Practices

Here is a question that costs nothing: has anyone in your family been told their vitamin D was low? It runs in families through genes, skin tone, where you live and how much time anyone spends outside.

The clinician telling this story found out only afterwards that his mother, father and brother had all been low. Nobody had mentioned it, because it…

Around seven in ten people who use herbal products never mention it to their doctor. Not out of secrecy, mostly because a tea or a gummy does not feel like it belongs on a list of medications.

The useful move is to answer a wider question than the one you were asked. When someone asks what medication you take, tell them what else you take…

If you are testing whether a food affects you or your child, the test has to be complete. Among children with suspected sensitivity to artificial colouring, most reacted to as little as 100 mg, so a bit left in is enough to blur the answer.

What usually happens is that a family removes the obvious sources, misses the ones hidden in medicines, sauces and cereals, sees no change, and…

If you are going to test whether a food matters, work out in advance where the plan will leak. School lunch swaps, a grandparent's biscuit tin, your own memory on a hard week: all of it decides whether the answer means anything.

Change one thing at a time and keep everything else steady, otherwise you cannot tell which change did what. Then be honest about who is running the…

Match the tablet to the person rather than to the diagnosis. For someone flattened and slowed who has said clearly that they will not accept sexual side effects, paroxetine is close to the worst choice available.

It is the most sedating in the class, the least activating, and carries a high risk of exactly the effect they ruled out, with weight gain and the…

If you are the therapist, hand the prescriber the profile and leave them the pick. What you hold that they do not is what this person is like across a week, and what they will absolutely not tolerate.

So write those two things down and send them: the presentation, in plain description rather than jargon, and the non-negotiables. Not a drug name.…

If a treatment reliably produces strange sensations, describe them beforehand. Expected strangeness is far easier to sit through than strangeness that arrives unannounced.

With esketamine, feeling oddly detached from your body or the room is the drug doing what it does, not a sign of harm, and it usually clears within a…

Saying that medication helps is not the same as saying everyone should be on it. If you have walked in braced for a push, it is fine to say so at the start.

Plenty of people do well with sleep, movement, work that suits them and someone in their corner, and plenty of people need all of that and a tablet…

Writing 'do not substitute' on a prescription tells the pharmacist what to hand over. It does not tell an insurer to pay for it, and that surprise at the counter is where a lot of prescriptions quietly get abandoned.

If a particular brand is being chosen for a reason, say out loud what it might cost and what the fallback is if the price turns out to be impossible.…

Worry about height is one of the commonest reasons families hesitate. The answer is to measure: height and weight plotted at every review, so you are watching an actual line rather than guessing at one.

Growth speeds up and slows down for all sorts of reasons during the years a child might be medicated, and one measurement tells you almost nothing. A…

People often refuse one name and accept another when both contain the same drug. Ritalin and Concerta are both methylphenidate, delivered differently.

A brand collects a reputation that has nothing to do with the molecule, usually from something somebody said years ago. So ask plainly: what is the…

Parents often ask whether starting a stimulant now makes drug problems more likely later. The question deserves the actual evidence, gently given, rather than reassurance.

It is one of the most studied worries in this field, followed in the same children across years instead of guessed at. Say what was looked at and…

Canada once pulled a stimulant from the market after four cardiac deaths, then reversed the decision. Three of the four had heart abnormalities from birth and the fourth had been hiking in desert heat without water.

A handful of deaths with nothing to compare them against cannot tell you what caused them. That is an uncomfortable thing to say about people who…

Rules about ADHD and military service move with recruiting needs. Send a family to a recruiter for the current position rather than answering from memory.

Every version has been seen: medication allowed, medication stopped before basic training, the diagnosis treated as disqualifying, the diagnosis…

No behavioural programme matches what medication does to the core symptoms. It is an uncomfortable sentence for anyone who would rather not medicate, and it is what the trials keep showing.

That does not make the rest of the work pointless, and it does change the order things go in. Where someone is drowning, the fastest reliable help…

Public health messages sometimes say parent training works just as well as medication and carries no side effects. Both halves of that are wrong, and a family who believes it can lose a year.

Parent training is genuinely useful and it is hard work, costing time, money, patience and a good deal of household goodwill. Calling it free of side…

Medication belongs in ordinary treatment here rather than at the end of the queue. Most people with a clear diagnosis will use it at some point.

Strategies and accommodations do real work while somebody is watching, and they fall away in the settings where nobody is. That is most of adult…

Nobody asks whether you believe in insulin. The language of belief has attached itself to ADHD medication, which happens to be among the more heavily tested treatments in medicine, so the useful question is what the testing found.

This is not a way of saying your worries do not count. Side effects, cost, how you feel about giving a child a drug: all of that is real and worth…

Wanting to try everything else first is a normal instinct and worth taking seriously. It is still fair to ask why we would have a child squint for a year before trying glasses.

The cost of waiting is not nothing. A school year is a school year, friendships form or fail to, and a child's sense of who they are is being built…

Most resistance to medication turns out to be something a person heard rather than something they decided. Work out which one you are holding, because the two need different things.

A worry built on a half remembered article tends to dissolve once you find out what was actually studied. A worry that comes from your values, about…