Focus, starting, and ADHD

While you are taking the family history, ask about seizure disorders and psychosis too, not only about attention. A family carrying other neurological or psychiatric conditions is worth knowing about whatever you end up concluding.

Keep the list short and ask it plainly: epilepsy, psychosis, learning difficulties, head injuries, anything neurological. Some of it will matter for…

Some people simply cannot get a family history. Refugee journeys, destroyed records, closed adoptions, families that did not survive. That is a gap in the paperwork and not evidence against the diagnosis.

Say so out loud, and write it in the notes as a gap rather than as a negative finding, so the next person reading does not mistake silence for an…

One man put his lamps on a timer so the room would go dark at eleven and send him to bed. It worked for a few nights. Then he simply carried on in the dark. A cue can tell you the time. It cannot make you stand up.

Worth remembering before you build anything clever. If the pull of whatever a person is already doing is stronger than the nudge you have designed,…

'I set a reminder and still did not do it' is not a story about a bad reminder. It tells you the missing piece was never information, and a bigger, louder version of the same thing will fail in the same way.

The reflex is to escalate: three alarms, a different app, an entire new system built on Sunday night. What is needed is a change of kind, something…

Long acting stimulants are the usual starting point for a plain reason: they cover the most hours and they remove the lunchtime dose, which is the dose ADHD is most likely to swallow whole.

Remembering a tablet in the middle of a busy day is itself an executive task, so asking for it is asking the person to do the thing they came for…

The most useful question about a dose is whether the person can tell. A shrug and 'I think it sort of helps a bit' usually means it is not yet doing its job.

At a dose that suits them, most people can say when it comes on, what the middle of the day feels like, and when it leaves. Vagueness points…

Half the useful health information arrives sideways. Someone says 'I am so tired' on the way into another subject, and that is an opening worth taking gently.

People rarely bring sleep or food to a session as a topic, because they do not file them as symptoms. So the tiredness, the skipped meals and the…

Count good days, not unbroken runs. Whatever yesterday was, brilliant or a write off, the only live question is what can be done with today.

Streaks make one slip cost everything, so the missed night turns into a missed week and then the whole effort gets quietly dropped. Aiming for more…

Most of what we call memory looks backwards. The kind that actually runs your week is the other sort: a plan that has to show up in your head at the one moment you could still act on it.

So when something gets missed, the question is not really whether you knew about it. You almost certainly did, at the time you agreed to it. What…

When a task is missed it is usually not sitting somewhere being refused. It has gone off the radar altogether, the way a name goes when somebody asks you for it.

The refusal reading is the expensive one, because it turns a lapse into an insult and starts the argument in the one place where nothing can be…

A thought you have in the car about something to say at home is worth nothing until the person is actually there in front of you. Cues have to sit where the action becomes possible, not where you happened to think of it.

Picture where you will be at the moment the thing can be done, and put the reminder there: a note on the front door for something that happens on the…

The moment you think of it is the only moment you are certain to have it. Do the thing, or write it down, or set the alarm, or put something odd in your pocket that will make no sense later until you check.

The two seconds of holding it in mind while you finish what you are doing is usually where it disappears. So make capture the reflex instead of the…

Start the email and then stop: address it, write the subject line, leave it unsent. The half finished thing sits in your drafts looking wrong until you deal with it.

It works because it leaves an odd looking object in a place you already go, and because unfinished jobs nag in a way that quiet decisions do not.…

The bag that has to travel with you tomorrow goes on top of your shoes, not neatly beside the desk. Let the object stand in the way of a route you walk without thinking.

The phrase worth keeping is point of performance: the reminder has to sit where the action happens, at the time it has to happen. A note on the…

Sometimes you cannot write it down. You are driving, your hands are full, you are halfway through a conversation. Then picture the moment in detail instead: the room you will be standing in, the object you will be looking at when you do it.

Make the picture concrete rather than worthy. Not a solemn 'I must ring the surgery' but the desk you will be sitting at, the mug beside the phone,…

A ping about a parcel and a ping about your mother's health feel identical in the second before you look. Give that feeling a name, false urgency, and you get a little room.

The buzz carries no information about importance. It borrows the feeling of importance and lends it to whatever happened to arrive. Naming it in the…

Gaming for an hour before you start the work almost never costs an hour. Do the thing that has to be done first, then the thing you want.

Once something enjoyable is running, whatever you were meant to do afterwards looks duller than it already did, and the hour quietly becomes three.…

Charge the phone in another room overnight and use a proper alarm clock. Small change, and it takes the decision away from you completely.

In bed the phone is right there, and stopping is left to you at the hour you have the least left. Out of the room, there is nothing to resist. Buy…

The aim was never to stop needing the aids. It is to find ways round the parts that do not work well, and then to keep using them.

People tend to treat the alarms, the lists, the whiteboard by the door as scaffolding they ought to take down eventually. That is usually why it all…

Everyone has something about themselves they wish were different, and something they cannot do reliably however much they mean to. Yours has a name and a good deal of research behind it, which is not the same as being uniquely broken.

Say this carefully, because there is a careless version that does real damage. Everyone is a bit ADHD is not what is meant, and it leaves a person…