Practices

Alongside diagnoses, ask how relatives died. Falls from roofs, crashes, deaths with the safety gear left on the ground: these recur in some family lines and they say something a list of diagnoses cannot.

Ask it gently and let people take their time, because you are asking about grief as much as about pattern. What you are listening for is a habit of…

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…

When something did not get done, find out which half broke. Did they not know what to do or when? Or was the plan fine, and the moment for doing it came and went?

Ask for the last time it happened, hour by hour, up to the point where it did not happen. A planning failure needs somewhere reliable to catch tasks…

Awareness is knowing what needs doing and when. Motivation is doing it once you know. Nearly every app on the market solves the first one, which is why buying another one so rarely helps.

Test it with one question: at the moment it did not happen, did you know? If the answer is yes, the reminder was never the missing piece, and a…

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…

Attention and impulse problems that appear for the first time in middle age or later are not ADHD arriving late. They need a doctor to look, not a prescription.

Several conditions affecting the frontal lobes can show up first as new disinhibition, poor judgement or a change in personality, and some are…

Ask about food two generations back. What the parents were like about it, what the grandparents were like, what the rules were at the table.

Much of how a person eats was learned long before anybody mentioned a diagnosis, and a fair amount of the shame around it was learned in the same…

The scales worth using are the ones that ask about situations rather than symptoms alone. Home, school, work, and what actually happens in each.

A questionnaire counting how often somebody loses their keys will label half the population. What a diagnosis needs is evidence that the difficulty…

Executive function scales ask how the week actually went. That is often more use than an afternoon of testing in a quiet room.

Office testing happens in the best conditions a person will ever meet: no interruptions, someone sitting with them, a clear finish line in sight.…

Ask about the family properly: parents, brothers and sisters, children, then aunts, uncles and grandparents. Include drinking and drug use, in them as well as in the person sitting with you.

This tends to be the highest yield few minutes of an assessment, because the condition runs strongly in families. Relatives who were never assessed…

The family history is not the warm up before the real assessment. Give it proper time and it will often tell you more than any single rating scale in the folder.

Walk through the family rather than asking one summary question about it. Who struggled at school, who could never sit through a meal, who changed…

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…

Ask whether anyone kept the old school reports. The same lines turn up generation after generation: not working to potential, talks too much, never has the right books with him.

They were written by teachers who had never heard of ADHD, about children nobody was going to assess, and that is exactly what makes them worth…

'I am disorganised' cannot be treated. 'The post piles up on the hall table until something ends up with a debt collector' can. Spend the time getting the problem down to something that specific.

Push for the particulars: which task, which moment, what was happening just before, what they did instead. Where you can, ask someone who was there…

When a child with attention difficulties is also at war with every instruction, that pairing is worth taking to someone early rather than waiting to see whether it settles.

The two travel together often, and a minority of children follow a path from constant defiance into more serious trouble later. Every stage of that…

Long acting stimulants are the usual starting point for a plain reason: they cover the most hours and they remove the lunchtime dose, which is the dose ADHD is most likely to swallow whole.

Remembering a tablet in the middle of a busy day is itself an executive task, so asking for it is asking the person to do the thing they came for…

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…

When somebody decides against medication, respect the decision and then say the rest plainly. Some of the struggle will stay, and no amount of therapy or another clever app will fully close that gap.

Left unsaid, the person keeps trying harder and reads the shortfall as personal inadequacy, which is the very belief you are working to undo. Said…