate job of determining the babies’ sex. There are literally dozens of shelf bought pregnancy tests that also admit a gender test as part of the chemical reaction that the test offers its user. These different commercial brand testing kits will all claim to be the safest, most invasive and more accurate than the competitor’s brand. This may be true in some cases however most claims go unwarranted and therefore the products keep up the eternal struggle of marketing verses product research.

Blood testing is said to be the most accurate thought the world knows no boundaries when it comes to claiming the best method to determine baby gender. There are hundreds of old wives tales plus the Chinese and many other countries possess their own spiritual or religious methods that also claim to be perfected over centuries. One thing is for sure that most methods are not fool proof and have all been known to be wrong from time to time.

Oral sex involves giving or receiving oral stimulation (i.e. sucking or licking) to the genitalia. Fellatio (also known as a ‘blow job’) is the term used to describe oral sex given to a man. Cunnilingus is the term which describes oral sex given to a woman.

Is oral sex common practice?

Many studies have shown that oral sex is practised by men and women of all ages, both gay and straight. It is a very common practice and may be performed on its own, or before or after sexual intercourse.

Is oral sex safe?

A number of studies have demonstrated that oral sex is not necessarily safe sex. Both giving and receiving oral sex can lead to the transmission of sexually transmitted infections or sexually transmitted diseases (also known as STIs or STDs).

Which STDs are transmitted via oral sex?

The most common STD transmitted via oral sex is herpes. There are two main types of herpes simplex virus (HSV): HSV type 1 and HSV type 2. HSV type 1 usually causes cold sores around the mouth, while HSV type 2 generally causes genital herpes sores. However, oral sex can sometimes cause HSV type 1 around the mouth to be transmitted to the genital area causing genital sores in the other person. This process can also work in reverse, with HSV-2 transmitted from the genitals to the mouth of the other person during oral sex, though this is rare.

The human papillomavirus that causes genital warts can very occasionally be transmitted through oral sex, causing warts to appear around or inside the mouth in anyone who has given oral sex to an infected person.

Gonorrhoea has been shown to infect the throat of some people who have given oral sex to an infected person. This infection can then be passed on from the throat to the genitals of any future partners. The body will almost always naturally clear the throat of the bacteria that cause gonorrhoea within three months, although infections in the genital tract will usually require antibiotics to cure. Chlamydia can also infect the throat in a similar way, although this is less common. Both infections may result in a sore throat, although many people will remain asymptomatic and unaware they are infected.

Syphilis may be passed on during oral sex if a person’s mouth comes into contact with an open sore or a skin rash caused by the infection.

Gastrointestinal infections and parasites may be passed on during oral contact with the anus.

The hepatitis A virus is also contained in human faeces, and may be passed on during anal-oral sex.

Hepatitis B is contained in sexual fluids and blood and may be transmitted during oral sex in a similar way to HIV (see below).

Hepatitis C is generally only contained in blood, and will only be transmitted if there is blood present during oral sex.

Can HIV be transmitted during oral sex?

HIV can pose a small risk for both the active (person giving the oral stimulation) and receptive (person receiving oral stimulation) partner.

Transmission from an HIV positive receptive partner to an HIV negative active partner may occur when the active partner gets sexual fluid (semen or vaginal fluid) or blood (from menstruation or a wound somewhere in the genital or anal region) into a cut, sore, ulcer or area of inflammation somewhere in their mouth or throat. The linings of the mouth and throat are very resistant to viral infections such as HIV, so infection is unlikely if they are healthy.

Transmission from an HIV positive active partner to an HIV negative receptive partner is generally believed to be less common. This is because HIV is normally only present in saliva in very low levels that are not sufficient to cause infection. The only risk in this scenario would be from bleeding wounds or gums in the HIV positive person’s mouth or on their lips, which may transfer blood onto the mucous membranes of the other person’s genitals or anus, or into any cuts or sores they may have. Hepatitis C can also be transmitted this way.

What is the risk of HIV transmission via oral sex?

The risk of HIV transmission from an infected partner through oral sex is much smaller than the risk of HIV transmission from anal or vaginal sex. Because of this, measuring the exact risk of HIV transmission as a result of oral sex is very difficult. In addition, since most sexually active individuals practice oral sex in addition to other forms of sex (such as vaginal and/or anal sex) when transmission occurs, it is difficult to determine whether or not it occurred as a result of oral sex or other more risky sexual activities. Finally, several co-factors can increase the risk of HIV transmission through oral sex, including oral ulcers and wounds, bleeding gums, genital sores, genital or oral piercings, and the presence of other STDs.

When scientists describe the risk of transmitting an infectious disease, like HIV, the term “theoretical risk” is often used. Very simply, “theoretical risk” means that passing an infection from one person to another is possible, even though there may not yet be any actual documented cases. “Theoretical risk” is not the same as likelihood. In other words, stating that HIV infection is “theoretically possible” does not necessarily mean it is likely to happen – only that it might. Documented risk, on the other hand, is used to describe transmission that has actually occurred, been investigated, and documented in the scientific literature.

Various scientific studies have been performed around the world to try and document and study instances of HIV transmission through oral sex. A programme in San Francisco studied 198 people, nearly all gay or bisexual men. The subjects stated that they had only had oral sex for a year, from six months preceding the six-month study to its end. 20 per cent of the study participants (39 people) reported performing oral sex on partners they knew to be HIV positive. 35 of those did not use a condom and 16 reported swallowing semen. No one became HIV positive during the study, although the small number of participants performing oral sex on HIV positive partners meant the researchers could only say that there was a less than 2.8 per cent chance of infection through oral sex over a year.¹ In 2000, a different San Francisco study of gay men who had recently acquired HIV infection found that 7.8 per cent of these infections were attributed to oral sex.² However, the results of the study have since been called into question due to the reliability of the participants’ data.

Measuring the exact risk of HIV transmission as a result of oral sex is very difficult.

In June 2002, a study conducted amongst 135 HIV negative Spanish heterosexuals, who were in a sexual relationship with a person who was HIV positive, reported that over 19,000 instances of unprotected oral sex had not led to any cases of HIV transmission.³ The study also looked at contributing factors that could affect the potential transmission of HIV through oral sex. They monitored viral load and asked questions such as whether ejaculation in the mouth occurred and how good oral health was. Amongst HIV positive men, 34 per cent had ejaculated into the mouths of their partners. Viral load levels were available for 60 people in the study, 10 per cent of whom had levels over 10,000 copies. Nearly 16 per cent of the HIV positive people had CD4 counts below 200. The study, conducted over a ten year period between 1990 and 2000, adds to the growing number of studies which suggest varying levels of risk of HIV transmission from oral sex when compared to anal or vaginal intercourse.

At the 4th International Oral AIDS Conference held in South Africa, the risk of transmission through oral sex was estimated to be approximately 0.04 per cent per contact.⁴ This percentage figure is a lot lower than the two American figures, because this figure is a risk per contact percentage, whereas the other figures are percentage risks over much longer time periods. Oral sex is still regarded as a low-risk sexual activity in terms of HIV transmission, but only when more work is done will we be clearer as to the risks of oral sex.

Are there any individual documented cases of HIV transmission during oral sex?

While it is very difficult to ever know how HIV transmission occurred, according to a factsheet on oral sex produced by the CDC in 2000⁵, there have been a few documented cases of transmission during oral sex. These have occurred in both receptive and active partners during fellatio, cunnilingus and anilingus.

How do I protect myself and my partner during oral sex?

The already low risk of becoming infected with HIV from oral sex can be reduced still further by using condoms. Flavoured condoms are available for those who don’t like the taste of latex or spermicide. For cunnilingus or anilingus, plastic food wrap, a condom cut open, or a dental dam (a thin square of latex) can serve as a physical barrier to prevent transmission of HIV and many other STDs.

Sexual intercourse between a man and a woman starts with them both getting sexually excited. This is sometimes referred to as foreplay, and might involve kissing and cuddling, touching each other and other sexual activities. Foreplay is important as it means a woman’s vagina begins to get moist and a man gets an erection. If the woman’s vagina does not get moist enough, then having sexual intercourse could be difficult or painful for her. 

If a man and woman are having sexual intercourse, then using a contraceptive properly, every time, will prevent the woman becoming pregnant. There is more information on the contraceptive page.

If two people have sex (sexual intercourse) and one of them has a sexually transmitted disease (STD) then they could pass it on to the other person. Using a condom is the best way to prevent any infection from being passed from one person to the other.

If a couple are going to use a condom for protection against pregnancy or infections, they should put it on the man’s penis as soon as he gets an erection. Some men say they worry about using condoms in case they lose their erection or have difficulty putting the condom on. You could get some condoms and practice beforehand. Condoms come with instructions in words and pictures which show exactly how to use them.

After the condom is on, the man or woman can guide his penis into her vagina. The couple then move their bodies so that his penis moves up and down inside her vagina. This usually rubs the penis and makes the man sexually excited so that he has an orgasm. The movement might also rub the woman’s clitoris (or sensitive areas inside her vagina) so she can have an orgasm. But this depends on the position the couple are in when they have sexual intercourse.

Does having sex hurt?

The best way to ensure pain free sex is for both partners to relax and take their time.

Having sex does not usually hurt, though first time sex may be a bit uncomfortable for a woman because her hymen (a thin layer of skin that partially covers the entrance to the vagina) may be stretched or torn. This may cause a little bleeding, but it does not usually last long. Sex is not usually painful for a man.

After the first time, sex should become more comfortable. The vagina is very stretchy and will usually accommodate a penis (even a large one) with ease. However, a woman may experience pain when having sexual intercourse if her vagina does not produce enough natural lubrication. Extra vaginal fluids are usually produced when a woman becomes sexually excited to allow the penis to enter the vagina easily. If a woman is tense or rushing when she has sex, her vagina may not become moist enough to allow the penis to move in and out smoothly. Stress can also cause the muscles in the vagina to involuntarily tense up, making penetration difficult and painful. The best way to ensure pain free sex is for both partners to relax and take their time.

Extra lubrication might also help, and can be bought from many chemists and some supermarkets. When using a condom, it is very important that a water-based lubricant (like KY jelly) is used, as oil-based lubricants like Vaseline can cause the condom to disintegrate.

What ‘counts’ as losing your virginity?

Different people have different opinions on this, and some say there are different types of virginity. But most people generally agree that if a man has had penetrative sex, that is sexual intercourse, with a woman then he (or she) is no longer a virgin.

Which position is best for having sex?

There are quite a lot of different positions for sexual intercourse. One of the most common is the missionary position, where a woman lies on her back and a man lies on top of her. A man and woman might also lie on their sides, the woman may sit on top of the man, or she may kneel on all fours while the man puts his penis into her vagina from behind. If a couple are in a position where the woman’s clitoris is not being stimulated, they can do this with their fingers.

Can a woman become pregnant even if she doesn’t have sexual intercourse?

Yes. Pre-ejaculate (pre-come), the lubricating fluid that leaks out of a man’s penis when he’s sexually excited, can sometimes contain sperm. If pre-come or semen (come) get inside or around the entrance to the vagina, this can lead to pregnancy. They can also pass on a sexually transmitted infection.

Semen and pre-come can be transferred to the vagina on fingers or sex toys, so it’s important to make sure they’re clean and washed before they go anyway near a woman’s vagina.

What does sex feel like?

Similar things happen to most people’s bodies when they have sex – they get sensitive and warm and excited and may have an orgasm. Enjoying sexual activities with another person is possible whether you have an orgasm or not. Not being able to have an orgasm with another person doesn’t mean that you don’t fancy them or love them. Your emotions might be different each time you have a sexual experience, depending on the circumstances. Having sex can be one of the most intense and pleasurable physical and emotional experiences a person can have. But it won’t always be wonderful.

How do you have an orgasm?

When sexual excitement builds up and reaches a peak a person might experience an orgasm, also called a climax, or ‘coming’. The sexual excitement might start from someone masturbating on their own, or through kissing, masturbating or having sex with another person.

Sexual excitement usually grows gradually and a person feels more and more pleasure and a kind of exciting tension. All the feelings of tension then disappear when the orgasm happens, and the person experiences feelings of intense pleasure. The feeling can be so strong that a person might not be able to see, or hear or think about anything for a moment. They might even groan and call out with the pleasure. Orgasms usually last only a few seconds but the feelings might last a lot longer.

When a man has an orgasm he ejaculates. This means that sperm mixed with semen comes out of the end of his penis in a sticky white fluid. After a man has ejaculated he loses his erection and usually needs to stop for a while. When a woman has an orgasm, her vagina often becomes very wet, but she can continue being sexually aroused as long as she likes. Some women can experience more than one orgasm without stopping.

If a person doesn’t have an orgasm, it doesn’t mean anything is wrong. In fact, worrying about reaching an orgasm or being nervous is quite likely to make it hard for a person to relax enough to have one.

What is anal sex?

Anal sex (also known as anal intercourse) is when a man puts his penis into the anus and rectum of another man or woman.

Some people might have strong objections, especially religious or moral objections to anal sex. Others may feel uncomfortable about the idea of anal sex simply because it’s not something they think they will find enjoyable or want to try. For others however, anal intercourse is a very enjoyable way to have sex.

If a couple do decide to have anal sex, they should think about using a water-based lubricant, like KY Jelly, and a good quality condom.

Anal sex is often portrayed as something that only gay men do. This is not true. Many straight couples engage in anal sex, while many gay men have never tried it.

Anyone wanting to try anal sex should make sure that their partner really wants to do it. If one person wants to try it but the other doesn’t, it is better to stick to other forms of sex that both partners enjoy.

If a couple do decide to have anal sex, they should think about using a water-based lubricant, like KY Jelly, and a good quality condom. They should also take it slowly. The lining of the rectum is delicate and easily damaged during vigorous thrusting, particularly if the receiving partner is not relaxed.

There is a popular misconception that anal intercourse between a woman and man is a good way to avoid pregnancy. Anal sex does carry a lower risk of pregnancy than vaginal sex, but pregnancy can still occur if any semen leaks out of the anus and into the vagina. Using condoms is a more reliable way of preventing pregnancy, and they will also protect against sexually transmitted infections.

How long does sex last?

It depends what you mean by sex! The time people devote to doing sexual things can last from a few minutes, to several hours, or even a whole day! The actual act of sexual intercourse will often last until a man has an orgasm (ejaculates or comes), although there’s nothing wrong with stopping before this point.

A man might find he comes very quickly the first time he has sexual intercourse. Usually sexual intercourse lasts longer as people get more experienced and know what to expect. But with a new partner it can take time for people to get used to each other. Sex will usually be different every time – it depends on how a couple feel and what they want.

Is sex noisy?

Only if you want it to be! Some people do make noises when they having sex. They might moan or groan with pleasure or even cry out. Some people talk to each other. Others don’t speak or make any noises. But your body might make noises that you can’t help – squelching and squishing. These might be embarrassing or funny, but they are perfectly normal.

How often do people have sex?

Sexual appetite is entirely a matter of personal taste. Some people have sex once or twice a day and others once a month. It probably varies for most people depending on whether they are in a relationship, how busy they are and how they feel. Most people think about sex far more often than they do it.

How do you have oral sex?

Oral sex is when one person licks or sucks another person’s penis or vagina. When oral sex is done to a man it is sometimes called a blow job. When it is done to a woman it is sometimes called licking out. If two people have oral sex with each other at the same time it is sometimes called a 69 because of the shape their bodies make. A woman cannot get pregnant from giving oral sex to a man, even if she swallows his sperm.

Oral sex can be a very intense and intimate experience. Some people enjoy giving oral sex or having it. Other people feel uncomfortable about the idea and don’t want to do it. Sometimes people feel pressure to have oral sex when they don’t want to. It is very important to think about what the other person really wants if you want to have oral sex. Some sexually transmitted infections can be passed on through oral sex. There are flavoured condoms available that you can use when having oral sex. These are to stop any infections which might be passed on.

How do you masturbate?

A woman usually masturbates by rubbing, stroking or squeezing her clitoris. The clitoris is the most sensitive sexual part of a woman. She might also touch her breasts and other sensitive areas of her body. A man usually masturbates by stroking, rubbing or ‘pumping’ his penis, and may concentrate particularly on the tip, which is the most sensitive part. Masturbation is sometimes referred to as playing with yourself, or, especially with men, jerking off, a hand job, or wanking.

There is no physical reason why you should or shouldn’t masturbate. It is not true that you’ll go blind if you masturbate.

People don’t necessarily begin masturbating when they reach puberty. Some people hardly ever masturbate, and others masturbate a lot. It varies according to how a person feels. Many people masturbate even when they are in a relationship with someone. Masturbation can last as long as you want, but generally people masturbate for between a few minutes and half an hour.

There is no physical reason why you should or shouldn’t masturbate. It is not true that you’ll go blind if you masturbate, or that you will become weak or lose your health. It is not possible to masturbate too much, though you should stop if you start to make yourself feel sore. Some people think that if a man doesn’t masturbate his testes will fill up with sperm. This is not true; the sperm are just absorbed into his body. It is also not true that women who think about sex or masturbate are ‘easy’.

The GFCF diet is not an easy route by any stretch. Unlike a diet program such as the Atkins diet, which restricts certain foods (vegetables and fruit) and advocates others (meat, cheese), the GFCF diet’s theory is based on the elimination of all foods that contain the proteins gluten (found in wheat, oats, barley, and rye) and casein (found in milk). There is evidence that shows many autistic people are unable to completely digest foods with these proteins in them. And gluten and casein are pervasive, so there’s a huge range of foods to avoid. Sound like a lot of work? It is.

Jenny*, mother of a 10-year-old autistic boy, was willing to roll up her sleeves and do that work. She believes the diet has transformed her son from severely autistic (his diagnosis at 3 years old) to functioning. He had lost all speech and communication skills during development, she explains. “Six months after going on the diet 100 percent, he went from no speech, through echolalia (the repetition of words or phrases just spoken by others), then spontaneous speech,” she says. Her son’s favorite meal is French toast made with eggs and water, bread made from rice flour, Pam spray, pure maple syrup, breakfast sausages, and dairy-free milk. And that’s just breakfast. But, Jenny tells parents: “If there’s a chance of getting your child back, isn’t that worth it?”

Naturopaths and nutritionists have been saying for years that autism may have something to do with environment, in addition to genes – and that’s why what kids eat may play a part. But while altering an autistic child’s diet has worked for some families, to date the GFCF diet has only anecdotal evidence, like the story above, to support it.

Before you get too excited by the possibility that eliminating oatmeal might transform your child, beware. What you substitute is as important as what you eliminate. “Many people have done well with GFCF diets, but in some cases it doesn’t work,” says Kaayla Daniel, Ph.D., Certified Clinical Nutritionist and author of the book The Whole Soy Story: The Dark Side of America’s Favorite Health Food. The main problem, says Daniel, is that children don’t reap all the benefits of the gluten-free, casein-free diet because parents replace gluten and casein with soy, which is very hard on the autistic child’s already sensitive digestive system.

What should they eat instead? Well, first, instead of replacing one food with another, go back to the basics, Daniel says. She suggests parents make homemade soup (chicken, lamb, or beef), using only the bones, water, a little vinegar, and whatever gluten-free, casein-free spices they’d like. Unlike foods that act merely as safer replacements for more problematic ones, the soup takes things one step further, aiming for the root of the problem. According to Daniel, the vinegar pulls out gelatin, cartilage, and minerals from the bones, which can help heal the child’s digestive track.

Kathleen McKenna, M.D., director of the Psychosis and Special Diagnostic Program at Children’s Memorial Hospital in Chicago, says that the most important thing parents can do for their autistic child with regard to nutrition is to provide a well-balanced diet. She recommends parents enlist a nutritionist to get the child on the right track. But McKenna warns, “It can be harmful if the parents focus only on diet and not speech and language, and other areas the child needs to develop.” Diet is just one piece of the puzzle, when it comes to autistic children.

So can a change in diet work? It depends on who you ask. Concrete evidence doesn’t exist, but anecdotal evidence abounds. And whether parents attempt the GFCF diet, or a diet based on a nutritionist’s recommendations, most experts agree that there is something to the theory that food combinations and/or eliminations can have an impact on an autistic child’s behavior. So put away the milk. Lay off the wheat. While there’s no proof-positive, it just might make a difference.

Picking the right name for your child is a daunting task. It will stick with them for life, so the pressure’s on! And while some countries have strict rosters of appropriate names you can choose from, in America almost anything goes. With all the options, it can be extremely overwhelming.

And of course, you’ll regularly be fending off suggestions from family, friends, and strangers. While it doesn’t hurt to be open to ideas, the decision is up to you and your partner. Don’t be afraid to say thanks, but no thanks!

Where do I begin?

Start discussing names with your partner as soon as possible to set some guidelines. Keep a list of favorites handy so you can add to it whenever a name pops into your head. Use our Baby Names Finder tool to find name ideas.

There are lots of considerations when you’re deciding on a name, such as appeasing relatives, avoiding embarrassing initials or nicknames, and steering clear of monikers associated with bad memories. These are some of the main points to keep in mind:

* Sound and compatibility. How your baby’s name sounds when it’s said aloud is one of the most essential things to think about. Is it melodious? Harsh? Does it go well with your last name? Often, longer first names work better with shorter last names, and vice versa. Combining a first name that ends in a vowel with a last name that starts with a vowel generally isn’t the best choice — the names tend to run together (”Eva Anderson”). Avoid first names that rhyme with your last name. And please resist puns: A name like “Holly Wood” or “Bud Weiser” will be cute for about five minutes. Then your poor child will be stuck with it for the rest of his or her life.

* Uniqueness. An unusual name has the advantage of making the bearer stand out from the crowd. Fran Barclay of Ann Arbor, Michigan, sometimes wishes she hadn’t named her second son Matthew. When he started school, he had three other Matts in his class. “It was years before he really understood that his name wasn’t Matt B.,” she says. On the other hand, a name no one has heard of and few can pronounce can bring attention a child would rather avoid. One way of striking a balance is to choose a familiar first name if the child’s last name is unusual, and vice versa. If your son’s last name will be Smith, you might want to consider something with more pizazz than Joe for his first name. But if his last name is Aytrivbsoan, then Joe might be preferable to, say, Archimedes as a given name.

* Relatives and friends. Many parents choose to name their babies after a grandparent, other relative, or close friend. This option can provide you with a good pool of names to consider. Take ideas graciously, but don’t tell anyone what you and your partner have decided until after the baby is born — when it’s too late to give in to any subtle hints. And never let anyone pressure you into a name you don’t like. Great Aunt Hepzibah may have survived all right with her name, but will your baby?

* Ancestry and heritage. Your child’s heritage is an essential part of who she is, and you may want her name to reflect that. Your religious preference may steer you toward a certain category of names. Or perhaps your family has a tradition of naming first-born sons after their fathers. If you love a name but it doesn’t meet your family’s traditional requirements, consider using it as a middle name. Or give her the name you prefer and use the traditional name for her middle name.

* Meaning. No one is likely to treat your daughter Ingrid differently because her name means “hero’s daughter,” but the derivation of your baby’s name is something you may want to think about. After all, if little Stockard finds out someday that her name means “from the yard of tree stumps,” she may not be pleased.

* Initials and nicknames. People, especially kids, can be cruel when it comes to nicknames, so try to anticipate any potentially embarrassing ones. Of course, just because you don’t think of something doesn’t mean some clever second-grader down the line won’t — and he’ll probably find it utterly hilarious. But at least you can rule out the obvious problems. Also, be aware of what your child’s initials spell. Zachary Ian Thomas will more than likely get a lot of teasing; Zachary Edward Thomas probably won’t.

Remember, none of these are hard rules. The most important criterion for a name is simply that you and your partner like it.

As any student of chemistry will assure you, acids and bases (alkalis) neutralize each other. If you eat a starch with a protein, digestion is impaired or completely arrested! The undigested food mass can cause various kinds of digestive disorders. Undigested food becomes soil for bacteria which ferment and decompose it. Its by products are poisonous, one of which, alcohol, is a narcotic that destroys or inhibits nerve function. It plays havoc with nerves of the digestive tract, suspending their vital action such that constipation may well be a result! As set forth in Dr. Herbert Shelton’s FOOD COMBINING MADE EASY these are the salient rules for proper food combining.

The Basic Rules of Proper Food Combining:

1. Eat acids and starches at separate meals. Acids neutralize the alkaline medium required for starch digestion and the result is fermentation and indigestion.

2. Eat protein foods and carbohydrate foods at separate meals. Protein foods require an acid medium for digestion.

3. Eat but one kind of protein food at a meal.

4. Eat proteins and acid foods at separate meals. The acids of acid foods inhibit the secretion of the digestive acids required for protein digestion. Undigested protein putrefies in bacterial decomposition and produces some potent poisons.

5. Eat fats and proteins at separate meals. Some foods, especially nuts, are over 50% fat and require hours for digestion.

6. Eat sugars (fruits) and proteins at separate meals.

7. Eat sugars (fruits) and starchy foods at separate meals. Fruits undergo no digestion in the stomach and are held up if eaten with foods that require digestion in the stomach.

8. Eat melons alone. They combine with almost no other food.

9. Desert the desserts. Eaten on top of meals they lie heavy on the stomach, requiring no digestion there, and ferment. Bacteria turn them into alcohols and vinegars and acetic acids.

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).

ADHD has three subtypes:¹

• Predominantly hyperactive-impulsive
  • Most symptoms (six or more) are in the hyperactivity-impulsivity categories.
  • Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.

• Predominantly inattentive
  • The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.
  • Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.

• Combined hyperactive-impulsive and inattentive
  • Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.
  • Most children have the combined type of ADHD.

Treatments can relieve many of the disorder’s symptoms, but there is no cure. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it.

What are the symptoms of ADHD in children?

Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD, these behaviors are more severe and occur more often. To be diagnosed with the disorder, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age.

Children who have symptoms of inattention may:

• Be easily distracted, miss details, forget things, and frequently switch from one activity to another
• Have difficulty focusing on one thing
• Become bored with a task after only a few minutes, unless they are doing something enjoyable
• Have difficulty focusing attention on organizing and completing a task or learning something new
• Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
• Not seem to listen when spoken to
• Daydream, become easily confused, and move slowly
• Have difficulty processing information as quickly and accurately as others
• Struggle to follow instructions.

Children who have symptoms of hyperactivity may:

• Fidget and squirm in their seats
• Talk nonstop
• Dash around, touching or playing with anything and everything in sight
• Have trouble sitting still during dinner, school, and story time
• Be constantly in motion
• Have difficulty doing quiet tasks or activities.

Children who have symptoms of impulsivity may:

• Be very impatient
• Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
• Have difficulty waiting for things they want or waiting their turns in games
• Often interrupt conversations or others’ activities.

ADHD Can Be Mistaken for Other Problems
Parents and teachers can miss the fact that children with symptoms of inattention have the disorder because they are often quiet and less likely to act out. They may sit quietly, seeming to work, but they are often not paying attention to what they are doing. They may get along well with other children, compared with those with the other subtypes, who tend to have social problems. But children with the inattentive kind of ADHD are not the only ones whose disorders can be missed. For example, adults may think that children with the hyperactive and impulsive subtypes just have emotional or disciplinary problems.

What Causes ADHD?

Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.

Genes. Inherited from our parents, genes are the “blueprints” for who we are. Results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several genes that may make people more likely to develop the disorder.^2,3 Knowing the genes involved may one day help researchers prevent the disorder before symptoms develop. Learning about specific genes could also lead to better treatments.

Children with ADHD who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. This NIMH research showed that the difference was not permanent, however, and as children with this gene grew up, the brain developed to a normal level of thickness. Their ADHD symptoms also improved.⁴

Environmental factors. Studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children.^5,6 In addition, preschoolers who are exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, may have a higher risk of developing ADHD.⁷

Brain injuries. Children who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children with ADHD have suffered a traumatic brain injury.

Sugar. The idea that refined sugar causes ADHD or makes symptoms worse is popular, but more research discounts this theory than supports it. In one study, researchers gave children foods containing either sugar or a sugar substitute every other day. The children who received sugar showed no different behavior or learning capabilities than those who received the sugar substitute.⁸ Another study in which children were given higher than average amounts of sugar or sugar substitutes showed similar results.⁹

In another study, children who were considered sugar-sensitive by their mothers were given the sugar substitute aspartame, also known as Nutrasweet. Although all the children got aspartame, half their mothers were told their children were given sugar, and the other half were told their children were given aspartame. The mothers who thought their children had gotten sugar rated them as more hyperactive than the other children and were more critical of their behavior, compared to mothers who thought their children received aspartame.¹⁰

Food additives. Recent British research indicates a possible link between consumption of certain food additives like artificial colors or preservatives, and an increase in activity.¹¹ Research is under way to confirm the findings and to learn more about how food additives may affect hyperactivity.

How is ADHD diagnosed?

Children mature at different rates and have different personalities, temperaments, and energy levels. Most children get distracted, act impulsively, and struggle to concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD. ADHD symptoms usually appear early in life, often between the ages of 3 and 6, and because symptoms vary from person to person, the disorder can be hard to diagnose. Parents may first notice that their child loses interest in things sooner than other children, or seems constantly “out of control.” Often, teachers notice the symptoms first, when a child has trouble following rules, or frequently “spaces out” in the classroom or on the playground.

No single test can diagnose a child as having ADHD. Instead, a licensed health professional needs to gather information about the child, and his or her behavior and environment. A family may want to first talk with the child’s pediatrician. Some pediatricians can assess the child themselves, but many will refer the family to a mental health specialist with experience in childhood mental disorders such as ADHD. The pediatrician or mental health specialist will first try to rule out other possibilities for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that seem like ADHD.

Between them, the referring pediatrician and specialist will determine if a child:

• Is experiencing undetected seizures that could be associated with other medical conditions
• Has a middle ear infection that is causing hearing problems
• Has any undetected hearing or vision problems
• Has any medical problems that affect thinking and behavior
• Has any learning disabilities
• Has anxiety or depression, or other psychiatric problems that might cause ADHD-like symptoms
• Has been affected by a significant and sudden change, such as the death of a family member, a divorce, or parent’s job loss.

A specialist will also check school and medical records for clues, to see if the child’s home or school settings appear unusually stressful or disrupted, and gather information from the child’s parents and teachers. Coaches, babysitters, and other adults who know the child well also may be consulted.

The specialist also will ask:

• Are the behaviors excessive and long-term, and do they affect all aspects of the child’s life?
• Do they happen more often in this child compared with the child’s peers?
• Are the behaviors a continuous problem or a response to a temporary situation?
• Do the behaviors occur in several settings or only in one place, such as the playground, classroom, or home?

The specialist pays close attention to the child’s behavior during different situations. Some situations are highly structured, some have less structure. Others would require the child to keep paying attention. Most children with ADHD are better able to control their behaviors in situations where they are getting individual attention and when they are free to focus on enjoyable activities. These types of situations are less important in the assessment. A child also may be evaluated to see how he or she acts in social situations, and may be given tests of intellectual ability and academic achievement to see if he or she has a learning disability.

Finally, if after gathering all this information the child meets the criteria for ADHD, he or she will be diagnosed with the disorder.

How is ADHD treated?

Currently available treatments focus on reducing the symptoms of ADHD and improving functioning. Treatments include medication, various types of psychotherapy, education or training, or a combination of treatments.

Medications

The most common type of medication used for treating ADHD is called a “stimulant.” Although it may seem unusual to treat ADHD with a medication considered a stimulant, it actually has a calming effect on children with ADHD. Many types of stimulant medications are available. A few other ADHD medications are non-stimulants and work differently than stimulants. For many children, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination.

However, a one-size-fits-all approach does not apply for all children with ADHD. What works for one child might not work for another. One child might have side effects with a certain medication, while another child may not. Sometimes several different medications or dosages must be tried before finding one that works for a particular child. Any child taking medications must be monitored closely and carefully by caregivers and doctors.

Stimulant medications come in different forms, such as a pill, capsule, liquid, or skin patch. Some medications also come in short-acting, long-acting, or extended release varieties. In each of these varieties, the active ingredient is the same, but it is released differently in the body. Long-acting or extended release forms often allow a child to take the medication just once a day before school, so they don’t have to make a daily trip to the school nurse for another dose. Parents and doctors should decide together which medication is best for the child and whether the child needs medication only for school hours or for evenings and weekends, too.

A list of medications and the approved age for use follows. ADHD can be diagnosed and medications prescribed by M.D.s (usually a psychiatrist) and in some states also by clinical psychologists, psychiatric nurse practitioners, and advanced psychiatric nurse specialists. Check with your state’s licensing agency for specifics.

*Not all ADHD medications are approved for use in adults.
NOTE: “extended release” means the medication is released gradually so that a controlled amount enters the body
over a period of time. “Long acting” means the medication stays in the body for a long time.

Over time, this list will grow, as researchers continue to develop new medications for ADHD. Medication guides for each of these medications are available from the U.S. Food and Drug Administration (FDA).

What are the side effects of stimulant medications?

The most commonly reported side effects are decreased appetite, sleep problems, anxiety, and irritability. Some children also report mild stomachaches or headaches. Most side effects are minor and disappear over time or if the dosage level is lowered.

• Decreased appetite. Be sure your child eats healthy meals. If this side effect does not go away, talk to your child’s doctor. Also talk to the doctor if you have concerns about your child’s growth or weight gain while he or she is taking this medication.
• Sleep problems. If a child cannot fall asleep, the doctor may prescribe a lower dose of the medication or a shorter-acting form. The doctor might also suggest giving the medication earlier in the day, or stopping the afternoon or evening dose. Adding a prescription for a low dose of an antidepressant or a blood pressure medication called clonidine sometimes helps with sleep problems. A consistent sleep routine that includes relaxing elements like warm milk, soft music, or quiet activities in dim light, may also help.
• Less common side effects. A few children develop sudden, repetitive movements or sounds called tics. These tics may or may not be noticeable. Changing the medication dosage may make tics go away. Some children also may have a personality change, such as appearing “flat” or without emotion. Talk with your child’s doctor if you see any of these side effects.

Are stimulant medications safe?

Under medical supervision, stimulant medications are considered safe. Stimulants do not make children with ADHD feel high, although some kids report feeling slightly different or “funny.” Although some parents worry that stimulant medications may lead to substance abuse or dependence, there is little evidence of this.

FDA warning on possible rare side effects

In 2007, the FDA required that all makers of ADHD medications develop Patient Medication Guides that contain information about the risks associated with the medications. The guides must alert patients that the medications may lead to possible cardiovascular (heart and blood) or psychiatric problems. The agency undertook this precaution when a review of data found that ADHD patients with existing heart conditions had a slightly higher risk of strokes, heart attacks, and/or sudden death when taking the medications.

The review also found a slight increased risk, about 1 in 1,000, for medication-related psychiatric problems, such as hearing voices, having hallucinations, becoming suspicious for no reason, or becoming manic (an overly high mood), even in patients without a history of psychiatric problems. The FDA recommends that any treatment plan for ADHD include an initial health history, including family history, and examination for existing cardiovascular and psychiatric problems.

One ADHD medication, the non-stimulant atomoxetine (Strattera), carries another warning. Studies show that children and teenagers who take atomoxetine are more likely to have suicidal thoughts than children and teenagers with ADHD who do not take it. If your child is taking atomoxetine, watch his or her behavior carefully. A child may develop serious symptoms suddenly, so it is important to pay attention to your child’s behavior every day. Ask other people who spend a lot of time with your child to tell you if they notice changes in your child’s behavior. Call a doctor right away if your child shows any unusual behavior. While taking atomoxetine, your child should see a doctor often, especially at the beginning of treatment, and be sure that your child keeps all appointments with his or her doctor.

Do medications cure ADHD?

Current medications do not cure ADHD. Rather, they control the symptoms for as long as they are taken. Medications can help a child pay attention and complete schoolwork. It is not clear, however, whether medications can help children learn or improve their academic skills. Adding behavioral therapy, counseling, and practical support can help children with ADHD and their families to better cope with everyday problems. Research funded by the National Institute of Mental Health (NIMH) has shown that medication works best when treatment is regularly monitored by the prescribing doctor and the dose is adjusted based on the child’s needs.¹²

Psychotherapy

Different types of psychotherapy are used for ADHD. Behavioral therapy aims to help a child change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a child how to monitor his or her own behavior. Learning to give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting, is another goal of behavioral therapy. Parents and teachers also can give positive or negative feedback for certain behaviors. In addition, clear rules, chore lists, and other structured routines can help a child control his or her behavior.

Therapists may teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.

How can parents help?

Children with ADHD need guidance and understanding from their parents and teachers to reach their full potential and to succeed in school. Before a child is diagnosed, frustration, blame, and anger may have built up within a family. Parents and children may need special help to overcome bad feelings. Mental health professionals can educate parents about ADHD and how it impacts a family. They also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.

Parenting skills training helps parents learn how to use a system of rewards and consequences to change a child’s behavior. Parents are taught to give immediate and positive feedback for behaviors they want to encourage, and ignore or redirect behaviors they want to discourage. In some cases, the use of “time-outs” may be used when the child’s behavior gets out of control. In a time-out, the child is removed from the upsetting situation and sits alone for a short time to calm down.

Parents are also encouraged to share a pleasant or relaxing activity with the child, to notice and point out what the child does well, and to praise the child’s strengths and abilities. They may also learn to structure situations in more positive ways. For example, they may restrict the number of playmates to one or two, so that their child does not become overstimulated. Or, if the child has trouble completing tasks, parents can help their child divide large tasks into smaller, more manageable steps. Also, parents may benefit from learning stress-management techniques to increase their own ability to deal with frustration, so that they can respond calmly to their child’s behavior.

Sometimes, the whole family may need therapy. Therapists can help family members find better ways to handle disruptive behaviors and to encourage behavior changes. Finally, support groups help parents and families connect with others who have similar problems and concerns. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.

Tips to Help Kids Stay Organized and Follow Directions

Schedule. Keep the same routine every day, from wake-up time to bedtime. Include time for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or on a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible.

Organize everyday items. Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys.

Use homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home the necessary books.

Be clear and consistent. Children with ADHD need consistent rules they can understand and follow.

Give praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior, and praise it.

What conditions can coexist with ADHD?

Some children with ADHD also have other illnesses or conditions. For example, they may have one or more of the following:

• A learning disability. A child in preschool with a learning disability may have difficulty understanding certain sounds or words or have problems expressing himself or herself in words. A school-aged child may struggle with reading, spelling, writing, and math.
• Oppositional defiant disorder. Kids with this condition, in which a child is overly stubborn or rebellious, often argue with adults and refuse to obey rules.
• Conduct disorder. This condition includes behaviors in which the child may lie, steal, fight, or bully others. He or she may destroy property, break into homes, or carry or use weapons. These children or teens are also at a higher risk of using illegal substances. Kids with conduct disorder are at risk of getting into trouble at school or with the police.
• Anxiety and depression. Treating ADHD may help to decrease anxiety or some forms of depression.
• Bipolar disorder. Some children with ADHD may also have this condition in which extreme mood swings go from mania (an extremely high elevated mood) to depression in short periods of time.
• Tourette syndrome. Very few children have this brain disorder, but among those who do, many also have ADHD. Some people with Tourette syndrome have nervous tics and repetitive mannerisms, such as eye blinks, facial twitches, or grimacing. Others clear their throats, snort, or sniff frequently, or bark out words inappropriately. These behaviors can be controlled with medication.

ADHD also may coexist with a sleep disorder, bed-wetting, substance abuse, or other disorders or illnesses.

For more information on these disorders, visit the NIMH website.

Recognizing ADHD symptoms and seeking help early will lead to better outcomes for both affected children and their families.

How can I work with my child’s school?

If you think your child has ADHD, or a teacher raises concerns, you may be able to request that the school conduct an evaluation to determine whether he or she qualifies for special education services.

Start by speaking with your child’s teacher, school counselor, or the school’s student support team, to begin an evaluation. Also, each state has a Parent Training and Information Center and a Protection and Advocacy Agency that can help you get an evaluation. A team of professionals conducts the evaluation using a variety of tools and measures. It will look at all areas related to the child’s disability.

Once your child has been evaluated, he or she has several options, depending on the specific needs. If special education services are needed and your child is eligible under the Individuals with Disabilities Education Act, the school district must develop an “individualized education program” specifically for your child within 30 days.

If your child is considered not eligible for special education services—and not all children with ADHD are eligible—he or she still can get “free appropriate public education,” available to all public-school children with disabilities under Section 504 of the Rehabilitation Act of 1973, regardless of the nature or severity of the disability.

For more information on Section 504 visit the U.S. Department of Education’s Office for Civil Rights which enforces Section 504 in programs and activities that receive Federal education funds.

Visit the Department of Education programs for more information about children with disabilities

Transitions can be difficult. Each school year brings a new teacher and new schoolwork, a change that can be especially hard for a child with ADHD who needs routine and structure. Consider telling the teachers that your child has ADHD when he or she starts school or moves to a new class. Additional support will help your child deal with the transition.

Do teens with ADHD have special needs?

Most children with ADHD continue to have symptoms as they enter adolescence. Some children, however, are not diagnosed with ADHD until they reach adolescence. This is more common among children with predominantly inattentive symptoms because they are not necessarily disruptive at home or in school. In these children, the disorder becomes more apparent as academic demands increase and responsibilities mount. For all teens, these years are challenging. But for teens with ADHD, these years may be especially difficult.

Although hyperactivity tends to decrease as a child ages, teens who continue to be hyperactive may feel restless and try to do too many things at once. They may choose tasks or activities that have a quick payoff, rather than those that take more effort, but provide bigger, delayed rewards. Teens with primarily attention deficits struggle with school and other activities in which they are expected to be more self-reliant.

Teens also become more responsible for their own health decisions. When a child with ADHD is young, parents are more likely to be responsible for ensuring that their child maintains treatment. But when the child reaches adolescence, parents have less control, and those with ADHD may have difficulty sticking with treatment.

To help them stay healthy and provide needed structure, teens with ADHD should be given rules that are clear and easy to understand. Helping them stay focused and organized—such as posting a chart listing household chores and responsibilities with spaces to check off completed items—also may help.

Teens with or without ADHD want to be independent and try new things, and sometimes they will break rules. If your teen breaks rules, your response should be as calm and matter-of-fact as possible. Punishment should be used only rarely. Teens with ADHD often have trouble controlling their impulsivity and tempers can flare. Sometimes, a short time-out can be calming.

If your teen asks for later curfews and use of the car, listen to the request, give reasons for your opinions, and listen to your child’s opinion. Rules should be clear once they are set, but communication, negotiation, and compromise are helpful along the way. Maintaining treatments, such as medication and behavioral or family therapy, also can help with managing your teenager’s ADHD.

What about teens and driving?

Although many teens engage in risky behaviors, those with ADHD, especially untreated ADHD, are more likely to take more risks. In fact, in their first few years of driving, teens with ADHD are involved in nearly four times as many car accidents as those who do not have ADHD. They are also more likely to cause injury in accidents, and they get three times as many speeding tickets as their peers.¹³

Most states now use a graduated licensing system, in which young drivers, both with and without ADHD, learn about progressively more challenging driving situations.¹⁴ The licensing system consists of three stages—learner’s permit, during which a licensed adult must always be in the car with the driving teen; intermediate (provisional) license; and full licensure. Parents should make sure that their teens, especially those with ADHD, understand and follow the rules of the road. Repeated driving practice under adult supervision is especially important for teens with ADHD.

Can adults have ADHD?

Some children with ADHD continue to have it as adults. And many adults who have the disorder don’t know it. They may feel that it is impossible to get organized, stick to a job, or remember and keep appointments. Daily tasks such as getting up in the morning, preparing to leave the house for work, arriving at work on time, and being productive on the job can be especially challenging for adults with ADHD.

These adults may have a history of failure at school, problems at work, or difficult or failed relationships. Many have had multiple traffic accidents. Like teens, adults with ADHD may seem restless and may try to do several things at once, most of them unsuccessfully. They also tend to prefer “quick fixes,” rather than taking the steps needed to achieve greater rewards.

How is ADHD diagnosed in adults?

Like children, adults who suspect they have ADHD should be evaluated by a licensed mental health professional. But the professional may need to consider a wider range of symptoms when assessing adults for ADHD because their symptoms tend to be more varied and possibly not as clear cut as symptoms seen in children.

To be diagnosed with the condition, an adult must have ADHD symptoms that began in childhood and continued throughout adulthood.¹⁵ Health professionals use certain rating scales to determine if an adult meets the diagnostic criteria for ADHD. The mental health professional also will look at the person’s history of childhood behavior and school experiences, and will interview spouses or partners, parents, close friends, and other associates. The person will also undergo a physical exam and various psychological tests.

For some adults, a diagnosis of ADHD can bring a sense of relief. Adults who have had the disorder since childhood, but who have not been diagnosed, may have developed negative feelings about themselves over the years. Receiving a diagnosis allows them to understand the reasons for their problems, and treatment will allow them to deal with their problems more effectively.

How is ADHD treated in adults?

Much like children with the disorder, adults with ADHD are treated with medication, psychotherapy, or a combination of treatments.

Medications. ADHD medications, including extended-release forms, often are prescribed for adults with ADHD, but not all of these medications are approved for adults.¹⁶ However, those not approved for adults still may be prescribed by a doctor on an “off-label” basis.

Although not FDA-approved specifically for the treatment of ADHD, antidepressants are sometimes used to treat adults with ADHD. Older antidepressants, called tricyclics, sometimes are used because they, like stimulants, affect the brain chemicals norepinephrine and dopamine. A newer antidepressant, venlafaxine (Effexor), also may be prescribed for its effect on the brain chemical norepinephrine. And in recent clinical trials, the antidepressant bupropion (Wellbutrin), which affects the brain chemical dopamine, showed benefits for adults with ADHD.¹⁷

Adult prescriptions for stimulants and other medications require special considerations. For example, adults often require other medications for physical problems, such as diabetes or high blood pressure, or for anxiety and depression. Some of these medications may interact badly with stimulants. An adult with ADHD should discuss potential medication options with his or her doctor. These and other issues must be taken into account when a medication is prescribed.

Education and psychotherapy. A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as a large calendar or date book, lists, reminder notes, and by assigning a special place for keys, bills, and paperwork. Large tasks can be broken down into more manageable, smaller steps so that completing each part of the task provides a sense of accomplishment.

Psychotherapy, including cognitive behavioral therapy, also can help change one’s poor self-image by examining the experiences that produced it. The therapist encourages the adult with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.

What efforts are under way to improve treatment?

This is an exciting time in ADHD research. The expansion of knowledge in genetics, brain imaging, and behavioral research is leading to a better understanding of the causes of the disorder, how to prevent it, and how to develop more effective treatments for all age groups.

NIMH has studied ADHD treatments for school-aged children in a large-scale, long-term study called the Multimodal Treatment Study of Children with ADHD (MTA study). NIMH also funded the Preschoolers with ADHD Treatment Study (PATS), which involved more than 300 preschoolers who had been diagnosed with ADHD. The study found that low doses of the stimulant methylphenidate are safe and effective for preschoolers, but the children are more sensitive to the side effects of the medication, including slower than average growth rates.¹⁸ Therefore, preschoolers should be closely monitored while taking ADHD medications.^19,20

PATS is also looking at the genes of the preschoolers, to see if specific genes affected how the children responded to methylphenidate. Future results may help scientists link variations in genes to differences in how people respond to ADHD medications. For now, the study provides valuable insights into ADHD.²¹

Other NIMH-sponsored clinical trials on children and adults with ADHD are under way. In addition, NIMH-sponsored scientists continue to look for the biological basis of ADHD, and how differences in genes and brain structure and function may combine with life experiences to produce the disorder.

Recent advances in nutritional neuroscience show that particular nutrients have certain affects on the development of the human brain, which influence intelligence, mood, and behavior.

The brain of a human fetus grows rapidly from the 10th to 18th week of pregnancy. During this time the fetus develops thousands of brain cells, called neurons, every minute. Moreover, these neurons begin to develop into a system of interlocking connections, forming essentially a network of specialized nerve cells that can have long-term effects on the child?s development. Therefore, it is important for the mother to eat nutritious foods during this time.

This process of rapid growth and development of the brain continues for about 2 years after birth. Just as a car needs fuel, proper nutrition during this important developmental stage is essential. As a matter of fact, malnutrition, or shortages of essential nutrients, during this period can have devastating effects on the nervous system and neurological development as well as physical growth.

Although the total number of neurons doesn’t increase much beyond the age of two, the number of connections that take place between them continues to develop dramatically over time. When a baby is born, every neuron in the cerebral cortex ? the outermost layer of the brain ? can connect with about 2,500 other neurons. By the time the child reaches the age of two or three, that number has increased to 15,000.

The connections formed within a child’s brain are vital to memory, cognition, and learning. These connections are the conduits along which the electrical impulses that make up our thoughts travel. During the most prominent learning years, children are literally hard-wiring the ways in which their brains work every minute.

For example, as very young children develop language skills repeating words again and again, they literally hard-wire the images they see in the world around them with the sounds they make. Every thought a young child has is represented by a ‘ripple’ of activity across the network of neurons within his or her brain. Repeated thoughts and actions, whether related to speech or movement, reinforce and strengthen neurological pathways. Moreover, as the child develops more advanced skills, like crawling and walking, the connections from infancy that are no longer needed weaken dramatically. Unlike other organs in the body, the brain is constantly renewing and restructuring itself.

The connections that form within the brain, called dendrites, are very important to a child?s physical, mental, and emotional development. The places where one dendrite meets another are similar to the gaps in a spark plug. As dendrites bridge these gaps, synapses are created. In other words, as dendrites ?spark? across these gaps in synapses, messages are sent from one neuron to another. The way in which these synapses traffic information?a process called neurotransmission?within the brain is crucial to the healthy functioning of the body as well as the development of the intellect.

The parts of the brain that send and receive messages are made up of essential fats, such as those found in fish and seeds; the phospholipids present in eggs and organ meats; and amino acids, which make up the raw material of protein. The message itself, known as a neurotransmitter, is in most cases made up of amino acids. Different amino acids make different neurotransmitters. For example, the neurotransmitter serotonin, which helps a child to feel happy, is made from tryptophan. Adrenalin and dopamine, which keep children motivated, are made from phenylalanine. However, turning an amino acid into a neurotransmitter is no simple task. Enzymes in the brain, which depend on vitamins, minerals, and special amino acids work to accomplish this task. These vitamins and minerals also control the steady supply of fuel? blood sugar or glucose?that powers each neuron. From all this, you can see how the food your children eat does more than build their bodies. It also helps to develop their brains, from the neurons themselves to the synapses that transmit information throughout the mind and body. Thus, food plays a vital role in determining how your children think and feel. Although the basic structure of your child’s brain is determined by genetics, the nutrition they receive and what they learn helps develop that structure, and ultimately their intelligence and ability to learn. It also affects how they adapt, and whether they have happy and fulfilling lives. While you can’t change genes, you can control your child’s nutrition and learning environment. For this reason, one of your main tasks, as a parent, is to ensure that your child receives optimum nutrition and a stimulating environment that encourages his or her capacity for learning. In the context of the development of your child’s brain, optimum nutrition is all about ensuring that your child gets sufficient quantities of five essential foods, while avoiding some others.

The news comes from research carried out by the the Columbia Center for Children’s Environmental Health (CCCEH) at the Mailman School of Public Health.

Polycyclic Aromatic Hydrocarbons are generated as the result of burning of fossil fuels such coal, diesel, oil and gas and other substances including tobacco. While most of us don’t live next to coal fired power stations, urban dwellers do have many opportunities for exposure through cars and other forms of transport.

The study found that children exposed to high levels of PAHs in New York City had IQ scores that were over 4 points lower than those of less exposed children; a similar drop to what would be experienced through low level lead exposure and enough to affect a child’s learning ability.

With so much focus on carbon emissions these days, it’s easy to forget there’s also other nasty chemicals in our air thanks to human activity that negatively impacts on us and the wider environment. Some of these chemicals are pervasive, traveling thousands of miles from their generation source to the most remotest corners of our planet.

Airborne PAH concentrations, like the lead threat of years ago, can be mitigated through emission control policies and greater utilization of renewable energy sources such as solar power. As with oil, this is just another reason we must kick the coal habit. Even “clean coal” technologies aren’t able to prevent some of the toxic chemicals from burning coal from entering our atmosphere.