Practices

The scales worth using are the ones that ask about situations rather than symptoms alone. Home, school, work, and what actually happens in each.

A questionnaire counting how often somebody loses their keys will label half the population. What a diagnosis needs is evidence that the difficulty…

Executive function scales ask how the week actually went. That is often more use than an afternoon of testing in a quiet room.

Office testing happens in the best conditions a person will ever meet: no interruptions, someone sitting with them, a clear finish line in sight.…

Ask about the family properly: parents, brothers and sisters, children, then aunts, uncles and grandparents. Include drinking and drug use, in them as well as in the person sitting with you.

This tends to be the highest yield few minutes of an assessment, because the condition runs strongly in families. Relatives who were never assessed…

The family history is not the warm up before the real assessment. Give it proper time and it will often tell you more than any single rating scale in the folder.

Walk through the family rather than asking one summary question about it. Who struggled at school, who could never sit through a meal, who changed…

Note who is a first degree relative and who is a second, instead of writing 'runs in the family'. Parents, children and siblings sit in one ring. Grandparents, aunts, uncles and cousins sit in the next.

A simple grid helps: names down the side, then relation, what they were like, what was ever diagnosed, what was ever treated. The picture comes out…

Ask whether anyone kept the old school reports. The same lines turn up generation after generation: not working to potential, talks too much, never has the right books with him.

They were written by teachers who had never heard of ADHD, about children nobody was going to assess, and that is exactly what makes them worth…

'I am disorganised' cannot be treated. 'The post piles up on the hall table until something ends up with a debt collector' can. Spend the time getting the problem down to something that specific.

Push for the particulars: which task, which moment, what was happening just before, what they did instead. Where you can, ask someone who was there…

For the child who flies off the handle at noise, labels and crowded rooms, with no autism diagnosis in the picture, a free parent completed sensitivity questionnaire will tell you more than another behaviour chart.

It gives you a structured way to describe the reactivity without reaching for a diagnosis the child may not have, and it points at what to change:…

Run the assessment yourself and watch while they work. Under real effort you will see the small movements, the tics and the overflow that never appear in ordinary conversation, and none of it reaches you if a technician or an app does the testing.

Sit where you can see hands and face. Note what happens as the task gets harder: the tongue that comes out, the leg that starts going, the free hand…

When a child with attention difficulties is also at war with every instruction, that pairing is worth taking to someone early rather than waiting to see whether it settles.

The two travel together often, and a minority of children follow a path from constant defiance into more serious trouble later. Every stage of that…

A clinician trained thoroughly in autism and ADHD may know almost nothing about coordination or reading difficulties, and can spend years working above foundations nobody ever checked. Ask yourself which of those categories your own training left out.

Go back over a handful of old cases rather than only reading about it. Where a child made less progress than you expected, ask what you never…

Processing speed is the stubborn one. It shifts a little with repeated, rhythmically paced practice and hardly at all with explanation, so say that to a family at the start rather than when they are disappointed.

Teaching a strategy will not make a slow processor quick, and telling a child to hurry up only makes the work more unpleasant. Graded practice with…

Assess, make a plan, do the work, and then keep measuring while you do it. Without that last part you have no way of knowing whether to push harder, change direction or stop.

Use more than one stream: your own measures, what parents notice at home, what school reports, and what the child says about it. Children will tell…

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.…

If talking about feelings has always felt foreign or a bit embarrassing, treat this as a once a day checklist instead. Five boxes, no discussion, nothing to perform.

Plenty of people who go blank at how are you feeling can tell you straight away whether their shoulders are tight or their breathing is shallow.…

Before you walk into a room with someone, ask what you are carrying in with you, and what you are likely to leave behind when you go.

State travels ahead of words. A hard conversation an hour ago, a bad night, a piece of news you have not dealt with: any of it will be in the room…

Ask who you are today and what body you are living in today, and let the answer be different from yesterday's. You are more fluid than solid.

Hard experience tends to freeze a person into a description: the damaged one, the difficult one, the one who cannot cope. Asking the question daily…

Whenever you offer a standing practice, offer the seated version in the same breath, and mean it. Say plainly that people should look after their own bodies and change anything that does not suit them.

Say it before you begin, not afterwards, so that nobody has to interrupt to ask. If you cannot see the people you are guiding, say that too, and say…

Before twisting, draw your belly gently in towards your spine. It looks after your lower back, and it is worth feeling for its own sake: you steady the middle before you turn towards anything.

The physical version is simple. A light drawing in of the abdomen, not a clench, held while you rotate and released as you come back. The felt…

Offer any movement in three sizes: small, medium and full. Let people take the one that fits today, and let them change their mind halfway through.

For a twist that might be a simple reach, or a reach with the other hand placed behind, or loose swinging arms. The three sizes do quiet work. They…