Practices

If you are pulled towards risk, you will do better giving that pull somewhere with a floor under it than trying to switch it off. Fast, high, cold, loud: choose the planned version rather than the one that turns up at two in the morning.

Work out what the appeal actually is. Speed, height, cold water, a crowd, the edge of fear. Then find the form of it that has brakes: a climbing wall…

Some of what feels like a flaw in your character is really a job that can be handed to something outside your head: a calendar, a list on the wall, a person who helps you lay out the week.

Coaching for attention difficulties is mostly this, and nothing more mysterious. Someone sits with you, builds the week, works out what comes first,…

When a young person is struggling to launch into adult life, it is usually two things at once: the practical scaffolding, and the social side. Work on one only and the other tends to pull it down.

Calendars, laundry and deadlines are the visible half. The harder half is friendship, saying no, asking for something, being alone in a room full of…

If you have been the one holding someone's schedule, meals and reminders together, do not put all of it down on the day they leave. Pass it over a piece at a time, each with a date on it.

Write out what you are actually doing for them: waking, appointments, repeat prescriptions, food, deadlines, forms. Most families are surprised by…

Medication can make the learning possible. It does not do the learning. If no tools get built while things are steadier, there is nothing standing there when the dose wears off.

A common disappointment runs like this: the medication helps, then it seems not to be enough, then it gets stopped. Often what happened is that…

A bridge year can be a deferred place, a course at the local college, a job, or a stretch of genuinely doing very little. That last one is a real option and not a refusal to choose.

For someone who has just come apart, a fresh demand can restart the same collapse, so a few months with nothing scheduled is sometimes the…

The next step has to be theirs. A job that looks like nothing to you might be the first thing in two years they chose without being pushed, and that is exactly why it holds.

Parents tend to want the step that recovers the lost ground. The young person needs the step they can actually take on Monday. Shifts in a shop, one…

When someone has shut down, pressure to get moving usually pushes them further in. Safety first and activity afterwards, even when the whole household is desperate for a sign of life.

Safety here is ordinary and physical. Food that turns up without being asked for. A room nobody is inspecting. Conversation that is not a progress…

If most of the difficulty is happening at home, most of the work needs to happen with the household in the room. Otherwise the hour of good conversation gets quietly undone by Tuesday.

In a settled stretch, seeing the young person on their own with occasional family time is fine. In a crisis, turn it round: everyone together,…

Sorting goes better fast than carefully. If every item stalls you, ask someone to sit in the room while you work, not to help but to keep the pace up.

A person nearby changes what the hour feels like, and they can be reading their own book the whole time. What they supply is momentum, which is…

Often the most useful thing a clinician does is not delivered by the clinician. It is delivered by the teacher, or the parent, after a conversation you had with them.

Taking that seriously changes how the hour gets spent, towards talking with the school, coaching the parents and designing the arrangement, and away…

The classroom is the strongest place to help and most clinicians cannot get into one. That is a reason to work well in the next best place, not a reason to give up.

ADHD sits in how a brain is built, and the work is on the executive skills themselves rather than on attitude or effort. Where the moment of…

The pull towards bread, pasta and biscuits when you are low is not simply greed. Carbohydrate makes it easier for the brain to get hold of the raw material it needs for serotonin, so it gives a real if short lived lift.

Calling it self medication instead of a failure of character changes what you do next. You stop trying to out-discipline the craving and start asking…

Allergies turn up more often alongside ADHD than chance would predict. Worth mentioning your allergy history at an assessment even when nobody asks, since the two seem to travel together.

The likeliest explanation is not that one causes the other. It is that some of the same underlying wiring makes both more likely in the same person.…

Some foods are formulated to be hard to stop eating. That is a design brief rather than a flaw in you, and it goes some way to explaining why one particular snack is the one you think about at eleven at night.

Knowing this moves the fight somewhere you can win it. Willpower at the moment of craving is a poor bet, and a decision made in the shop is a much…

Here is a question that costs nothing: has anyone in your family been told their vitamin D was low? It runs in families through genes, skin tone, where you live and how much time anyone spends outside.

The clinician telling this story found out only afterwards that his mother, father and brother had all been low. Nobody had mentioned it, because it…

Even where a herb has good evidence behind it, that evidence belongs to the plant and not to the bottle in your hand. Testing keeps turning up products that do not contain what the label says.

This part of the argument does not depend on whether herbal remedies work. You could accept every claim made for a plant and still be left with the…

Own brand products from large retailers were among the worst performers in these tests. A big name on the packet is not a quality check, however much it feels like one.

Own label goods are usually made under contract on thin margins with no independent verification of what comes out the other end. So the reassurance…

People often turn to herbal remedies hoping to avoid side effects. Plants are chemistry too, and some of them interact with prescribed medication in ways that matter.

A plant extract is not one substance, it is a mixture of many, which gives it more places to interact rather than fewer. Origin has nothing to do…

Around seven in ten people who use herbal products never mention it to their doctor. Not out of secrecy, mostly because a tea or a gummy does not feel like it belongs on a list of medications.

The useful move is to answer a wider question than the one you were asked. When someone asks what medication you take, tell them what else you take…