There are many issues here that need help. What jumps out at me as a former social worker, child protective services worker, and foster mom is first and foremost everyone seems to be putting pressure on a Mom who is ill (mentally or physically you did not specify) and has been out of the "mothering" for a while. The benefit of the children is primary, but certainly the health of the mother and her having the positive support she needs is necessary so must be addressed. Medication of the children is NOT the answer and changing it simply adds another dimension. There are many other things that can improve ADD and ADHD symptoms that I can recommend. But dealing with children, especially multiples, with behavior problems can be exhausting for the best parent. Have you explained/coached her in the methods of discipline you used successfully? Is the boyfriend supportive or demanding? Whose interest is he prioritizing? I personally have a problem with the b/f status when children are in the home (my value system validated by many years of counseling troubled moms). Where's the commitment to her AND the children: The ring, the certificate and the effort? She doesn’t need another CHILD in the home. Do they agree on discipline or allow the children to "play" them? What is her health status? Did the doctors who released her understand the pressures at home and provide adequate support? It sounds like to me that she needs a good coach and some better support. And the time is now! IF the children are ALREADY in the state system, i.e. foster care payments to you, CPS, etc. then there is coaching available to her through the system and they would truly rather keep the children at home and give her the support than take the children into their overloaded foster care resources. She needs to admit her difficulties to a professional counselor (not a caseworker - some of them dont have human service degrees) However, the BIG IF! IF THEY ARE NOT IN THE SYSTEM ALREADY, my advice is don't go there. Too many children get lost when the mother doesn't have the right kind of advocacy and help. I will be glad to help you more but there are too many unanswered questions. The final question is a hard one: Does she want help to make her family balanced and pleasant and is she willing to work at that putting her children first? If not, you can either sue for custody and take them back or leave them to the state's discretion because the desire and work is absolutely mandatory. Whining and crying will not get it done.