Focus, starting, and ADHD

Say the plan out loud to somebody. A manager, a colleague, your wife, a coach. Hearing yourself explain it does something that turning it over privately does not.

The listener does not need to be an expert in any of it. Talking forces you to put things in order, and the gaps tend to announce themselves halfway…

Difficult things come out more easily when your hands are occupied and you are not looking straight at the other person. Walk side by side, drive somewhere, wash up together, keep the sewing going.

If you are the one listening, offer it first. Most people assume that picking something up would look rude or half interested, so they sit still and…

Support does not have to stop at eighteen. Plan for it to thin out gradually through the twenties, at a level everyone has agreed rather than one that gets argued over every month.

A workable version names three things: what is still being helped with, how much, and when you will look at it again. Every six months is usually…

Some things only happen when another person is there, even if they are doing something entirely different. Ring a friend and clean your two kitchens together with the phone on the counter.

This works for studying, tidying, paperwork and the weekly shop, because what you are borrowing is presence rather than help. Agree a start time and…

A behaviour agreement needs six things in it: the goal, exactly what the child does, what they earn, what happens if they do not, signatures from everyone, and an adult who sticks to it.

Most of these fall apart over what was meant rather than over what was done, so write the specifics down to the level of what counts as finished. The…

Work the deal out with the child instead of handing it to them. Much the same rules, an entirely different feeling.

Let them argue for a bit longer on the console, or for Friday off, and give ground where you honestly can. The terms tend to land in roughly the same…

Instead of stopping the worry, follow it all the way to the end. And then what happens. And then what. At each step, ask whether you could bear that.

Most catastrophes stop being catastrophes somewhere along the chain, and the place where you say no, I could not bear that, is the useful discovery.…

One sign that the heat has come off a little: you can hold I am furious with you and you probably did not mean it in the same moment, without dropping either one.

In the middle of an argument that second thought is simply not available, and its absence is not a failure of character. It comes back as the arousal…

Some people are done with an argument in ten minutes. If the person you live with needs three hours, your quick recovery can look to them like proof that you never cared.

Say the mismatch out loud when things are calm, so that it is understood before the next row rather than argued about during it. If you are the fast…

Saying I need a break only works if you have agreed beforehand what a break means. How long it lasts, what the other person does meanwhile, and when the two of you come back to it.

Settle it on a calm evening. Twenty minutes, no following, no messages in between, and we sit back down at nine. Then keep the return time exactly,…

Before treating something as your failure to get going, check whether you ever agreed it was yours. A job that bothers one person and genuinely does not bother the other has not been agreed by anybody.

That turns a stuck task back into a conversation, which is where it belongs. Say plainly that the unpainted wall does not trouble you, ask what it…

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…

Ask for the most frightening moment of their life, then the next one down, then the next, until there is a scale running from one to a hundred. You get the ladder you needed, and they get something they did not expect: fear comes in sizes.

Do it slowly and write it in their words rather than yours. Most people arrive believing anxiety is one solid block that either has hold of them or…

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…

If someone is about to send off a saliva kit to fill in the family history they never had, have a conversation first. These tests hand back more than health information, and they hand it back with nobody in the room.

A father who is not the father, a sibling nobody mentioned, a donor conception no one planned to explain: these arrive by email on an ordinary…

'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…

Run the assessment yourself and watch while they work. Under real effort you will see the small movements, the tics and the overflow that never appear in ordinary conversation, and none of it reaches you if a technician or an app does the testing.

Sit where you can see hands and face. Note what happens as the task gets harder: the tongue that comes out, the leg that starts going, the free hand…

Phonological awareness is not one skill. Telling sounds apart, rhyming, breaking a word into its sounds and blending them back are separate jobs, and a child can be fine at one and stuck at another.

Before agreeing that a child needs phonics, find out which piece is missing. Ask them to say the sounds in cat, then to join up sounds you give them,…

A display organised by sound rather than by alphabet gives a child more to hold on to. Let them feel where each sound is made, lips, tongue, teeth, and match that to the letters that spell it.

Reading is learned from speech towards print, so a border running A, B, C tells a child very little about what they are actually doing. Grouping by…

Before drilling number facts, check whether the child has any feel for how much a number is. Which pile is bigger, is eight nearer to ten or to two, give me three of those.

A child with no sense of quantity can still learn to recite that seven and eight make fifteen, and it will be a string of sounds attached to nothing.…

Build numbers and break them up again. Seven is five and two, and also six and one, and a child who can see that has the thing mental arithmetic is made of.

Blocks, buttons, coins, anything you can push into two piles and back together. Ask which numbers fit inside other numbers and let the child show you…

Patterns sit underneath both reading and arithmetic. Blue, red, green, blue, red, green: making a sequence, copying it, then breaking it on purpose builds the ordering that words and numbers both run on.

Use blocks, beads, claps, a drum, anything with an order to it. Ask the child to make the same pattern, then to spoil it deliberately and tell you…

Find something the child already loves, a team, an orchestra, a game, and lay their results over it. These players are strong, these ones need coaching, and none of it means the team is no good.

Feedback lands very differently when the low scores are players who need training rather than facts about who someone is. Do it with their own…

In practice, you sometimes have to stop a child using the trick that has kept them afloat, so the weaker skill finally gets used. Expect them to hate it for a while.

If memorising is doing the work, the part that should be doing it never gets a turn. So build short pieces of practice where the workaround is simply…

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,…

Medication treats the attention difficulty. It does not teach reading, lift a depression, or repair a household that has been fighting for years.

Those things need treatment of their own, and they are often what the family actually came about. Treating the attention difficulty well can stop…

Smoking runs high in ADHD, and nicotine genuinely does something for attention. It helps to treat that as self-medication rather than as one more impulsive habit.

It changes what a conversation about stopping looks like. If a cigarette is doing a job, taking it away and leaving the job undone is a plan that…

Stopping medication rises sharply in the early teenage years. If that is where you are, it helps to know this is the usual pattern rather than a sign that something has gone wrong with your child.

The pull is understandable: wanting to be in charge of your own body, hating being the one who is different, and a parent no longer standing over the…

When a medicine seems to be underperforming, look at what else is in the room before reaching for a higher dose. Anxiety, low mood and a wrecked sleep pattern can each blunt a good response or imitate a poor one.

Otherwise the dose climbs while the real driver goes untreated, and the side effects arrive without the benefit. Ask what a bad night actually looks…

Headsets have become cheap enough to sit in an ordinary consulting room, and the use with the best backing is graded exposure. You can set the intensity exactly and repeat it as often as the person needs.

The value is in the control. A feared situation can be dialled up in small steps, run again the moment it stops being frightening, and ended without…

With some sensory routines, the part doing the work may be a parent's steady hands and full attention rather than the technique itself. Worth knowing, because contact carries into the rest of the day and a protocol does not.

Views differ on this and the research has not sorted it out. What follows practically is that a family who cannot keep the exact routine going has…

The more one person checks up, the more the other hides, and the more they hide the more the checking looks justified. Both are responding reasonably to the last move and nobody is having a good time.

Getting out of it usually means the monitoring comes down first, which feels like the wrong direction to whoever is doing the monitoring. A workable…

Ask your child to show you their feed and explain it to you. You are asking to be taught rather than to inspect, and from the other side those feel nothing like each other.

Something shifts when the young person is the one who knows more. They slow down, they explain who these people are, they tell you which bits are…