Practices

There are three families of medicine here: the stimulants, the agents that work on noradrenaline alone, and the alpha-2 drugs that began as blood pressure treatments. Three routes rather than three brands of one thing.

That matters when one of them does not work or cannot be used. A poor response inside one family says little about the others, so a sequence has…

Methylphenidate and amphetamine are not two names for the same thing. One mainly blocks dopamine from being taken back up, and the other does that and pushes more of it out as well.

That extra step is why the amphetamines tend to produce somewhat larger average effects, and why somebody who got nothing from one can do well on the…

The potential for misuse belongs to one of the three families rather than to ADHD medicines generally. The stimulants reach the reward circuitry and the others do not.

That gives a clear answer where there is a substance history in the house, or a worry about tablets going missing at school. Say plainly that a…

Plenty of children on a stimulant are taking something else as well, most often an antidepressant. That second medicine is usually there for a second problem rather than for the attention itself.

It is a useful lens when a regimen has grown complicated. Ask what each item is for, and the list generally resolves into a treatment for the…

To find out whether treatment is helping, ask the people who live with the person. One parent who stopped her medication for a family holiday remembered a lovely trip, while her children remembered running it.

Two teenagers had packed for her, fetched what she forgot, and kept an eye on the airport clock. She had no idea any of it happened. There is no…

The old argument about medication against behaviour therapy was set down years ago. The useful question now is what each one covers.

They work by different routes and they reach different hours of the day, so putting them in a single contest was never going to tell anyone much.…

Adding psychosocial work to medication buys something extra, and less than people hope. The extra tends to arrive in the places medication was never going to reach.

Homework routines, the temperature of arguments at home, how a teacher speaks to a child, the hours after a dose has worn off: that is where the…

Doing the behavioural work alongside a medicine can mean managing on less of it. That matters most for the side effects that follow the size of the dose.

Appetite, sleep and irritability all tend to scale with how much is being taken. Where part of the load is carried by routines, by support at school,…

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…

Stopping medication rises sharply in the early teenage years. If that is where you are, it helps to know this is the usual pattern rather than a sign that something has gone wrong with your child.

The pull is understandable: wanting to be in charge of your own body, hating being the one who is different, and a parent no longer standing over the…

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…

Classes and clubs work mostly because somebody notices when you are not there. It is the being expected, more than the workout, that gets you out of the door.

A running club, a swimming group, a friend at the gate at seven. On the evening when you feel like nothing, an arrangement with another person…

Moving your body and being with people you like are the two most reliable things for feeling well. Doing both at once is not a trick, it is just efficient.

Each of them changes how you feel through the body, and neither depends on you having a good week. A walk with a friend gets you both. If you can…

Agree a short phrase to use at home. Saying I am having OCD worries tells a parent what is going on without handing them the worry to solve.

Once a parent hears the details they will nearly always try to help by answering, and answering is the thing that feeds it. A label gives them…

You can take someone's fear entirely seriously without walking through the frightening story with them. Say you can see how frightening it feels, and leave the plot alone.

It reads colder written down than it lands in the room. What the person needs is to feel believed. What they do not need is a second person weighing…

With some sensory routines, the part doing the work may be a parent's steady hands and full attention rather than the technique itself. Worth knowing, because contact carries into the rest of the day and a protocol does not.

Views differ on this and the research has not sorted it out. What follows practically is that a family who cannot keep the exact routine going has…

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 steadiness worth aiming for: hearing someone disagree with you without either going off at them or going quiet and small.

Those are the two ways it usually falls over. Either the temper goes and the point is lost, or the confidence goes and you find yourself agreeing…

Who pays the bill does give a household some say. That argument weakens every year a child gets older, and it runs out entirely once they are an adult sitting in front of you asking for help.

With a sixteen year old at home on the family plan, parents setting terms is reasonable and worth saying out loud. With an adult, the same move…