Practices

People expect to feel wired and often describe feeling settled instead. That surprise is common enough to be worth knowing about before you start.

What tends to quieten is the churn: the half started tasks, the jumping from one thing to another, the low hum of being behind. That can read as calm…

Most long acting stimulant capsules hold two sorts of beads, one that dissolves straight away and one coated to dissolve later. That is the whole reason a single morning capsule can do what used to need a lunchtime dose as well.

It matters because the midday dose was the one that got missed, and missing it was rarely carelessness. A dose that has to be remembered in the…

The line about not cutting, crushing or chewing a long acting medicine is a safety instruction with a real mechanism behind it. Break the coating and the whole day's dose arrives in one go.

People sometimes crush a capsule because swallowing is genuinely hard, not because they are misusing it, so ask before assuming. There are usually…

Long acting stimulants are the usual starting point for a plain reason: they cover the most hours and they remove the lunchtime dose, which is the dose ADHD is most likely to swallow whole.

Remembering a tablet in the middle of a busy day is itself an executive task, so asking for it is asking the person to do the thing they came for…

The most useful question about a dose is whether the person can tell. A shrug and 'I think it sort of helps a bit' usually means it is not yet doing its job.

At a dose that suits them, most people can say when it comes on, what the middle of the day feels like, and when it leaves. Vagueness points…

A short acting dose lasts around four to six hours in most people, and bodies vary a great deal around that. Some clear it quickly and feel almost nothing, some clear it slowly and feel every side effect at a small dose.

If a tablet seems to have worn off by mid morning, or a low dose feels overwhelming, report it as a pattern rather than as a failure. It usually…

Dry mouth, a later bedtime and a smaller appetite are the usual early complaints, and each has a workaround. Knowing about them in advance turns a nasty surprise into something you were already expecting.

Water and sugar free sweets for the mouth, an earlier dose for the sleep, food loaded into breakfast and dinner for the appetite. Most people who…

When a dose that was working seems to stop working in a growing child, check height and weight before you reach for the word tolerance. These medicines are dosed by body weight, and a child can simply have outgrown the dose.

It is the cheaper explanation and the more common one, and it takes a single appointment to test. Bring the growth chart and the dates when you…

A prescribed dose swallowed as a tablet is set to bring you into the ordinary range, not to make you high. The rise it produces is too slow and too small to be the sort of thing anybody chases.

Misuse in the research is concentrated among people who do not have ADHD and who take the medicine in ways it was never designed for, by crushing it,…

The realistic difficulty with this medicine is not misuse. It is forgetting, since part of what is being treated is the very ability to remember to do something later.

So put the reminder outside your head. A weekly pill organiser sitting on top of whatever you pick up every morning, an alarm with the name of the…

An untreated attention difficulty rarely stays a blank space. People tend to find something that steadies them, and what they find is not always kind.

Nicotine, coffee at strange hours, cannabis in the evening, a bit of somebody else's prescription: these are often attempts at self correction rather…

Medication does not simply turn the brain up. On scans the regions that should be busy during a task get busier, and the ones that should stay quiet settle.

That detail matters more than it sounds. It says the trouble is one of aim rather than a shortage of effort, which is the opposite of what many…

Watch someone on a laboratory stop task and two things move together on medication: the fidgeting drops and the stopping gets more accurate.

Holding still and holding back turn out to run on the same machinery. That is why inhibition sits underneath so much else, from waiting your turn to…

In simulator work the biggest improvements on medication show up in the drivers who were worst without it: stopping properly, slowing for an amber, actually looking around.

That pattern is quietly reassuring. A drug that made everyone sharper would lift the good drivers as well, and this does not look like that. It looks…

Offered ten pounds now or twenty in an hour, plenty of people with attention difficulties take the ten and know while they are doing it that it makes no sense. The pull towards now is not a flaw of character.

It shows up in a laboratory and it shows up on a bank statement. Naming it helps, because a thing with a name can be planned around: money moved by…

None of the non-stimulants should be stopped suddenly. Guanfacine and clonidine began life as blood pressure medicines, and taking them away all at once can send blood pressure sharply back up.

Atomoxetine has its own unpleasant discontinuation effects, closer to those of an antidepressant. So a break because a prescription ran out, or…

In practice the non-stimulants turn up more often as an addition than on their own. A stimulant in the morning with guanfacine alongside it is a common shape.

The two act at different points of the same circuit, so they tend to complement rather than repeat each other, and the blood pressure effect of one…

When a dose wears off, things can feel worse than they ever did untreated. A good deal of that is contrast rather than the medicine leaving a debt behind.

You have spent the day at one level and then meet your own baseline without warning, late in the afternoon, usually with something still to do.…

A small short-acting dose in the afternoon, on top of the long-acting one, is ordinary practice rather than a special case. Homework and the evening drive often fall outside what the morning dose still reaches.

The hours when you most need to hold back are frequently the hours the medicine has stopped covering. Raising the morning dose to solve an early…

Skipping weekends, holidays and summers is a common suggestion and mostly it is the wrong call. The difficulty does not take a holiday when school does.

Unstructured time asks more of planning and self-regulation rather than less: whole days to fill, everyone at home, no timetable holding the shape of…