Focus, starting, and ADHD

Ask about the family properly: parents, brothers and sisters, children, then aunts, uncles and grandparents. Include drinking and drug use, in them as well as in the person sitting with you.

This tends to be the highest yield few minutes of an assessment, because the condition runs strongly in families. Relatives who were never assessed…

Ask for the most frightening moment of their life, then the next one down, then the next, until there is a scale running from one to a hundred. You get the ladder you needed, and they get something they did not expect: fear comes in sizes.

Do it slowly and write it in their words rather than yours. Most people arrive believing anxiety is one solid block that either has hold of them or…

The family history is not the warm up before the real assessment. Give it proper time and it will often tell you more than any single rating scale in the folder.

Walk through the family rather than asking one summary question about it. Who struggled at school, who could never sit through a meal, who changed…

Note who is a first degree relative and who is a second, instead of writing 'runs in the family'. Parents, children and siblings sit in one ring. Grandparents, aunts, uncles and cousins sit in the next.

A simple grid helps: names down the side, then relation, what they were like, what was ever diagnosed, what was ever treated. The picture comes out…

Ask whether anyone kept the old school reports. The same lines turn up generation after generation: not working to potential, talks too much, never has the right books with him.

They were written by teachers who had never heard of ADHD, about children nobody was going to assess, and that is exactly what makes them worth…

If someone is about to send off a saliva kit to fill in the family history they never had, have a conversation first. These tests hand back more than health information, and they hand it back with nobody in the room.

A father who is not the father, a sibling nobody mentioned, a donor conception no one planned to explain: these arrive by email on an ordinary…

'I am disorganised' cannot be treated. 'The post piles up on the hall table until something ends up with a debt collector' can. Spend the time getting the problem down to something that specific.

Push for the particulars: which task, which moment, what was happening just before, what they did instead. Where you can, ask someone who was there…

For most people who get as far as asking for help with ADHD, medication is the single change that shifts the most. It is not compulsory and plenty live well without it, and it does deserve an honest look rather than a place at the back of the queue.

The reason is unglamorous. Nearly every strategy anyone teaches assumes you can pause before responding, hold a plan in mind while doing something…

If you are not the one prescribing, you can still take an active part in the medication conversation. You see the person weekly and hold the ordinary detail their prescriber never gets to see.

Ask what they notice and write it down in their own words. With their permission, send the prescriber a short note that can be read in a minute: when…

When a medicine seems to be underperforming, look at what else is in the room before reaching for a higher dose. Anxiety, low mood and a wrecked sleep pattern can each blunt a good response or imitate a poor one.

Otherwise the dose climbs while the real driver goes untreated, and the side effects arrive without the benefit. Ask what a bad night actually looks…

The more one person checks up, the more the other hides, and the more they hide the more the checking looks justified. Both are responding reasonably to the last move and nobody is having a good time.

Getting out of it usually means the monitoring comes down first, which feels like the wrong direction to whoever is doing the monitoring. A workable…

There is a point where a to do list stops being a tool and becomes something you flinch away from. If you have not opened yours in a fortnight, it has passed that point.

The usual advice is to work through it, which is precisely what nobody does with a list that long. It is kinder and quicker to start a fresh page…

Take one of the gaps you already have, the commute or the walk or the shower, and use it to ask what is coming up this week and what might be slipping. No new tool, no new app, just the question.

That turns something accidental into something you can count on. It works best in the same place each time, so that the place starts asking the…

Anything that comes round every month should be leaving your account without you. Direct debits and standing orders take the remembering out of the job altogether, which beats any reminder you could set.

It is worth an afternoon. List what recurs, automate what can be automated, and put one calendar note to check the statement each month instead of…

Every extra step in a task is another place to lose it. Three clicks and done beats a process with a form, an envelope and a walk to the postbox, even when the second one saves a little money.

Before you commit to a routine, count its steps, then take some out. Bin bags stored next to the bin, stamps kept with the envelopes, paying on the…

Check, feel the small relief, put it down, feel the pull again a minute later. If your phone use has that shape, it is running like a compulsion, whatever else it is.

The structure matters more here than the label. An urge rises, checking brings it down, and every check teaches the urge to come back sooner. Which…

Sitting with one long unrewarding task has got harder for almost everyone. If you are planning work for yourself, or setting it for someone else, build the variety in rather than hoping for stamina.

In practice that means breaking a long stretch into shorter ones with something marking the end of each, changing what the work looks like part way…

Ask two questions and then sit with the difference. How much time on this would you like? And how much do you think is actually good for you?

Almost nobody gives the same answer twice, and the gap between the numbers is more persuasive than anything you could have told them, because they…

For a week, jot down what was going on just before you picked up the phone, what you were thinking while you scrolled, and how you felt when you put it down. Nothing cleverer than that.

What usually surfaces is not that screens are bad but that two or three specific things are: one account, one time of day, one mood you always reach…

Part of what keeps the late start going is that it has genuinely worked. You have produced something good in one long night before, and you remember it clearly.

So telling you that leaving it late is a bad plan tends to fail, because you have evidence and the other person does not. The honest version is…