Practices

If you are helping someone get moving, start with the thing they mind about, even when you can see something else that needs it more. A goal a person picked for themselves is the only kind they will chase when you are not in the room.

Keep that first target small and specific enough to finish: one drawer, one email, the bag by the door on Tuesday. The thing you can see needs…

Before intensive work ends, turn what you have learned about a child's thinking into things a teacher can actually do on a Tuesday morning. That translation is what decides whether any of the gains survive going back to school.

A profile written for clinicians is no use in a classroom of thirty. Give three or four concrete actions instead: where this child sits, how…

Start with a couple of minutes of movement before any of the difficult talking. Not a warm up for its own sake: a body that has moved is easier to think in.

Two or three minutes is enough. Roll the shoulders, round and lengthen the spine, turn gently side to side. It also says something without anyone…

Telling someone they have changed their brain lands harder than telling them they have changed their mind. That is worth knowing, and worth handling carefully.

Brain language feels solid and permanent, so a person can lean on it. That same weight is why it should not be stretched: promising rewiring you…

If the word mindfulness makes you wince, leave the word out. Paying attention to your breath, or to the sounds in the room, is the whole of it.

A lot of people turn the practice down before trying it, because the label sounds like it belongs to somebody else's religion or somebody else's sort…

When you offer a practice to someone, use their words for it rather than yours. Keep the fuller version ready for the day they ask where it comes from.

A plain, unmystical version suits most people and costs them nothing to accept. Anyone who gets curious can have all of it, and they will take more…

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…