Q. My nephew is a superstar of a kid — alert, bright and caring, but he may have Attention Deficit Hyperactivity Disorder (ADHD) and Asperger's Disorder. My brother refuses to consider medication for my nephew because he believes that if everyone would simply be "consistent" with him, he would "behave." He bases this on the fact that he doesn't act out when his dad is around. My nephew acts out a lot when he's alone with his mother.

My brother is very stringent and demanding with regard to anyone's behavior and is also extremely verbally aggressive (his wife is terrified of him). Importantly, my brother has been asked to remove my nephew from three daycare and school situations. His ADHD makes it difficult for him to "sit still," and his Asperger's makes it hard for him to bear "injustices." He's large and very strong for his age. Since the beginning, he's had difficulty measuring his physical behavior relative to others so that others are not hurt. If a teacher attempts to intervene in situations involving him and children, and if she touches him, he flails and/or kicks to be released. Given his strength, it becomes almost impossible to control him. He can and has injured others around him. Notably, he only acts out when he has indeed been "wronged."

My brother tells his son "to be more patient," which helps some. However, with our family history, I suspect there's more to this. Both my brother and I have bipolar tendencies, my sister is bipolar and has Asperger's, her twin has schizophrenia, and we have another sibling with schizophrenia.

My nephew was evaluated for ADHD three years ago, and the doctor conceded that he was too young for a conclusive diagnosis at that time. He is now 7. My brother has regard for my opinion. I have not mentioned medication. Should I say something? I'm concerned that my nephew will lose self-esteem by accepting the blame for what's going on with him when it may well be his biology that's at fault. Please advise, and many thanks.

A. Being stringent and demanding may be helpful to a high-energy child, but being verbally aggressive can model aggressive behavior to the boy and can become part of his problem. A doctor may have hesitated about prescribing medication at age 4 because he was so young, and many of the ADHD medications aren't recommended for children below age 5. It would be a mistake to recommend medication to your brother or to assume, based on your family history, that your nephew necessarily has some of the diagnoses that have already been found in the family. Family history does increase the likelihood of mental illnesses, but doesn't necessarily assure that these problems will appear. As a caring, loving and observing aunt and sibling, this would be a great time for you to recommend that your nephew get another evaluation by a psychologist. The psychologist could also review the strategies the parents are using. In that way, the psychologist can help the dad be firm without being abusive and can help the mom become firmer, and perhaps less overprotective. If the psychologist deems that the child should have medication, the he or she can refer the family to a family physician or child psychiatrist. The recommendation for an evaluation based on his age should help everyone without causing you relationship problems with your brother.

For free newsletters about ADHD or parenting do's and don'ts for aunts and uncles, send a large, self-addressed, stamped envelope to P.O. Box 32, Watertown, WI, 53094, or go to www.sylviarimm.com for more parenting information.

Dr. Sylvia B. Rimm is the director of the Family Achievement Clinic in Cleveland, Ohio, a clinical professor of psychiatry and pediatrics at the Case Western Reserve University School of Medicine, and the author of many books on parenting. More information on raising kids is available at www.sylviarimm.com. Please send questions to: Sylvia B. Rimm on Raising Kids, P.O. Box 32, Watertown, WI 53094 or [email protected]. To read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com.