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…

Once a week, both calendars open on the table. Who is doing scouts, who has football, what is happening on Thursday. Twice a week if the house is busy.

The point is finding the collisions while there is still time to sort them out, rather than at eight on Thursday morning with coats half on. Keep it…

If you keep it all in your head, it is worth asking who else is keeping it. Very often somebody nearby is doing the remembering, and neither of you has ever said so out loud.

This matters because from outside it looks like coping, right up until that person is away, unwell or worn out by it. Ask the plain question at home:…

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…

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,…

If someone close to you has become the person who chases you, that arrangement is wearing you both down, even on the days it works. It is worth naming out loud and changing on purpose.

Once a partner or a manager supplies all the pressure, nothing inside you ever needs to. They end up tired and resentful, you end up handled like a…

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…

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…

'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…

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…

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,…

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…

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…

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…

When someone reminds you often enough, things do get done. But the sense of time doing the work is theirs, which is why it all collapses the moment they stop.

Worth naming out loud in a household, because the reminding costs the relationship something and never builds the missing part. A better arrangement…

Coaching for adult ADHD comes down mostly to one thing: a standing appointment with somebody who will ask how it went. That sounds thin until you have tried keeping a plan alive entirely on your own.

A coach is not a therapist and does not need to be. They hold the horizon you keep losing and the fortnight that has quietly gone by, and they make…

ADHD reaches into a marriage in ways couples rarely say out loud: attention drifting during a conversation that mattered, or a partner who has started to feel like an unpaid manager. It is a fair thing to talk about and to get help with.

The hurt usually comes from what each of you concludes rather than from the behaviour itself. One reads distraction as not being loved, the other…