Practices

For most people who get as far as asking for help with ADHD, medication is the single change that shifts the most. It is not compulsory and plenty live well without it, and it does deserve an honest look rather than a place at the back of the queue.

The reason is unglamorous. Nearly every strategy anyone teaches assumes you can pause before responding, hold a plan in mind while doing something…

Finding the dose is a search rather than a calculation. It goes up in small steps until either the effect you want turns up, or the side effects get annoying enough that you come back down a step and settle there.

There is no way to work the right dose out from body weight or from how bad things look, which surprises people who expect medicine to be more exact…

One of the founding figures of biological psychiatry summed the whole business up as some medicine helping some people at some doses some of the time. Knowing that before you start makes the first disappointment much easier to survive.

Most people need more than one adjustment: the dose, then the timing, sometimes the drug itself. Go in expecting the first prescription to be the…

Use a timer you can see rather than a warning you have to remember. A dial that shrinks, or a light that goes from green to red, does the work that five more minutes never quite does.

Time is not something everyone feels passing. Turning it into something you can look at moves the job from guessing to seeing, which is much easier.…

One minute of moving between tasks. Star jumps, a lap of the corridor, anything that gets the blood going before you sit down to the next thing.

Classrooms that do this report smoother changeovers and better recall of whatever was just taught. The same trick works at a desk: end one job, move…

Do not stop dead. Give the end of anything energetic a few minutes of winding down, so the change of gear is a routine rather than a demand.

Stopping is a transition, and transitions are where things fall apart for a lot of people. A short unwinding phase, the same one every time, takes…

Move just before the difficult task, not after it as a reward. Five minutes of skipping, stairs or running on the spot, then sit down to the thing.

The window straight after moving is when focus is at its best, so that is the bit worth spending on whatever you have been dreading. For a child,…

If every step you try keeps not working, however small you make it, that is information rather than failure. A more intensive programme is the next thing to look at, and it should be put to you as an option.

The whole point of shrinking the steps is to find one that moves. When nothing moves at any size, staying in the same weekly arrangement out of…

The strengthened warning on this class covers misuse, addiction, physical dependence and withdrawal. The part most people miss is that dependence builds with ordinary correct use over weeks, with nobody doing anything wrong.

That distinction needs handling gently, because patients hear dependence and hear addict. Physical dependence is the body settling around something…

For most of childhood somebody else held the diary. Parents remember the dentist, the kit, the letter that needs signing, and then one day nobody is doing that for you and the whole job is yours.

This is often why someone who managed well enough at school comes apart in their twenties. Nothing got worse. The scaffolding came down, and the…

One man with ADHD described the goal as no longer suffering from it, only having it. The diagnosis had not changed. What it cost him had.

Half of that shift comes from removing particular sources of pain: the job that was never going to work, the arrangement at home that left everything…

Most children with ADHD grow into adults with ADHD. Some of it settles as the brain finishes developing into your late twenties, and adult life gives you more say over how your days are arranged, but the underlying difficulty tends to stay.

This is worth knowing because much of the improvement people do get comes from arranging things to suit themselves: the job that fits, the hours that…

Instead of one warning, give several: half an hour, fifteen minutes, five, one. The child then has time to arrive at the ending rather than having it dropped on them.

A single warning asks a child to track the gap on their own, which is the thing they cannot do. A ladder of prompts turns a stretch of time into a…

Look back over your own history for the times you were knocked down and started something anyway. That pattern is common with ADHD, and it is easy to miss while you are busy counting the failures.

It may be a side effect of not weighting the future heavily. The past does not press down quite as hard either. People who have been sacked, dropped…

Walking away from a course or a job that was never going to fit can be the sensible move rather than a failure of nerve. It is also frightening, particularly when other people are paying for it.

Fit does more work here than effort does. The person who cannot survive a rigid nine to five in an open plan office may be excellent somewhere with…

Some people book their first assessment on the day they turn eighteen, because it is the first day they can consent without a parent. If you have been waiting like that, the waiting was not laziness.

Where a family or a community treats mental health care as shameful, a young person can spend a decade struggling with nobody's permission to ask for…

Moving between lessons is where things fall apart, so plan the move out loud before it happens. What to bring, where to go, and who will be waiting.

Before the child leaves maths, walk them through what comes with them and tell them to check in with the next teacher on arrival. That teacher greets…

The best ending is often that therapy stops and the practices carry on. People finish their sessions and keep the yoga, the bodywork, the acupressure, the sitting quietly.

It is worth building towards that from early on rather than at the end. If everything that settles you happens in one room with one person, then…

These medicines work on a timescale of four to six weeks, not days. Say the number out loud at the start, because someone expecting relief this week will have decided by Friday that it failed.

Something does happen on the first day, but it is only the first step of a change that takes weeks to finish. The useful version of this is a date:…

Describe what the first fortnight might feel like before the first tablet, not after the first worried phone call. A warning given in advance turns a bad week into a milestone.

The wording can be plain. Some people feel more wound up for the first week or ten days, it usually passes, and nobody changes anything without…