Practices

A display organised by sound rather than by alphabet gives a child more to hold on to. Let them feel where each sound is made, lips, tongue, teeth, and match that to the letters that spell it.

Reading is learned from speech towards print, so a border running A, B, C tells a child very little about what they are actually doing. Grouping by…

Before drilling number facts, check whether the child has any feel for how much a number is. Which pile is bigger, is eight nearer to ten or to two, give me three of those.

A child with no sense of quantity can still learn to recite that seven and eight make fifteen, and it will be a string of sounds attached to nothing.…

Build numbers and break them up again. Seven is five and two, and also six and one, and a child who can see that has the thing mental arithmetic is made of.

Blocks, buttons, coins, anything you can push into two piles and back together. Ask which numbers fit inside other numbers and let the child show you…

Patterns sit underneath both reading and arithmetic. Blue, red, green, blue, red, green: making a sequence, copying it, then breaking it on purpose builds the ordering that words and numbers both run on.

Use blocks, beads, claps, a drum, anything with an order to it. Ask the child to make the same pattern, then to spoil it deliberately and tell you…

Find something the child already loves, a team, an orchestra, a game, and lay their results over it. These players are strong, these ones need coaching, and none of it means the team is no good.

Feedback lands very differently when the low scores are players who need training rather than facts about who someone is. Do it with their own…

In practice, you sometimes have to stop a child using the trick that has kept them afloat, so the weaker skill finally gets used. Expect them to hate it for a while.

If memorising is doing the work, the part that should be doing it never gets a turn. So build short pieces of practice where the workaround is simply…

Ask a struggling ten year old what division actually is and you will often get a blank, or a method with no meaning under it. Going back to what each operation does is usually worth more than another go at this term's work.

Division is sharing out, or taking the same amount away again and again until nothing is left. Multiplication is that same amount repeated. Children…

When someone tells you they have been hurting themselves, keep your face steady and stay curious. Alarm closes the conversation, and you need it open.

A visible flinch teaches the person that this is not something you can hear, and the next disclosure goes elsewhere or nowhere. It can also make the…

Put something in before you take something out. Removing the only way a person has of coping leaves them with nothing, which is not safer.

In practice this looks like smaller steps than a promise to stop: cutting the frequency, changing what is used, agreeing to wait ten minutes and do…

Ask what the behaviour does for them, and then ask how they would like to feel instead. Both questions open more than telling them to stop ever does.

The first question maps what is being managed: numbness, rage, panic, a need to make something visible. The second gives you a goal in their words…

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…

Pill swallowing can be taught in a few short sessions with sweets. Start with the tiniest ones, give two to eat for every one swallowed whole, and work up in size across a week.

Keep each session short and cheerful and stop before anyone is upset, since one frightening attempt can set the whole thing back weeks. For capsules,…

Being given a medicine that holds no licence for your condition can feel like being experimented on. Usually it means the evidence is decent but thinner than a licence demands.

Bupropion is the common case. It helps some people with attention difficulties, often alongside a stimulant, and it never gained the indication, so…

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…

Before you explain anything about medication, ask what the person already believes about it. You cannot correct a worry that has never been said out loud.

Most people arrive carrying something: a cousin who could not sleep, a headline, a parent with a strong view. Lead with your own information and you…

Stimulants are not the only licensed route. Atomoxetine, guanfacine and clonidine all hold approval for attention difficulties, and they matter when a stimulant cannot be used.

They usually sit after stimulants rather than beside them, because the comparative evidence still favours stimulants overall. They come into their…

In practice the non-stimulants turn up more often as an addition than on their own. A stimulant in the morning with guanfacine alongside it is a common shape.

The two act at different points of the same circuit, so they tend to complement rather than repeat each other, and the blood pressure effect of one…

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…

A heart tracing before starting a stimulant is not routinely needed. Some practices still ask for one anyway, and it can hold a child up for months.

What the guidance asks for is a careful history and an examination, with a tracing kept for children whose own or family history warrants it. An…