Practices

Invent words together. Say a made up word, pull it apart into its sounds, put it back, then take one sound out and hear what is left. The nonsense is the point, because there is nothing for memory to fall back on.

With a real word, a child who cannot work with sounds can often get by on memory, and you learn nothing about what they can actually do. A made up…

Plenty of children read the equals sign as put the answer here. Write it the other way round sometimes, eight equals three plus five, so they meet the idea that both sides are simply the same amount.

Move the sign about. Leave the gap in the middle, four plus something equals two plus five, and watch what the child does with it. If they add…

The word one does several jobs at once: a digit, a number, a single object, a whole set. A child who has not sorted those out will put figures in the wrong columns and later read a third as a number instead of a part of something.

When digits land in the wrong place, check whether the child knows what is being counted before calling it carelessness. Say the unit out loud: one…

A child who talks well, listens well and seems bright will have their reading failure read as laziness. The strengths are exactly what makes the blame stick.

Strong spoken language, decent attention and an easy manner give an impression of capability that nobody can square with work coming back unfinished.…

When the usual route into reading or arithmetic does not form, children build another one, and it nearly always runs through memory. It works for years, and it costs far more effort than anyone watching realises.

This is the bright child who is somehow always tired, always slow with written work, quietly memorising what everyone else is working out. The route…

In most children attention and memory sit at roughly the same level. When memory is far ahead of everything around it, ask what it has been quietly making up for.

Only fair attention with an unusually strong working memory is a signal rather than a strength to celebrate. The memory is carrying something. Look…

Ask someone to repeat a made up word and memory cannot rescue them. That is exactly why this small task keeps finding difficulties a clever, well practised person hides everywhere else.

Real words can be recalled, and a strong memory will lift a score without the skill underneath being there at all. A word that has never existed…

Under every complaint or hard feeling there is a longing. Listen for the wish underneath.

Behind the anger or sadness is a desire. Find the longing and you find what they actually need.

Do not stay hidden. Tell your partner about your day, your worries, your inner world.

Hiding your reality to protect them keeps you strangers. Let them know you.

The chemistry story runs backwards from how it is usually told. Nobody found a low chemical and then built a drug. They noticed what certain drugs did to mood and reasoned back to what must have been missing.

Reserpine emptied out the monoamines and people became depressed. Iproniazid and imipramine raised them and mood lifted. Out of that came the account…

Depression is not one thing with one address. Fatigue, blank concentration, lost libido and the loss of pleasure do not all come from the same place, so it helps to name which one you most want moved.

This is why two people with the same diagnosis get offered different tablets. A flat, pleasureless presentation points one way, a fatigued and achey…

Ask why the tablets take weeks. That one question sorts the honest accounts of how they work from the tidy story about a chemical being low.

Four competing versions sit under the same umbrella: too little released, reuptake running too hard, too much broken down, or receptors that need an…

Nearly all of them do the one thing: keep a monoamine hanging about in the synapse for longer. So when you hear that some other tablet is stronger, be a little sceptical.

Head to head, the differences in how much they lift mood are modest. Where they really differ is in everything else they do to you, and in how well…

SSRIs became the default for four reasons, and being more effective is not among them. They are easier to tolerate, taken once a day, far safer in overdose, and cheap as generics.

Tricyclics match them for lifting mood and are dangerous in overdose because of what they do to the heart. MAOIs carry food and drug interactions…

The standing side-effect list is sexual difficulty, less appetite, an unsettled stomach, disturbed sleep and headache. Sexual side effects are common, and almost nobody raises them unprompted.

So ask directly, and ask about sleep while you are there. People do not usually announce these things. They quietly stop taking the tablet and say…

One person's side effect is another person's treatment. Sedation is a burden for someone who cannot get out of bed and a gift for someone who cannot get to sleep.

Read the comparison charts that way and they stop being lists of harms. They turn into a set of levers: this one settles, this one gets you moving,…

Two rough shapes of low mood are worth telling apart: the irritable, restless, crabby kind, and the flattened, heavy, nothing matters kind.

They ask for different things. The agitated version often tolerates and even welcomes something sedating, while the flattened version needs whatever…

A genetic test can tell you how quickly your body clears a medicine. It cannot tell you whether that medicine will lift your mood, and it helps to keep those two questions apart.

Where these panels earn their place is in dosing and tolerability. Someone who breaks a drug down slowly may need less of it, and someone who clears…

Some newer antidepressants do two jobs in a single tablet: the familiar one of keeping serotonin available, plus a direct nudge at the receiving end.

This is worth knowing because it explains what a person actually feels. A drug with a second action brings a second set of effects, wanted and…

No option comes without a cost. The useful question is not which medicine has side effects, it is which side effects you could live with.

One drug may unsettle your stomach for a fortnight and leave your sex life alone. Another may be kind to the stomach and flatten desire for as long…