Focus, starting, and ADHD

If you are pulled towards risk, you will do better giving that pull somewhere with a floor under it than trying to switch it off. Fast, high, cold, loud: choose the planned version rather than the one that turns up at two in the morning.

Work out what the appeal actually is. Speed, height, cold water, a crowd, the edge of fear. Then find the form of it that has brakes: a climbing wall…

A child who has spent years being told they are careless will often say yes to whoever finally seems glad of them. Work on how they see themselves is not a soft extra to the clinical work.

Count the corrections in a single day and it is easy to see what accumulates. By the time an offer comes from someone friendly, the pull is belonging…

Being in recovery is not a reason to leave an attention difficulty untreated. The restlessness that made a substance useful is still there once the substance goes.

Clinicians often hold back here, uneasy about a stimulant for someone with a history, and that caution is understandable. The other choice carries a…

Some people find they drive better in a manual, because there is always something to be done. Treat that as an experiment rather than a finding.

The reasoning is the same as a fidget toy or a standing desk. A little constant demand can keep an under-occupied system in the room instead of…

Blood pressure on a stimulant is an individual matter. For most people it is a non-event, and where it does rise the answer is often a different stimulant rather than none at all.

No blood test or cheek swab will tell you in advance which one suits you. Finding out means trying, measuring and being willing to change, which is…

For a small number of children the question was never about school reports. A toddler who runs into a road and keeps running, a child who climbs the pool fence: what is being weighed there is whether they stay alive.

Most decisions about treating a very young child are finely balanced and deserve to be taken slowly. Where the behaviour itself is life threatening,…

If the first medicine disappoints, that is information about the first medicine. Plenty of people who get nothing from one class do well on another.

Methylphenidate and amphetamine are not the same drug at different strengths. They work by partly different routes, so a poor result on one says…

Finding the dose is a search rather than a calculation. It goes up in small steps until either the effect you want turns up, or the side effects get annoying enough that you come back down a step and settle there.

There is no way to work the right dose out from body weight or from how bad things look, which surprises people who expect medicine to be more exact…

Most people who try do find something that helps, but often not the first thing they try. Not responding to one class of stimulant says surprisingly little about the other.

The high response figures you may have read come from people who worked through more than one option, not from one prescription going well. Response…

One of the founding figures of biological psychiatry summed the whole business up as some medicine helping some people at some doses some of the time. Knowing that before you start makes the first disappointment much easier to survive.

Most people need more than one adjustment: the dose, then the timing, sometimes the drug itself. Go in expecting the first prescription to be the…

When medication works, its best effect is often on everything else you were already trying. Coaching, exercise, a routine: each of them needs enough attention to get started, and attention is the thing in short supply.

That is why setting medication against the other approaches usually misses the point. The plan you could not keep last year may be perfectly keepable…

Food colouring is the one narrow exception in this area. Large studies suggest it may mildly wind up some very young children, so a trial removal in a preschooler is a reasonable thing to do.

Keep it in proportion though. This is a minor irritant in a subset of little children, nowhere near the sweeping dietary cause that was claimed…

The restrictive elimination diet has real methodological problems, and it is expensive and exhausting to run. If a family still wants to try it, they can, because unproven and dangerous are different words.

There is usually more to lose by forbidding it. A family who feels blocked either does it anyway without telling you or spends another year…

Play therapy and insight based psychotherapy do not treat ADHD. There is no buried, unexpressed feeling driving it that talking will let out.

The difficulty sits in executive control and how it develops, not in hidden conflict. That said, a child with ADHD can also be anxious, grieving or…

The diet evidence has drifted away from cutting particular things out and towards eating decently overall. That is easier on everyone at the table.

Removing additives or colourings helps a small number of children, and the trouble is that you cannot tell in advance who they are, so most families…

Think of ADHD as sitting at the centre of an onion. Poor sleep, sleep apnoea, low vitamin levels, allergy, ongoing pain, untreated anxiety or low mood all sit in layers around it, and each one makes the centre look worse than it is.

This explains something that otherwise looks strange: treatments that do nothing whatever for ADHD can still make a real difference, because they…

When a child with ADHD and a parent get stuck in daily rows, the rows themselves start doing damage. Getting the ADHD properly managed early takes some heat out of those exchanges before defiance settles in as a habit.

The chain people worry about runs from constant friction at home to entrenched defiance, and from there to difficulties in the teenage years that are…

The most convincing programme for teenagers does the obvious thing. It runs at school, twice a week, so nobody has to be driven anywhere: homework systems, organisation, some social practice and sport, in the place where the trouble actually happens.

By the teenage years the leverage parents had is thinning, and a clinic appointment is the first thing to fall off the week. Putting the help inside…

Paying someone to help sort the house will not mend the marriage. It will remove one of the things you fight about most weeks, and that counts for more than it sounds.

Nobody should pretend this reaches anything deep. The point is arithmetic. A couple has a certain number of rows in them, and if the living room is…

People who are sleeping properly, eating properly and moving a bit tend to want each other more. The unglamorous parts of life management run closer to the bedroom than either of you might expect.

It is worth saying out loud when desire has quietly gone from a marriage, because the usual explanations reach for something heavier: he has lost…