Practices

Do not write off simply sitting with someone. When researchers looked into why dummy treatments helped, one of the things they kept finding was half an hour of a person's full attention.

Thirty minutes of someone listening properly to your difficulties is not filler around the real treatment. Across the talking therapies, who the…

A great many people are diagnosed and then left with a starting dose nobody ever revisited, no reading, no group, nothing else at all. If things have stalled, the first thing to check is whether the treatment was ever actually finished.

Optimising is unglamorous and often the quickest thing available. Was the dose ever adjusted upwards, and on what basis. Does the cover reach the…

If the prescriber, coach or therapist is not delivering much, say so and ask for someone else. Working around poor care quietly is the thing that convinces a couple this is simply as good as it gets.

A dose never revisited, or a therapist who has never worked with ADHD, sets a low ceiling. The trouble is that the ceiling gets read as the person:…

Think of ADHD as sitting at the centre of an onion. Poor sleep, sleep apnoea, low vitamin levels, allergy, ongoing pain, untreated anxiety or low mood all sit in layers around it, and each one makes the centre look worse than it is.

This explains something that otherwise looks strange: treatments that do nothing whatever for ADHD can still make a real difference, because they…

The most convincing programme for teenagers does the obvious thing. It runs at school, twice a week, so nobody has to be driven anywhere: homework systems, organisation, some social practice and sport, in the place where the trouble actually happens.

By the teenage years the leverage parents had is thinning, and a clinic appointment is the first thing to fall off the week. Putting the help inside…

When something feels unbearable to risk, follow it downwards. If that did happen, what would it mean, and what would happen after that?

Keep asking gently, and stop when you reach something that is a statement about the person rather than about the situation, such as it would prove I…

An exam is a task with requirements. It is not a ruling on whether you are capable, however much it feels like one while you are sitting inside it.

Saying that once changes very little. The person this comes from took a long time to arrive at it, and that is worth knowing so you do not expect it…

Some of the low, grey stretches are not depression. They are what happens when there has been nothing on the go for a while, and the colour comes back when a project starts.

It is a quieter thing than depression and it does not look like much from outside. Sleep is fine, you are still working, but the zest has gone out of…

There is a real difference between a person who will not start and a person who cannot get started, and with ADHD it is nearly always the second.

This matters most in how you speak to yourself, and in how the people near you speak to you. Refusal invites pressure and punishment, which reliably…

With ADHD the one dependable thing is that you are not dependable in the same way each day. A day when everything works and a day when nothing does can arrive with no reason you can find.

Say this out loud to the people who need to know, because the good days get held against you later, by them and by you. Plan around your average…

Anything that gives a quick lift, a bet, a purchase, speed, a risk taken late at night, pulls harder when your brain is short of reward. The workable move is not more willpower, it is putting friction between you and the thing.

Friction is a delay you build while you are calm: the card left at home, the app deleted, a rule that anything over a set amount waits until…

The same mistake costs far more when you have no money behind you. Legal trouble is not handed out evenly, and that sits on top of the earning difficulties ADHD already brings.

This is worth naming when somebody is carrying shame about a record: what happened was shaped by what they could afford at the time and not only by…

A lot of people with ADHD quietly believe they are not clever. Usually it comes from reading a page four times and taking nothing in, and concluding the obvious thing about themselves.

That belief does a great deal of damage. It keeps people out of courses and jobs they could do, and it makes them give up on any new strategy the…

Eating and body image are part of this for more people than you would think. Forgetting meals all day and then eating without stopping in the evening is a very ordinary ADHD pattern rather than a separate failing.

The useful move is usually to eat by the clock rather than by hunger, since the signal arrives late or not at all when you are absorbed. Put one…

If you have not been assessed because of money, waiting lists or simply getting to appointments, that is a barrier and not a lack of seriousness on your part.

The loop is unkind: the difficulties themselves make earning and organising harder, and that makes assessment and treatment harder to reach. Before…

Plenty of adults with ADHD grew up being called lazy, difficult or naughty, and some were punished in ways nobody would allow now. That history usually needs saying out loud, because it left a belief behind.

The belief tends to sound like: there is something wrong with me and people will find out. It shows up as bracing for criticism, or hearing an…

Making a child repeat a year rarely fixes what went wrong. The same lessons without different support tend to produce the same result, plus the sting of being the oldest in the room.

If a year has gone badly, the useful questions are what support was missing and whether something else, such as an unrecognised learning difficulty,…

Relationships take a lot of the strain here, and the usual shape is one person quietly carrying all the planning while the other feels constantly told off. Both halves are worth naming out loud before resentment sets hard.

The practical work is splitting the load by what each of you is actually good at rather than down the middle, and putting the shared admin somewhere…

If sport or a club is the reason a struggling student still turns up, do not let it be the first thing taken away when grades slip. Removing it usually removes what was holding the rest together.

Eligibility rules that cut a young person from the team below a certain average tend to take out the structure, the daily exercise, the one place…

Ask yourself two questions: how did I actually do, and what do I think I could have done. The gap between those two answers is real, and it is usually where the grief sits.

Most people can name that gap within seconds, which tells you they have been carrying it a long time without saying it. Writing both answers down…