Practices

Where a relative has taken ADHD medication, take the details: who they are to your patient, what they were given, what it did, and what was tried and dropped. Then put it in the referral letter.

No blood test tells a prescriber where to start, so a brother's clear response to one drug, or a mother's bad reaction to another, is one of the few…

There is no box you type 'always late' into and get the answer out of. When a sensible strategy is not landing, the work is finding out what is blocking it rather than producing another strategy.

If you notice yourself handing over the fourth tool for the same problem, stop and ask a different kind of question. What happened the last time they…

When something did not get done, find out which half broke. Did they not know what to do or when? Or was the plan fine, and the moment for doing it came and went?

Ask for the last time it happened, hour by hour, up to the point where it did not happen. A planning failure needs somewhere reliable to catch tasks…

Awareness is knowing what needs doing and when. Motivation is doing it once you know. Nearly every app on the market solves the first one, which is why buying another one so rarely helps.

Test it with one question: at the moment it did not happen, did you know? If the answer is yes, the reminder was never the missing piece, and a…

A man who could not get himself to bed kept his bedtime alarm upstairs, where his wife and baby were sleeping. Switching it off meant climbing the stairs, and leaving it meant waking them. The walk to the alarm was the thing he was trying to do anyway.

That is the part worth copying. Put the cue somewhere that costs something to answer, and make answering it land you where you meant to be. Anything…

Carry the rough proportions into every ADHD assessment. Executive function difficulty in the great majority, coordination difficulty in around half, dyslexia in something like a quarter to two fifths. A workup that never asks about handwriting, sport or reading is not finished.

The behaviour problem you were called about is often the visible end of an unidentified reading or coordination difficulty. Ask what PE is like, what…

It runs the other way as well. Among children referred for dyslexia, a sizeable minority also have ADHD and many have coordination difficulties too. Whatever is written on the referral, treat it as one part of the picture.

Where the reading difficulty is severe, motor involvement is more likely to be there alongside it, which is why the first look should be wider than…

Dyspraxia and developmental coordination disorder are the same thing carrying different passports. Search only the American term and you will miss a large European literature on assessing and helping these children.

Search both, and try the older names while you are there. It matters most when you are looking for what actually helps, since much of the…

When a bright, talkative autistic child arrives looking mainly behavioural, look underneath for a coordination or reading difficulty. Once the first label is in place, whatever comes after tends to get filed under it and never assessed on its own.

Watch for the child who does well in conversation and badly on paper, or who is fine in class and miserable at PE. Those gaps are usually a second…

Keep the tasks short, a couple of minutes each, with results back the same day. A long test given to a child who cannot sustain attention measures how long they can last, not the thing you were trying to measure.

Brevity is not a convenience you are allowing yourself. It is what keeps the data honest, and it keeps the child willing for whatever you ask next.…

Choose the subtests that answer the question you were actually asked, and read whatever reports the family already has before adding anything of your own. Children arrive with thick folders, and they also arrive with nothing at all.

Where occupational therapy, speech and language or neuropsychology have already covered ground, do not cover it again for the sake of a complete…

When you explain executive function to parents and teachers, four words will do: attention, reasoning, speed, memory. Each one can be worked on, and four is a number people can still repeat at the school gate a week later.

The academic models have a dozen headings and nobody outside the field retains them. A short list gives parents something to hang observations on, so…

Ask about food two generations back. What the parents were like about it, what the grandparents were like, what the rules were at the table.

Much of how a person eats was learned long before anybody mentioned a diagnosis, and a fair amount of the shame around it was learned in the same…

The scales worth using are the ones that ask about situations rather than symptoms alone. Home, school, work, and what actually happens in each.

A questionnaire counting how often somebody loses their keys will label half the population. What a diagnosis needs is evidence that the difficulty…

Executive function scales ask how the week actually went. That is often more use than an afternoon of testing in a quiet room.

Office testing happens in the best conditions a person will ever meet: no interruptions, someone sitting with them, a clear finish line in sight.…

Ask about the family properly: parents, brothers and sisters, children, then aunts, uncles and grandparents. Include drinking and drug use, in them as well as in the person sitting with you.

This tends to be the highest yield few minutes of an assessment, because the condition runs strongly in families. Relatives who were never assessed…

The family history is not the warm up before the real assessment. Give it proper time and it will often tell you more than any single rating scale in the folder.

Walk through the family rather than asking one summary question about it. Who struggled at school, who could never sit through a meal, who changed…

Note who is a first degree relative and who is a second, instead of writing 'runs in the family'. Parents, children and siblings sit in one ring. Grandparents, aunts, uncles and cousins sit in the next.

A simple grid helps: names down the side, then relation, what they were like, what was ever diagnosed, what was ever treated. The picture comes out…

Ask whether anyone kept the old school reports. The same lines turn up generation after generation: not working to potential, talks too much, never has the right books with him.

They were written by teachers who had never heard of ADHD, about children nobody was going to assess, and that is exactly what makes them worth…

'I am disorganised' cannot be treated. 'The post piles up on the hall table until something ends up with a debt collector' can. Spend the time getting the problem down to something that specific.

Push for the particulars: which task, which moment, what was happening just before, what they did instead. Where you can, ask someone who was there…