Eight-year-old Kaitlyn Holbrook reads above grade level, her test scores are high and her mother says she's extremely intelligent. Yet, for a long time, she really struggled in school.

Kaitlyn came home from kindergarten every day with a note from her teacher. She wouldn't stay in her seat. She had a hard time transitioning from one subject to another. She had no impulse control. And she couldn't focus.

"She hated school," said Kaitlyn's mother, Amanda Pfeiffer. "I didn't want her to have this focus on being in trouble all the time."

At the end of the school year, Kaitlyn was diagnosed with attention deficit hyperactivity disorder. She went to counseling but didn't start medication until later.

She still was having problems in first grade, so by November of that year her mother decided to put her on medication.

"My fear with her in actually getting her on medication was the fact of the impulse control -- being outside, riding her bike," Pfeiffer said. "She doesn't have the control to stop and say, 'I need to look both ways before I cross the street.' "

But it wasn't easy to find the right medication for Kaitlyn. Parents of children with attention deficit often struggle to find the right approach to helping their children focus. It might take some time to find what works, but there are plenty of options available.

Kaitlyn started with Adderall but had a hard time sleeping and didn't want to eat. The doctor switched her to Metadate, but Pfeiffer didn't like the side effects of that one either. Kaitlyn still was having a hard time focusing, and the medication was wearing off before she had time to get her homework done at the end of the day.

Then she switched to Vyvanse, which Pfeiffer said is working well for her daughter. It stays in her system longer, so she is able to focus on her homework better. Pfeiffer said the medication has made a world of difference for her daughter. She said Kaitlyn hasn't gotten a note home in a long time, and she will be in the Gifted & Talented program next year.

Combination therapy

In addition to the medication, Kaitlyn sees licensed psychologist Dr. Kristin Anderson twice a month.

Anderson said she works with a lot of children with attention problems. She said as a cognitive behavioral therapist, she focuses on the children's behaviors and finding strategies to help them cope with their conditions. She also helps parents figure out how they can help their children.

Anderson said the research shows that the best treatment for children with attention deficit is a combination of medication and counseling.

"Medication is going to help with the physiological aspect of the disorder ... the brain, the chemicals, the chemistry," Anderson said. "But that's not going to solve the whole problem. You have to give kids skills so they can be effective at school and at home and manage the disorder, because it's typically not something that people grow out of. We can improve the symptoms, but it's probably something that's going to stay with you your whole life."

On top of medication and counseling, Anderson recommends limiting the amount of time children spend watching TV and playing video games. She said 30 minutes a day is reasonable during the school week and said parents can be a little more flexible on the weekends. She said children with attention problems crave that kind of stimulation, but they can get overstimulated, which can cause additional problems.

"Unfortunately, school can't compete with that level of stimulation," Anderson said. "So of course they're not going to be interested, and it's going to be much harder for them to sustain their attention because they're not going to find something that stimulating."

Anderson also said to make sure your child is eating healthy, sleeping enough and exercising because those are the big three things that affect mood.

She said routine is very important for children, especially those with attention problems. When it's homework time, don't expect your child to sit still for hours. Give them a little break to have a snack, do some homework, have another break to run around and then finish homework. Whatever the routine, she said to just be consistent.

"Especially kids on medication, homework is really difficult because ... the medication is starting to wear off, and they're having that afternoon rebound effect in which they get much more irritable and cranky," Anderson said. "And they've been in school all day, so all they want to do is play. But homework is important, so it has to get done. ... That is something that definitely helps is if you have a structured routine."

Tuning in

Kristin Lucchesi, the lead occupational therapist at Lowcountry Therapy Center in Bluffton, also works with several children with attention issues.

She said as an occupational therapist she tries to get kids in the right state of mind for learning.

"We help the kids figure out what their bodies need in order to pay attention," Lucchesi said.

She said people do different things to stay focused. Some lean against a wall to pay attention to a conversation. Others sway back and forth. Some have to chew gum to stay awake while studying, and some need to move around. Some people need quiet to read; others want white noise.

Because of that, Lucchesi said therapy is very individualized. She helps kids figure out what it is they need to calm down and get focused.

"It's a lot of trial and error," she said. "It's really about finding what organizes your child. ... There isn't a cookie cutter one-size-fits-all for what's going to help with attention. ... Kids will give you clues on what they need. It's really about tuning into them."