Practices

There is a sort of avoidance that looks like getting things done. Sorting the drawer, clearing the inbox, any mildly useful job that is not the one you are dreading.

It is harder to catch than obvious time wasting because it leaves you nothing to feel guilty about. At the end of the day the shelf is tidy, the…

Rather than asking whether what you are doing is worthwhile, ask what it is keeping you away from.

The first question is too easy to pass. Almost anything you are doing can be defended as useful, which is why it never catches you out. The second…

If you are being assessed for attention, say something about your mood and your worry as well, even if nobody asks.

Anxiety and low mood sit alongside ADHD often enough that a thorough assessment will go looking for them anyway. But shame is quiet, and years of…

When someone says they feel restless inside, ask what the restlessness wants. Restless to move, or restless to do one particular thing until it feels right?

The two feel similar from the inside and point in different directions. With ADHD it is usually undirected: the legs go, the chair is wrong, you need…

A distracted person can be brought back with a nudge. Someone who has gone elsewhere cannot, and the difference shows itself in a couple of seconds.

Say their name, ask something simple, and watch what returns. Attention that has drifted comes back with a small apology and picks the thread up…

Try not to ask why. If the person knew why, they would probably have sorted it out already, and the question tends to land like an accusation.

Ask what happened just before instead. What was going on, what they felt, what came after, what sort of day it had been. Those answers can be worked…

If someone was adopted, or simply does not know their family history, say early and plainly that this is not a problem. It helps to have and it is not needed.

Otherwise the question lands as one more reminder of what is missing, and some people will spend the rest of the appointment feeling they brought the…

Some of what looks like muddle is the system's fault. Our tenth month is named for eight, because two months were added later and nobody renamed the rest.

Worth saying to anyone who feels stupid about dates and forms. A calendar whose numbers are out of step, a tax year starting in April, forms asking…

When someone says their heart races on their medication, ask whether it ever did before they started. It is the cheapest question you have and it usually sorts the answer out.

Go looking for the old settings: waiting to be called on in class, standing outside a room before a difficult conversation, three in the morning with…

While you are taking the family history, ask about seizure disorders and psychosis too, not only about attention. A family carrying other neurological or psychiatric conditions is worth knowing about whatever you end up concluding.

Keep the list short and ask it plainly: epilepsy, psychosis, learning difficulties, head injuries, anything neurological. Some of it will matter for…

Some people simply cannot get a family history. Refugee journeys, destroyed records, closed adoptions, families that did not survive. That is a gap in the paperwork and not evidence against the diagnosis.

Say so out loud, and write it in the notes as a gap rather than as a negative finding, so the next person reading does not mistake silence for an…

One man put his lamps on a timer so the room would go dark at eleven and send him to bed. It worked for a few nights. Then he simply carried on in the dark. A cue can tell you the time. It cannot make you stand up.

Worth remembering before you build anything clever. If the pull of whatever a person is already doing is stronger than the nudge you have designed,…

'I set a reminder and still did not do it' is not a story about a bad reminder. It tells you the missing piece was never information, and a bigger, louder version of the same thing will fail in the same way.

The reflex is to escalate: three alarms, a different app, an entire new system built on Sunday night. What is needed is a change of kind, something…

Four steps you can do in ten seconds in the middle of anything: stop, take one breath, look at what is actually happening, then carry on.

It fits inside an argument, a shopping queue, the second before you send a message you will regret. The value is not the breath itself, it is the…

Say it plainly whenever you teach anything: the way I am showing you this is not the way it has to be done. Change it until it works for you.

Anyone who has failed at the standard version of something several times will not try again unless they are told clearly that adapting it is allowed.…

Cold water on your face, especially around the eyes and cheeks, slows things down fast. Splash it, or hold a cold flannel there for half a minute.

This is one of the few things that works when you are too far gone to concentrate on anything. It asks for no skill and no privacy beyond a tap. Lean…

Cross your arms over your chest, hook your thumbs together, and tap your shoulders slowly, left then right. You set the pressure and the speed.

Twenty or thirty seconds is enough to feel something shift, and most people find the breath falls into step with the tapping on its own. Warmth in…

You do not need a diagnosis to be worth teaching this to. Something that takes seconds, costs nothing and travels with you is worth having before you need it.

Practise it on an ordinary day, sitting on the bus or waiting for the kettle, so your hands already know it when the day is not ordinary. That is…

When you are helping someone settle, put the technique in their hands rather than your own. They tap themselves, they set the pressure, they stop when they want to.

Being touched by someone else, even kindly and with permission, asks a lot of a person whose body has been handled badly before. Self-administered…

Trace a square in the air with your finger while you breathe: in for four along the first side, hold for four, out for four, hold for four.

The counting slows the breath to roughly the rate that suits the heart best, and the tracing gives your eyes and hand something to do, which is…