Practices

Four things carry most of the difference within the class: how much it sedates, how much it activates, what it does to weight, and what it does to sex.

Before anything is chosen, write down which of the four you cannot live with. Almost nobody is neutral about all four, and the one you will not…

Match the tablet to the person rather than to the diagnosis. For someone flattened and slowed who has said clearly that they will not accept sexual side effects, paroxetine is close to the worst choice available.

It is the most sedating in the class, the least activating, and carries a high risk of exactly the effect they ruled out, with weight gain and the…

If you are the therapist, hand the prescriber the profile and leave them the pick. What you hold that they do not is what this person is like across a week, and what they will absolutely not tolerate.

So write those two things down and send them: the presentation, in plain description rather than jargon, and the non-negotiables. Not a drug name.…

If a treatment reliably produces strange sensations, describe them beforehand. Expected strangeness is far easier to sit through than strangeness that arrives unannounced.

With esketamine, feeling oddly detached from your body or the room is the drug doing what it does, not a sign of harm, and it usually clears within a…

When a treatment is offered, it is fair to ask whether it is the licensed version or a use that sits outside the licence, and what monitoring comes with it.

Ketamine for depression is the live example. The doses used are far below anaesthetic ones, the nasal form has approval for treatment resistant…

Stimulants are not the only licensed route. Atomoxetine, guanfacine and clonidine all hold approval for attention difficulties, and they matter when a stimulant cannot be used.

They usually sit after stimulants rather than beside them, because the comparative evidence still favours stimulants overall. They come into their…

A heart tracing before starting a stimulant is not routinely needed. Some practices still ask for one anyway, and it can hold a child up for months.

What the guidance asks for is a careful history and an examination, with a tracing kept for children whose own or family history warrants it. An…

Licences start at six years old, and that number comes from how trials have to be run rather than from a safety finding. Younger children do get treated where the case is strong.

Trials need the child's own assent alongside a parent's consent, and assent means a form the child can read and understand, so studies stop where…

Rules about ADHD and military service move with recruiting needs. Send a family to a recruiter for the current position rather than answering from memory.

Every version has been seen: medication allowed, medication stopped before basic training, the diagnosis treated as disqualifying, the diagnosis…

There are three families of medicine here: the stimulants, the agents that work on noradrenaline alone, and the alpha-2 drugs that began as blood pressure treatments. Three routes rather than three brands of one thing.

That matters when one of them does not work or cannot be used. A poor response inside one family says little about the others, so a sequence has…

Before you decide a club is out of reach, ask. Some let children earn the uniform through the levels, and plenty have quiet arrangements for families who need them.

Cost keeps more children out of these things than lack of interest does. A single phone call is worth making, and the answer is often better than the…

Before committing to a course that runs into thousands, set the same money next to the other things it could buy. Tutoring, a proper assessment, a medication review and a well tested psychosocial programme all sit in the same envelope.

Neurofeedback courses often run for a month or more, insurers rarely pay, and the training of whoever delivers it varies a great deal. The cost is…

Regulators let devices through by several different routes, and only some of them mean what a family assumes. A game cleared for further investigation has not passed the bar a medicine passes.

The word approval carries an authority that advertising borrows freely, and device pathways are shorter and lighter than the ones drugs travel. It is…

Almost everyone says the same thing afterwards, that the waiting was worse than the thing itself. Say it out loud in your own words, because your own words land differently from anyone else's reassurance.

Before a difficult conversation, write one line about how bad you expect it to be. Afterwards, write one line about how it actually went. Over a few…

Let one trustworthy person in slowly. Trust is rebuilt in small, safe steps, not all at once.

You do not owe everyone access, and you do not have to stay walled off forever. One safe person, by degrees.

Ask everybody, at the start, what they use and how it goes for them there. Not only the ones who arrive with an obvious phone problem.

Two questions do most of the work: which platforms are you on, and what is it like for you on them. Asked early, without any warning tone, it makes…

Before sending anyone for hands on work, ask what touch has meant in their life. A massage table is a poor place to discover that touch brings something back.

The person delivering it is not there to hold what surfaces, and often has no training for it. So ask directly, ask about what parts of the body are…

When a treatment is described as approved, ask what it is approved for. Magnetic brain stimulation is licensed for depression, and using it for attention problems is off label.

Off label is not the same as forbidden or useless, and it does change three things: how much evidence stands behind it for your situation, what the…

The same treatment in two different clinics can go two different ways, and the difference is often the people. Kind, unhurried staff who explain things get better results.

So when you refer someone, or choose somewhere yourself, ask about that as well as the equipment. Do they remember your name, do they answer…

Telling someone what a treatment will actually be like improves how they respond to it. What it feels like, how long, what is normal afterwards.

Uncertainty makes everything sharper, so filling it in with plain description takes some of the edge off before anything starts. Do not oversell it…