Practices

Going from talking online to talking in person is not one more step up the same ladder. It is a different ladder, and it deserves rungs of its own.

Those rungs might run from voice notes, to a phone call, to a video call with the camera on, to meeting one person you already know somewhere quiet,…

Write it up before you leave. One salesman, knowing full well he will not remember the visit an hour later, does his notes in the car with the engine still off.

The strength of it is that the trigger is fixed and physical. Sitting down in the car is the cue, and the notes happen before the key turns. No…

Whatever the record is, do it the same day, every time. The salesman writes his notes in the car outside the client's office. Not that evening, not on Friday.

No exceptions is the part doing the work. One skipped day teaches you that skipping is survivable, and 'it worked out fine that once' is the thought…

This is not a milestone you pass. The two year old's version goes, then a version comes back at twenty two, and again at fifty two, wearing whatever clothes that stage of life provides.

So think maintenance rather than course completion. When conditions change, a new baby, a new manager, an illness in the family, expect the old…

An ADHD diagnosis usually arrives with two extra words attached: which presentation it is, and how severe. Both are descriptions of what gets in your way, not a grade you were awarded.

Inattentive, hyperactive and impulsive, or the two together, and then mild, moderate or severe. Mild means you met the threshold and the effect on…

Never come off an antidepressant on your own. The taper belongs to the prescriber, and for some drugs it needs to be slower and longer than people expect.

The moment to raise this is before anybody acts, not afterwards. If a client is feeling better and starting to think about stopping, that thought is…

Some antidepressants take weeks to build up and weeks to clear, so both the improvement and the aftermath run on a slower clock than you would expect.

Fluoxetine is the usual example. It and the substance it turns into stay around a long time, which means a fair trial is counted in weeks and…

Raising a dose does not simply raise the benefit. It raises everything the drug does, including the parts nobody was asking for.

As the amount climbs, a medicine begins touching things it barely touched before, which is why new side effects can appear at a higher dose of…

Coming off an antidepressant is a piece of work in itself. Plan it slowly with the prescriber rather than stopping on the day you feel well.

Some, venlafaxine especially, leave the body fast enough that a missed dose is felt within a day: dizziness, strange electrical sensations, a mood…

Two products can hold the identical molecule and still behave differently in a person, because the difference lives in how fast the drug is released. A change of formulation is a real change, and it is a different thing from a change of drug.

The release pattern sets how high the level climbs, how quickly it gets there, and how long it holds. For stimulants that decides whether cover…

If you take a prescribed stimulant and your workplace tests, sort the paperwork before anyone asks. A labelled bottle and a short letter from your prescriber turn an alarming result into a filing matter.

Prescribed amphetamine shows up on a standard screen as amphetamine, because that is what it is. The test cannot tell the pharmacy from anything…

Some settings simply suit an attention difficulty better. Expectations set out minute by minute, consequences that arrive the same day, a visible ladder to climb: military life often fits for exactly those reasons.

The point carries well beyond the army. When you are helping someone choose work, ask what the day actually looks like rather than what the job is…

One minute of moving between tasks. Star jumps, a lap of the corridor, anything that gets the blood going before you sit down to the next thing.

Classrooms that do this report smoother changeovers and better recall of whatever was just taught. The same trick works at a desk: end one job, move…

Do not stop dead. Give the end of anything energetic a few minutes of winding down, so the change of gear is a routine rather than a demand.

Stopping is a transition, and transitions are where things fall apart for a lot of people. A short unwinding phase, the same one every time, takes…

Move just before the difficult task, not after it as a reward. Five minutes of skipping, stairs or running on the spot, then sit down to the thing.

The window straight after moving is when focus is at its best, so that is the bit worth spending on whatever you have been dreading. For a child,…

One man with ADHD described the goal as no longer suffering from it, only having it. The diagnosis had not changed. What it cost him had.

Half of that shift comes from removing particular sources of pain: the job that was never going to work, the arrangement at home that left everything…

Most children with ADHD grow into adults with ADHD. Some of it settles as the brain finishes developing into your late twenties, and adult life gives you more say over how your days are arranged, but the underlying difficulty tends to stay.

This is worth knowing because much of the improvement people do get comes from arranging things to suit themselves: the job that fits, the hours that…

The best ending is often that therapy stops and the practices carry on. People finish their sessions and keep the yoga, the bodywork, the acupressure, the sitting quietly.

It is worth building towards that from early on rather than at the end. If everything that settles you happens in one room with one person, then…

ADHD does not usually vanish at eighteen. The visible fidgeting often settles while the inattention stays, and the restlessness moves inwards where nobody can see it.

A teenager who has stopped bouncing off the walls can look much improved at exactly the point their workload has quadrupled, which is a poor moment…

If you swallow it all day at work and it comes out at home, home is not where the problem is. It is just the safest place to put it down.

Anger lands where retaliation costs least, which usually means on the people who will forgive you. Two things help more than trying to be calmer at…