Practices

By response rate, extended release stimulants are among the most effective medicines in psychiatry, and most people tolerate them well. That is worth hearing plainly, particularly from people who are not generally keen on medication.

What the long acting form buys you is coverage. A dose that has faded by four in the afternoon leaves the evening bare, and the evening is where home…

Medication does not make somebody care more. It narrows the distance between meaning to do the thing and doing it, and that distance is exactly what the other person has been feeling as being let down.

It helps a couple enormously to have the right name for what has been happening. The intention was real every single time. What went missing was the…

People who use several kinds of help tend to report more benefit than people relying on one. Medication, therapy, coaching, reading, sleep and movement all seem to add something rather than compete.

That turns a hard conversation into an easier one. Instead of pressing a reluctant partner towards the single thing they least want, you can offer a…

Managing the ADHD is not the goal. Being happy together is the goal, and the ADHD work is only worth doing to the extent that it gets you there.

Keeping that order straight changes the atmosphere of the whole effort. A partner who has spent years being a project stops being one. Requests stop…

A great many people are diagnosed and then left with a starting dose nobody ever revisited, no reading, no group, nothing else at all. If things have stalled, the first thing to check is whether the treatment was ever actually finished.

Optimising is unglamorous and often the quickest thing available. Was the dose ever adjusted upwards, and on what basis. Does the cover reach the…

If the prescriber, coach or therapist is not delivering much, say so and ask for someone else. Working around poor care quietly is the thing that convinces a couple this is simply as good as it gets.

A dose never revisited, or a therapist who has never worked with ADHD, sets a low ceiling. The trouble is that the ceiling gets read as the person:…

Sleep, food and movement will not cure anything, but they lengthen the fuse. Bad moments still arrive, and you handle them differently when your body is not already running on empty.

This matters more here than it sounds, because ADHD tends to wreck exactly these three and then the wreckage feeds back into the flare ups. Late…

Paying someone to help sort the house will not mend the marriage. It will remove one of the things you fight about most weeks, and that counts for more than it sounds.

Nobody should pretend this reaches anything deep. The point is arithmetic. A couple has a certain number of rows in them, and if the living room is…

People who are sleeping properly, eating properly and moving a bit tend to want each other more. The unglamorous parts of life management run closer to the bedroom than either of you might expect.

It is worth saying out loud when desire has quietly gone from a marriage, because the usual explanations reach for something heavier: he has lost…