Practices

Being in recovery is not a reason to leave an attention difficulty untreated. The restlessness that made a substance useful is still there once the substance goes.

Clinicians often hold back here, uneasy about a stimulant for someone with a history, and that caution is understandable. The other choice carries a…

Some people find they drive better in a manual, because there is always something to be done. Treat that as an experiment rather than a finding.

The reasoning is the same as a fidget toy or a standing desk. A little constant demand can keep an under-occupied system in the room instead of…

Blood pressure on a stimulant is an individual matter. For most people it is a non-event, and where it does rise the answer is often a different stimulant rather than none at all.

No blood test or cheek swab will tell you in advance which one suits you. Finding out means trying, measuring and being willing to change, which is…

For a small number of children the question was never about school reports. A toddler who runs into a road and keeps running, a child who climbs the pool fence: what is being weighed there is whether they stay alive.

Most decisions about treating a very young child are finely balanced and deserve to be taken slowly. Where the behaviour itself is life threatening,…

If the first medicine disappoints, that is information about the first medicine. Plenty of people who get nothing from one class do well on another.

Methylphenidate and amphetamine are not the same drug at different strengths. They work by partly different routes, so a poor result on one says…

Finding the dose is a search rather than a calculation. It goes up in small steps until either the effect you want turns up, or the side effects get annoying enough that you come back down a step and settle there.

There is no way to work the right dose out from body weight or from how bad things look, which surprises people who expect medicine to be more exact…

Most people who try do find something that helps, but often not the first thing they try. Not responding to one class of stimulant says surprisingly little about the other.

The high response figures you may have read come from people who worked through more than one option, not from one prescription going well. Response…

One of the founding figures of biological psychiatry summed the whole business up as some medicine helping some people at some doses some of the time. Knowing that before you start makes the first disappointment much easier to survive.

Most people need more than one adjustment: the dose, then the timing, sometimes the drug itself. Go in expecting the first prescription to be the…

When medication works, its best effect is often on everything else you were already trying. Coaching, exercise, a routine: each of them needs enough attention to get started, and attention is the thing in short supply.

That is why setting medication against the other approaches usually misses the point. The plan you could not keep last year may be perfectly keepable…

If the word exercise makes you flinch, drop it. Say moving about, or getting out, and see whether a plan turns up.

For a lot of people that word carries school changing rooms and years of not keeping things up. Swap it and the list of things that count grows:…

Missing a day is not the end of the programme. You missed a day. Tomorrow you carry on.

The dangerous part is not the missed session, it is the story that follows it, the one where you have blown it so you may as well stop altogether.…

When you reach a goal, stop and let yourself register it before moving on to the next one. Otherwise you collect achievements and never feel any of them.

The pause can be tiny. Say out loud what you did, tell someone, sit with it for a minute, thank God for it. Racing straight on to the next target…

When you need to correct one person, say it to the room. Everyone gets the instruction and nobody gets the sting.

Good instructors do this without thinking: they see one child dropping their guard and say that everybody needs to keep their hands up. The teaching…

Use a timer you can see rather than a warning you have to remember. A dial that shrinks, or a light that goes from green to red, does the work that five more minutes never quite does.

Time is not something everyone feels passing. Turning it into something you can look at moves the job from guessing to seeing, which is much easier.…

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…

A silent room is not restful for everybody. If every cough and creaking knee pulls at you, ask for music or bring headphones with something plain in them.

Too little going on can be as unsettling as too much. A low steady sound covers the sudden little noises that keep snagging your attention. Some…

When someone describes a day like that, do not answer with a lecture on living better. Say that this is hard, and that you find parts of it hard too.

They have heard the virtue speech many times already and it has never once helped. Admitting that you also struggle to exercise, or to keep up with…

Five minutes of moving about sharpens concentration enough to notice. You do not need a session, you need a lap of the building.

Before a task you have been avoiding, get the blood going for five minutes. Stairs, a brisk walk to the end of the road, star jumps in the kitchen if…

It does not have to be one block. Ten minutes here and ten there add up to the same total, and they are far easier to get.

An hour set aside is an hour that one interruption can swallow. Bits scattered through the day survive better and they break up the sitting, which is…

Nobody sits down at a piano and plays Mozart the first afternoon. Set the bar at this week rather than at the finished version of yourself.

The stretch between starting and being any good is where most attempts die, because the reward sits a long way off and today feels like nothing.…