Focus, starting, and ADHD

Someone who will tell you the part that was not good is someone whose 'that was fine' you can believe. That is what settles the doubt, not reassurance.

Blanket praise carries no information, so it slides off and the doubt is back within the hour. If you tend to worry about how you came across, ask…

With attention difficulties the organising side often runs a few years behind the birthday. A nineteen year old may be running life more like a sixteen year old, and that is a lag rather than a verdict.

Set expectations against where someone actually is instead of what year they were born in. That way the support that felt normal at school does not…

A young person hears the fear in a house even when nobody says anything. If the adults are frightened about their future, they usually take that fear as a verdict on themselves.

If you are the worried parent, you do not have to perform calm. It works better to say the true version out loud: I am anxious about this, the…

Not knowing how to do an ordinary thing, a bank transfer, a form, a phone call to book something, says nothing about your intelligence. It says nobody ever sat down and showed you.

These gaps hide well, because they embarrass people in a way that larger problems somehow do not. Someone can talk fluently about difficult ideas and…

The next step has to be theirs. A job that looks like nothing to you might be the first thing in two years they chose without being pushed, and that is exactly why it holds.

Parents tend to want the step that recovers the lost ground. The young person needs the step they can actually take on Monday. Shifts in a shop, one…

When someone has shut down, pressure to get moving usually pushes them further in. Safety first and activity afterwards, even when the whole household is desperate for a sign of life.

Safety here is ordinary and physical. Food that turns up without being asked for. A room nobody is inspecting. Conversation that is not a progress…

A wave across the road, a joke with the man in the shop, asking someone how they are and meaning it. These unplanned seconds count for more than they look like they should.

They are also the easiest place to start when arranging a proper meet up feels like too much. Almost nothing is at stake in a greeting, so a fear of…

If rating a feeling out of ten means nothing to you, use something that does. Colour in bubbles, point at a picture, hold your hands apart to show how big it is today.

This began as an adaptation for children, swapping the numbered anxiety ladder for bubbles to colour in, and it is just as useful for anyone who goes…

When someone has gone flat, the question is not what they ought to be doing. It is what still has any life in it for them, however small or unimpressive, and then how to get more of that.

Activities handed out from the outside do not lift much. Someone who brightens talking about their car, or a cousin, or a game has just given you the…

When somebody looks like they have stopped caring, it is often that they have stopped expecting it to go well. Giving up on yourself tends to come after a long run of trying and being told it was not enough.

That changes what helps. Another plan, another chart, another talk about wasted potential all land on the wrong problem. What shifts things is a…

Some of what looks like muddle is the system's fault. Our tenth month is named for eight, because two months were added later and nobody renamed the rest.

Worth saying to anyone who feels stupid about dates and forms. A calendar whose numbers are out of step, a tax year starting in April, forms asking…

Waking your child at six to give the tablet so it has taken hold by breakfast, then letting them fall back to sleep, is not a strange thing you invented because you are failing. It is a reasonable answer to a real gap in how the medicine works.

Families quietly carry a lot of these. The early alarm, the switch to a faster product, the parent who does the whole morning alone because it goes…

Doing badly on one long acting product does not mean the medicine inside it was wrong for you. The same molecule in a different capsule can behave differently enough to be worth trying before anyone gives up on it.

What gets described as the medicine not working is often the shape of the day being wrong: too slow to start, too abrupt at the end, strongest at the…

People usually stop for one of three reasons: the side effects are not worth it, the price is too high, or the dose was never raised far enough to do anything. The last one is the saddest, because it makes a workable medicine look useless.

If a trial ended with the words nothing happened, it is worth going back over what dose was actually reached and for how long it was held there. A…

Before anyone concludes that medication does not work for you, check what dose was actually reached. Doses in general practice often stay lower than a specialist would use, and a fair share of so called non responders respond once the dose goes up.

You are allowed to ask this, gently and without any accusation in it: what was the highest dose tried, and how long did it stay there? A trial that…

If one family of stimulant did nothing, or felt awful, that tells you very little about the other. Methylphenidate and amphetamine work in overlapping but different ways, and plenty of people who do badly on one do well on the other.

Stopping after a single class is one of the commonest routes to believing that nothing helps. Trying the second one is a normal next step rather than…

For someone who cannot swallow tablets, or whose mornings fall apart long before the tablet gets taken, patches exist that release medicine slowly through the skin over hours.

Going through the skin skips the first pass through the liver and smooths out the peak, which changes the timing and sometimes how well it is…

Treat the first fortnight as a stretch that needs contact rather than silence. Say plainly that things may feel worse before they feel better, and arrange to hear from the person during that window instead of after it.

This is when most people quietly stop. Somebody who has been warned experiences a rough two weeks as expected; somebody who has not experiences it as…

Most people who try do find something that helps, but often not the first thing they try. Not responding to one class of stimulant says surprisingly little about the other.

The high response figures you may have read come from people who worked through more than one option, not from one prescription going well. Response…

Keep something to eat and drink within reach for hard conversations. Handing someone a biscuit and a glass of water often settles a room faster than any instruction does.

Part of why it works is that nobody has to be told how. A person too wound up to follow a breathing exercise can still take a sip and chew. Sharing…

You can mean something completely, drive most of the way there with it in your head, and still turn left instead of right. Meaning it and doing it are two separate events, and only one of them is visible to anyone else.

To a partner, the missed errand looks like a verdict on where they come in your order of things. It helps to say out loud, at a calm moment rather…

Saying it is done when it is not is a common next step, and it makes more sense than it looks. The lie is rarely about the parcel, it is a way out of the look on somebody's face.

It also makes everything worse, because being found out turns a forgotten task into a trust problem, and that is a much longer repair. If this is…

You will still forget things. What decides how much damage a missed task does is usually the ten minutes after you notice, not the miss itself.

Two moves reliably make it worse: sinking into shame until you cannot look at the person, and defending yourself as though nothing had been dropped.…

Some of what circulates makes being unwell look good. Drugs filmed like a party, low mood styled into something delicate and photogenic, until the illness starts to feel like a personality.

This is worth spotting because of what it does to recovery. If sadness has become part of how someone is known, getting better means losing something…

Real footage of people dying circulates without any warning, sometimes buried inside a video that starts off looking harmless. Young people rarely raise this themselves, so it is worth asking.

Ask plainly what they have come across that they wish they had not seen, and how often it happens. There is no preparation before it and nothing…

The quietest damage comes from a young person deciding that feeling like this is simply how it is, because everyone around them feels it too.

Once distress counts as ordinary it stops being reported. Nobody mentions it at home, nobody brings it to an appointment, and years can pass with…

Nobody gets far taking the drink away without asking what the drinking was for. It is the same here. Find out what the scrolling is doing for someone before you start subtracting hours.

It is doing something, or it would not have lasted this long. Company at one in the morning. A way to stop thinking. Somewhere they are good at…

Asked what all the scrolling had done to her most, one young woman did not say sad. She said angry, more or less all the time.

Constant irritability in a teenager usually gets worked up as depression or ADHD, and sometimes that is right. Saturation belongs on the list too,…

People rarely stop at you are late. They move on to what sort of person is late, and then it is about respect and reliability rather than about time. You have probably taken that account on board yourself.

Naming the jump out loud helps, at home and at work: this is a difficulty with timing, here is what I am putting in place, and it is not a comment on…

Put the rules up on the wall where everyone can see them, and put the child's own version on a card on their desk.

A rule that lives only in memory is not there in the second it is needed, which is the second something more interesting has just walked past. A card…

The teenager with ADHD is often the one who admits it while everyone else produces a story. That is not worse judgement about right and wrong, it is less thinking ahead about how it will land.

Parents can read a caution or a suspension as proof of a moral problem, when the honesty in the room points the other way. Instead of a lecture,…