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…

A relationship with no friction in it can leave an ADHD partner restless rather than content. A bit of heat is not the same as a bad marriage. What matters is what happens afterwards.

Plenty of couples decide that any argument means something is broken, and then start managing each other into blandness, which nobody enjoys. The…

Relationships take a lot of the strain here, and the usual shape is one person quietly carrying all the planning while the other feels constantly told off. Both halves are worth naming out loud before resentment sets hard.

The practical work is splitting the load by what each of you is actually good at rather than down the middle, and putting the shared admin somewhere…

ADHD reaches into a marriage in ways couples rarely say out loud: attention drifting during a conversation that mattered, or a partner who has started to feel like an unpaid manager. It is a fair thing to talk about and to get help with.

The hurt usually comes from what each of you concludes rather than from the behaviour itself. One reads distraction as not being loved, the other…

Holding anger in does not hide it. It comes out in the face, the shoulders and the shortness of your answers, and the person opposite reads all of it.

This is why gritted politeness so often makes things worse rather than better. They can feel something and now they cannot ask about it. Saying the…

How you show anger was taught to you long before you had any say. Some households raise their voices and forget it by supper, others go quiet for three days.

Neither is health and neither is illness. They are rules, learned early enough that they feel like instinct. Saying yours out loud is the useful…

Anger works by sorting the world into me and not me. Once someone has landed on the wrong side of that line, everything they do starts reading as evidence.

You can feel the sorting happen if you watch for it. Their tone becomes proof, their silence becomes proof, the way they load the dishwasher becomes…

Defence starts at a boundary. When anger flares, something has been read as crossing a line, so the question worth asking is which line.

The answer is often smaller and clearer than the reaction: being spoken over, being made to look stupid in front of someone, having your time taken…

Some anger is really about being left. It flares when someone pulls away, goes quiet or seems less interested, and it comes out as an accusation rather than as the fear it is.

The giveaway is that it happens with the same one or two people, the ones whose closeness you rely on. Anger skills alone do little here, because the…

Being late on purpose, the joke with an edge, the job done just badly enough: that is anger at full strength, only sent by a quieter route.

People who do this often say honestly that they never get angry, and they believe it, because what they are picturing is shouting. The feeling is all…

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…

Your family had its own rules about anger, quite apart from anything cultural. Those are the ones that shaped you, and they can be renegotiated.

Name two of them plainly. Nobody leaves the table. Whoever shouts loudest wins. We do not mention it the next day. Then ask which you still want.…