Practices

If stopping the ritual is out of reach for now, do it differently every time. Different order, different hand, different room, as long as it is never the same twice.

Compulsions take a lot of their grip from exactness, and disturbing the shape loosens that grip while you are still allowed to do the thing. It also…

Offer choices rather than instructions. With a problem that runs on control, being told what to do gives that control somewhere to dig in.

Two or three real options, the trade-offs said plainly, and then the pick is genuinely theirs. That holds for the big decisions too, like moving to a…

Neurofeedback rests on a tidy idea: in ADHD the slower theta rhythm shows up when the faster beta rhythm should be running, so the training rewards you for shifting the balance. Knowing the idea is worth a few minutes, because it is what the brochure is built on.

Electrodes sit on the scalp, a screen animates when the signal moves the wanted way, and the person practises staying in a state of relaxed…

Ask what happens after the course ends, not only what happens during it. A gain that fades once the sessions stop was probably never a change in the person.

Neurofeedback tends to look decent while it is being delivered and then drift back, and the studies that followed people afterwards did not find…

When a parent is set on something that will not hold, one honest story often lands better than a pile of studies. A family finished the better part of a year of neurofeedback and watched their child slide back to where he started within weeks.

Told plainly, with no note of triumph in it, a story like that raises durability without telling a parent they were foolish. They were not foolish.…

When you read that a treatment worked, look for who judged the improvement and whether they knew what the child had been given. In much of this literature, they knew.

The design to look for is a sham condition, where everybody goes through the same routine and only some receive the active ingredient, with the…

Brain training games make you better at the game. Sadly, that improvement tends to stay inside the game.

Sorting shapes faster or planning a conveyor belt more smoothly comes from learning the task, not from stretching a capacity, so the classroom and…

The fair test for anything offered alongside medication is whether it adds something on top. In one small imaging study, cognitive training added to a stimulant left inhibition no better than the stimulant on its own.

Add on designs are unkind to hopeful ideas, which is exactly why they are worth running. About twenty children took part, so this is one small piece…

Programmes built on tones through headphones and balance drills have not been shown to help ADHD. If a child does seem steadier during them, the likeliest reason is that something is occupying the part of them that goes looking for stimulation.

That effect is real enough, and it is cheap to get elsewhere. A walk, a job with the hands, background sound they choose themselves, all of it…

If someone has genuine positional vertigo, get it treated, and do not expect the treatment to touch their ADHD. Both things can be true at the same time.

Benign paroxysmal positional vertigo often follows a sinus infection or a bang to the head, and it responds well to repositioning manoeuvres that…

Several professional bodies came together to say that vision therapy is not a treatment for ADHD. A joint statement like that is unusual, and it is worth quoting to a family word for word.

Convergence problems, where the eyes struggle to work together on something close up, are a little more common in ADHD and deserve treating in their…

Saying that something does not work leaves a parent holding the same worry that sent them looking in the first place. Say what the time and money would buy instead, and put exercise at the top of the list.

The energy behind an unevidenced treatment is usually love with nowhere to go, and if it is not given somewhere to go it moves on to the next…

Sensory processing difficulties are real and worth accommodating, and they are not a standalone diagnosis. The proposal for one was turned down for lack of evidence that it stands apart from the conditions it appears with.

In practice it usually shows up alongside ADHD or autism, so it is best written up as a feature of the person: what they cannot tolerate, what they…

Ask which direction a person's sensory difficulty runs before offering anything. Someone who is under responsive needs more input and someone who is over responsive needs less, and the wrong one makes the day harder.

The under responsive child is the one climbing, chewing, pressing into things, hunting for sensation in order to feel settled. The over responsive…

Turn the socks inside out so the seam sits away from the toes, cut the label out and print the size onto the fabric instead, and look at seamless clothing. These cost pennies against a course of therapy and they work by teatime.

A scratchy seam or a stiff tag is a small thing that keeps announcing itself all day, and every announcement takes a piece of attention with it.…

Weight across the body settles a lot of people and sends some of them to sleep quickly. It is a preference though, not a remedy, and for others it feels like being closed in.

If you try it, watch what actually happens rather than what is supposed to happen. Some people have wanted pressure, small dark spaces and being…

Since 1994, supplements have not had to satisfy a regulator before going on sale. Nobody checked the bottle in your hand the way they check a prescription.

The gap is wider than most people expect. Drug factories get unannounced inspections and can be shut down on the spot; supplement makers do not face…

Natural is not a regulated word: anyone can print it next to a picture of a leaf, on anything at all. Organic in the USDA sense does have a legal definition sitting behind it.

The same goes for the reassuring line about following good manufacturing practices, which describes what a company aims at rather than what an…

Kava, valerian, St John's wort, ginkgo, ginseng and the proprietary blends have not shown benefit for ADHD in trials that matched the amount in every capsule and kept both the person handing them out and the person rating behaviour unaware of who got what.

Those two design details are most of the story. Ordinary use has dose wobble and expectation running through it, and expectation is powerful,…

Ask what someone takes that is not food, rather than asking what medications they are on. People do not file their supplements under drugs, so the usual question comes back empty.

There is a case worth carrying around for this. A liver transplant patient kept rejecting the organ, and it turned out he was quietly taking…