Focus, starting, and ADHD

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…

When a child with attention difficulties is also at war with every instruction, that pairing is worth taking to someone early rather than waiting to see whether it settles.

The two travel together often, and a minority of children follow a path from constant defiance into more serious trouble later. Every stage of that…

When a child truly does not mind losing the privilege, taking more away will not get you anywhere. That is the moment to change approach rather than raise the stakes, usually to a structured parent programme that works on the pattern between parent and child.

Star charts fail with these children because the reward was never the point of the behaviour. What helps is a proper course of parent management…

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…

When somebody decides against medication, respect the decision and then say the rest plainly. Some of the struggle will stay, and no amount of therapy or another clever app will fully close that gap.

Left unsaid, the person keeps trying harder and reads the shortfall as personal inadequacy, which is the very belief you are working to undo. Said…

Ask how many hours the cover really lasts, not only whether it helps. A long acting stimulant is meant to carry roughly ten to twelve hours, so if everything collapses by mid afternoon that is worth reporting.

Very few lives need only six good hours. Evenings hold homework, cooking, driving, tempers and the people you live with, and those hours get written…

Put today next to the night before it, out loud and often. How did today go after seven hours of sleep, next to the day that followed staying up until three?

ADHD makes it hard to link a consequence back to a choice made hours or days earlier, so the link has to be supplied from outside until it starts…

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…

Unmanaged ADHD wrecks sleep, food and movement, and wrecked sleep, food and movement make the attention worse the next day. The loop feeds itself, which is also the hopeful part: a small repair anywhere in it pays back more than it should.

Short sleep hits the same front part of the brain that is already struggling, so a late night costs you more than it costs other people. Pick the one…

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.…