Practices

Difficult things come out more easily when your hands are occupied and you are not looking straight at the other person. Walk side by side, drive somewhere, wash up together, keep the sewing going.

If you are the one listening, offer it first. Most people assume that picking something up would look rude or half interested, so they sit still and…

The thing worth admitting is not that you were angry. It is what you were frightened of underneath it: being made a fool of, being left, being counted as useless.

Anger is the easy half to say and it rarely lands well. The fear underneath is harder to say and it is the part that gets you heard. One sentence…

There is a particular relief in hearing a room of strangers admit the same frightened thing you have never said aloud. It is why groups reach people that advice does not.

You go in expecting contempt. What comes back is usually recognition, along with a few nods from people who have been ruder to their families than…

Debt, impulsive spending, an account that never quite recovers: this belongs in the conversation about attention rather than in a separate drawer marked shame.

People hide this part longer than anything else, which means it is usually the last thing to get any help. If you are the one struggling, saying it…

Where anxiety sits alongside the attention difficulty, a non-stimulant is sometimes the better first choice. Stimulants sharpen anxiety in some people, and that is a hard trade to live with.

The same holds when blood pressure rises on a stimulant that is otherwise working, since adding an alpha-2 agent can make it possible to keep the…

Medication treats the attention difficulty. It does not teach reading, lift a depression, or repair a household that has been fighting for years.

Those things need treatment of their own, and they are often what the family actually came about. Treating the attention difficulty well can stop…

Smoking runs high in ADHD, and nicotine genuinely does something for attention. It helps to treat that as self-medication rather than as one more impulsive habit.

It changes what a conversation about stopping looks like. If a cigarette is doing a job, taking it away and leaving the job undone is a plan that…

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…

If several medications have failed, ask whether anyone else in the family had the same experience. A pattern of non response runs in some families.

It is a question that rarely gets asked and can save a year. If a parent or sibling went through the same list without success and then responded to…

Medication does not make somebody care more. It narrows the distance between meaning to do the thing and doing it, and that distance is exactly what the other person has been feeling as being let down.

It helps a couple enormously to have the right name for what has been happening. The intention was real every single time. What went missing was the…

Do not write off simply sitting with someone. When researchers looked into why dummy treatments helped, one of the things they kept finding was half an hour of a person's full attention.

Thirty minutes of someone listening properly to your difficulties is not filler around the real treatment. Across the talking therapies, who the…

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…