Practices

When you read that some proportion of people with ADHD have a particular problem, the number tells you nothing until you know the figure for everybody else.

Twenty percent sounds alarming until you learn what the rate is in the general population. What matters is the multiple, how many times more likely,…

Check the licensing before assuming you cannot afford a good instrument. Some come with permission to photocopy once you have bought the manual.

That detail matters most to the clinicians least likely to have a budget, which usually means the services seeing the families with fewest options. A…

There is more than one decent instrument, and which you use often comes down to what you were trained on. If you have never used one, say so rather than having a view about it.

Several rating scales are in wide circulation for children and for adults, validated by different groups for slightly different purposes. Picking one…

The manual now asks for signs by age twelve rather than age seven, and it added wording that fits adult life, including restlessness felt on the inside.

The older cut-off quietly excluded a familiar group: bright children, or well supported ones, who managed until the demands rose and only visibly…

Nearly everything on the ADHD list can show up inside a bipolar presentation, and the reverse is not true. So the shared features settle nothing, and the distinctly manic ones carry all the weight.

Put your attention on episodic elevation, grandiosity and a genuinely reduced need for sleep. Those do not belong to ADHD on its own, so they tell…

How an outburst ends tells you more than how it starts. Give an ADHD storm some room and it often burns itself out. The rage that runs for an hour with the lights out behind the eyes is a different animal, and so is the child who genuinely does not mind what you take away.

Ask the parents to walk you through the last three. What set it off, how long it ran, what stopped it, what the child was like an hour afterwards.…

When someone cannot let go of the old rule after the rules have changed, that is the same machinery that loses their keys and drops the thread of a sentence. Stuck, not stubborn.

It shows up in small places. The game changes and they argue for the old version. The usual road is closed and the whole trip falls apart. A plan…

Where a relative has taken ADHD medication, take the details: who they are to your patient, what they were given, what it did, and what was tried and dropped. Then put it in the referral letter.

No blood test tells a prescriber where to start, so a brother's clear response to one drug, or a mother's bad reaction to another, is one of the few…

There is no box you type 'always late' into and get the answer out of. When a sensible strategy is not landing, the work is finding out what is blocking it rather than producing another strategy.

If you notice yourself handing over the fourth tool for the same problem, stop and ask a different kind of question. What happened the last time they…

A man who could not get himself to bed kept his bedtime alarm upstairs, where his wife and baby were sleeping. Switching it off meant climbing the stairs, and leaving it meant waking them. The walk to the alarm was the thing he was trying to do anyway.

That is the part worth copying. Put the cue somewhere that costs something to answer, and make answering it land you where you meant to be. Anything…

Time management is only the fit between tasks and the hours you have: planning them against time, then doing them against time. It is a skill with parts, not a verdict on what kind of person you are.

Most people arrive having already decided they are lazy, and that decision is doing them no good at all. Describing it mechanically gives you both…

It runs the other way as well. Among children referred for dyslexia, a sizeable minority also have ADHD and many have coordination difficulties too. Whatever is written on the referral, treat it as one part of the picture.

Where the reading difficulty is severe, motor involvement is more likely to be there alongside it, which is why the first look should be wider than…

Dyspraxia and developmental coordination disorder are the same thing carrying different passports. Search only the American term and you will miss a large European literature on assessing and helping these children.

Search both, and try the older names while you are there. It matters most when you are looking for what actually helps, since much of the…

When a bright, talkative autistic child arrives looking mainly behavioural, look underneath for a coordination or reading difficulty. Once the first label is in place, whatever comes after tends to get filed under it and never assessed on its own.

Watch for the child who does well in conversation and badly on paper, or who is fine in class and miserable at PE. Those gaps are usually a second…

Choose the subtests that answer the question you were actually asked, and read whatever reports the family already has before adding anything of your own. Children arrive with thick folders, and they also arrive with nothing at all.

Where occupational therapy, speech and language or neuropsychology have already covered ground, do not cover it again for the sake of a complete…

Two referrals turn up again and again. A young child being asked to leave a school for behaviour, with no developmental or cognitive information anywhere in the file. And a parent saying something is wrong while the school says everything is fine. Both are describing adult frustration rather than a formulation.

In each case the first job is the same: get some data. Not another opinion, not another meeting, but something measured about how this child thinks…

If you cannot remember much about being six, you are in the majority. Early childhood comes back poorly for most adults, while the teenage years are far easier to describe.

So do not sit in an assessment feeling you have failed a test because the early years are a blur. Bring what you can find instead: old school…

A list of symptoms on its own does not make a diagnosis. What counts is that they cost you something real in at least two areas of ordinary life.

That means work or school, money, home, friendships, driving, getting through the week. Almost everyone loses keys and drifts off in meetings, so the…

Much of the symptom wording was written with children in mind. If a question sounds like it is about someone climbing the furniture, translate it into your adult life rather than answering no.

Restlessness at forty is rarely running about. It is being unable to sit through a film, the leg going under the table, two jobs left out of boredom.…

Note who is a first degree relative and who is a second, instead of writing 'runs in the family'. Parents, children and siblings sit in one ring. Grandparents, aunts, uncles and cousins sit in the next.

A simple grid helps: names down the side, then relation, what they were like, what was ever diagnosed, what was ever treated. The picture comes out…