CHINA puts a premium on studious, high-scoring, well-behaved children and those who are restless, unruly and unfocused often have school, family and social problems. For Children's Day, Wang Jie looks at children who are inattentive and hyperactive.

A seven-year-old boy is given a book and told to sit alone for a while in a classroom. Through a door porthole, teachers observe whether he fidgets, squirms and walks around, or whether he's focused, calm and well-behaved.

To get into some top primary schools, children typically must pass written tests and also sit quietly with a book, alone, for 30 minutes. It's the sitting quietly part that many children flunk.

Some are naturally restless, some may have attention deficit hyperactivity disorder (ADHD), a range of symptoms that ranges from lack of focus to agitated, unruly or disruptive behavior.

With parents getting ready for fall enrollment in kindergarten, primary, middle and high schools, the topic of ADD or ADHD (duo dong zheng 多动症), literally "excessive movement syndrome") is becoming familiar. Parents who read a lot about child development want their children to perform well in school where they are evaluated by test scores throughout their lives.

ADHD is not an illness and is described by most experts as resulting from abnormal chemical levels in the brain that impair impulse control and attention skills. According to some controversial views, it's identified more in societies that value order and "good" behavior; thus, those on the active end of the active-passive spectrum may be seen as problems.

According to the Society of Pediatrics under the Chinese Medical Association, as many as 20 million children in China have some type of ADHD and less than 1 percent received appropriate treatment, which typically includes some medication.

"Different aged children have different symptoms," says Wu Qiong, professor at the ADHD Center of Shanghai Fu Da Hospital in Hongkou District. "ADHD is a common condition that affects both children and adults and it can have serious consequences for academic, emotional, social and occupational functioning."

For some parents, ADD or ADHD is becoming a synonym for what's called "naughty behavior" that can stand in the way of academic performance, good family relations and social acceptance.

Few parents get a medical diagnosis and most reject the idea of medication, believing that it has serious side effects and impairs IQ. There's also perception that "naughty" children or those with some kind of ADHD have a higher IQ and are more creative than disciplined and obedient children.

Doctors say that many but not all ADHD children have a high IQ and that medication doesn't affect intelligence, while it does help children to focus.

"My little boy must have ADD, see how naughty he is! He's not quiet for a moment except when he falls asleep," complains Wang Yang, who has a two-year-old boy. She hasn't seen a doctor.

"My boy has been so difficult to handle since the moment he was born," says Sophie Yang of her five-year-old son. "Compared with other mothers, I'm nearly in a state of collapse."

Yang has read many books and come across the term ADHD but when she told her mother, the older woman scoffed. "She told me no child is easy to deal with and my worry was pointless. But now he's five and as naughty as ever. My mom told me ADD children are smarter."

Grandparents often say that "naughty" and hyperactive children are smarter than their peers.

"If a kid remains silent and is quiet all the time, it is definitely not a good sign," says Feng Yuqi, grandmother of a six-year-old boy. "If a child is too active, that only proves he's smarter and it's nothing to worry about."

According to Tan Hui, a professor of child health care at Fudan University, the number of Chinese children with ADHD is increasing.

"Reasons vary. Our study shows that Caesarean birth, hormones in food and various electronic gadgets are all relate," he tells Shanghai Daily.

Most Chinese parents prefer to send a child to a psychologist instead of considering medication, Tan observes.

"There is no connection between lower intelligence and medication," Tan says, adding that medication to control symptoms isn't recommended for children under six. Side effects such as loss of appetite and stomach upset can be managed, he adds.

Treatment is a long-term process, requiring both medication and behavior modification therapy, he says. For example, a child could be encouraged to focus attention by giving rewards. Some children seem to "outgrow" ADHD symptoms, others do not. Medication as well as herbal medicine can help, he says.

Although ADHD children are entitled to enroll in public kindergartens and other schools, they are not welcome by teachers or classmates if they are disobedient or disruptive.

"I am a mother of an ADHD boy," says Wen Qing, a professional who returned to China from overseas where the boy was diagnosed. "Now I send him to a local kindergarten but the teacher asked me to bring him back home."

Teachers are sympathetic but they have their limits.

"I am not unkind and I fully understand the situation of parents with an ADHD child," says a teacher at Happy Kindergarten, who asks not to be identified. "But I have nearly 20 other children in class and I cannot spare time to help one difficult child. I am exhausted. If I take my eye off him for a moment, he throws a bowl of soup into another child's face or makes a mess of the toys."

Parents of other children complain about disruptive pupils and fear they will influence their own well-behaved children. "Now I suggest that the boy be in class for just half a day," the teacher says.

"Surely the earlier the diagnosis, the better the cure," says Dr Wu from Fu Da Hospital.

The prejudice against ADHD children cannot be cured, it seems.

"My son has no friends at class," says Wen, the mother who returned from overseas. "I know this is not his fault. Of course, he cannot win the heart of the teacher. I feel they treat my kid like an alien and I am helpless."

She frequently takes her five-year-old son to the doctor who tells her to be patient, saying it may take months or years for him to "ease down." She's now resorting to TCM treatment.

"Do you know how the top primary schools in town choose the children in the entrance exam?" asks Rebecca Wu, a 30-something mother.

"Besides the written exam, children are required to sit in the classroom for half an hour with a book, while a teacher watches from outside to see who is well-behaved," she says.

"It's common for teachers to like disciplined children who can focus on studies. Today when everything depends on test scores, teachers and parents prefer children who are able to sit for hours and do homework and excel on exams," she adds.

Because these children cannot control their behavior, they need encouragement and understanding, say psychologists.

Lin Zhiming, a father of a seven-year-old ADHD girl, says he plans to emigrate to Canada to ease situation for his daughter.

At first, he didn't think the problem was serious and a doctor said her condition was not severe.

"But as parents, we could feel the prejudice around her since she was little," says the 40-year-old owner of a small trading company. "She is not too welcome at public kindergarten and has almost no playmates. There's no association where I can communicate with other parents. I feel my princess is not happy, so I want to shift to a friendly environment for her, a least one that's more tolerant of an ADHD child."