Practices

Plenty of children on a stimulant are taking something else as well, most often an antidepressant. That second medicine is usually there for a second problem rather than for the attention itself.

It is a useful lens when a regimen has grown complicated. Ask what each item is for, and the list generally resolves into a treatment for the…

To find out whether treatment is helping, ask the people who live with the person. One parent who stopped her medication for a family holiday remembered a lovely trip, while her children remembered running it.

Two teenagers had packed for her, fetched what she forgot, and kept an eye on the airport clock. She had no idea any of it happened. There is no…

The old argument about medication against behaviour therapy was set down years ago. The useful question now is what each one covers.

They work by different routes and they reach different hours of the day, so putting them in a single contest was never going to tell anyone much.…

Adding psychosocial work to medication buys something extra, and less than people hope. The extra tends to arrive in the places medication was never going to reach.

Homework routines, the temperature of arguments at home, how a teacher speaks to a child, the hours after a dose has worn off: that is where the…

Doing the behavioural work alongside a medicine can mean managing on less of it. That matters most for the side effects that follow the size of the dose.

Appetite, sleep and irritability all tend to scale with how much is being taken. Where part of the load is carried by routines, by support at school,…

One question is worth asking before choosing between products: which part of the day actually goes wrong? Bead type capsules tend to give more early on, while the pump type keeps more back for the afternoon.

Two products can hold the same molecule and cover the same number of hours, and still fit one person and not another, because of where the strongest…

When appetite disappears at lunchtime, work with the child's rhythm instead of against it. Feed them properly at the hours they are actually hungry, which is usually breakfast and then the late afternoon and evening.

What counts over a week is the total, not whether it arrived at the socially correct hour. A decent breakfast before the medicine takes hold, a light…

Non-stimulants are usually tried after the stimulants rather than instead of them, mostly because they are harder to tolerate. That is about order, not about the drug being second rate.

There are people for whom one is the right first choice: tics, real anxiety alongside, a history that makes a stimulant a poor idea, or a body that…

If you learn one thing about how these medicines work, learn the junction between two nerve cells. Nearly every drug in this field acts at one of a handful of points in that small space.

It saves a great deal of memorising. Once you can picture a message being released, landing, and then being cleared away, most explanations turn out…

Mechanism is a moving thing, so it is easier to watch than to read. A university made animation of what happens at the junction will teach you more in ten minutes than a page of description.

Prefer something made by a university or a public body over whatever a search puts at the top, since much of what is written about these drugs is…

Once you can follow the sequence, release, landing, clearing away and breaking down, most new drugs turn out to be recombinations of those four. That is a fair claim to competence and a good place to stop.

Learning drug by drug never ends and never transfers. Learning the sequence means you can place something you have never heard of and ask a sensible…

Learn the family rather than the members. If you know roughly how one drug in a class behaves, you already know most of what the others will do.

The medicines people are most often on collapse into a handful of families. A new arrival is usually a variation inside one of them, and occasionally…

If you are not the one prescribing, you can still take an active part in the medication conversation. You see the person weekly and hold the ordinary detail their prescriber never gets to see.

Ask what they notice and write it down in their own words. With their permission, send the prescriber a short note that can be read in a minute: when…

A child who has spent years being told they are careless will often say yes to whoever finally seems glad of them. Work on how they see themselves is not a soft extra to the clinical work.

Count the corrections in a single day and it is easy to see what accumulates. By the time an offer comes from someone friendly, the pull is belonging…

Some people find they drive better in a manual, because there is always something to be done. Treat that as an experiment rather than a finding.

The reasoning is the same as a fidget toy or a standing desk. A little constant demand can keep an under-occupied system in the room instead of…

Blood pressure on a stimulant is an individual matter. For most people it is a non-event, and where it does rise the answer is often a different stimulant rather than none at all.

No blood test or cheek swab will tell you in advance which one suits you. Finding out means trying, measuring and being willing to change, which is…

When medication works, its best effect is often on everything else you were already trying. Coaching, exercise, a routine: each of them needs enough attention to get started, and attention is the thing in short supply.

That is why setting medication against the other approaches usually misses the point. The plan you could not keep last year may be perfectly keepable…

When you reach a goal, stop and let yourself register it before moving on to the next one. Otherwise you collect achievements and never feel any of them.

The pause can be tiny. Say out loud what you did, tell someone, sit with it for a minute, thank God for it. Racing straight on to the next target…

When you need to correct one person, say it to the room. Everyone gets the instruction and nobody gets the sting.

Good instructors do this without thinking: they see one child dropping their guard and say that everybody needs to keep their hands up. The teaching…

A silent room is not restful for everybody. If every cough and creaking knee pulls at you, ask for music or bring headphones with something plain in them.

Too little going on can be as unsettling as too much. A low steady sound covers the sudden little noises that keep snagging your attention. Some…