Practices

Offer school again at ten, and at eleven, and after lunch. One refusal at half past seven should not be allowed to decide the whole day.

Morning dread usually peaks around the time they would be leaving and then drains away over a couple of hours. A child who could not face it at half…

Find one adult in the building the child already trusts, and have them meet the child at the entrance. The doorway is the hardest minute of the day.

The job is small and specific: be there at the door, walk with them to their locker, get them started, be findable later on. It turns the worst…

The first day back is worse than the weeks before it, not better. Plan for that spike rather than letting it take you by surprise.

Anxiety climbs as the return gets close and peaks somewhere near the doorway, then it comes down, but only for someone who stays long enough to find…

When the thing is over, sit down for twenty minutes and go through it: what happened, what worked, what did not, what you will do differently. Put it in the diary, because it never happens on intention alone.

The monthly report, the school year, the audit. Write the answers where you will actually find them next time, and be specific about the point it…

If telling your doctor or midwife what you are using feels impossible, you can ask someone you already trust to pass it on for you, with your permission and in your words.

People often stay quiet with the very clinician who could help, because saying it out loud feels heavier than the problem does. Handing the message…

Before someone has said a word, you have often already decided what they are: only here because they were made to come, not really interested, wasting your time. That decision changes how the meeting goes.

The person sent by a court, or pushed into the room by a partner or a manager, walks in already read. Try starting the hour with nothing written: no…

Let the person facing it choose the first step, and let them choose an easy one. A rung somebody picked gets climbed. A rung assigned to them gets argued about.

Ask which one they would be willing to have a go at this week, not which one they ought to be able to manage. The answer usually sits somewhere in…

No step happens without the person agreeing to it. Not ordered, not dragged, not talked round in a bright voice. Agreement is a condition of the thing working, not a courtesy.

Coerced exposure teaches two lessons at once: that the situation is dangerous, and that you are not safe with the people who arranged it. After that…

Nobody tolerates something unpleasant for no reason. Before starting anything difficult, get clear about what you want on the other side of it, in your own words.

Something like: I want to sit an exam without being sick, so I am willing to practise feeling uncomfortable. The sentence has to be yours. A goal…

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.…

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…

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…

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…

To someone in grief, a short gentle word beats advice or fixing. Say something kind, and mean it.

You do not need to solve their loss. A soft, sincere word lands better than any counsel.

With someone grieving, offer your presence more than your words. Sit with them; let silence be enough.

You do not need the right thing to say. Being there, quietly and again and again, is the help.

If a treatment reliably produces strange sensations, describe them beforehand. Expected strangeness is far easier to sit through than strangeness that arrives unannounced.

With esketamine, feeling oddly detached from your body or the room is the drug doing what it does, not a sign of harm, and it usually clears within a…

Stimulants are not the only licensed route. Atomoxetine, guanfacine and clonidine all hold approval for attention difficulties, and they matter when a stimulant cannot be used.

They usually sit after stimulants rather than beside them, because the comparative evidence still favours stimulants overall. They come into their…

A heart tracing before starting a stimulant is not routinely needed. Some practices still ask for one anyway, and it can hold a child up for months.

What the guidance asks for is a careful history and an examination, with a tracing kept for children whose own or family history warrants it. An…

Licences start at six years old, and that number comes from how trials have to be run rather than from a safety finding. Younger children do get treated where the case is strong.

Trials need the child's own assent alongside a parent's consent, and assent means a form the child can read and understand, so studies stop where…

Rules about ADHD and military service move with recruiting needs. Send a family to a recruiter for the current position rather than answering from memory.

Every version has been seen: medication allowed, medication stopped before basic training, the diagnosis treated as disqualifying, the diagnosis…