Focus, starting, and ADHD

If you are being assessed for attention, say something about your mood and your worry as well, even if nobody asks.

Anxiety and low mood sit alongside ADHD often enough that a thorough assessment will go looking for them anyway. But shame is quiet, and years of…

Some people simply cannot get a family history. Refugee journeys, destroyed records, closed adoptions, families that did not survive. That is a gap in the paperwork and not evidence against the diagnosis.

Say so out loud, and write it in the notes as a gap rather than as a negative finding, so the next person reading does not mistake silence for an…

One man put his lamps on a timer so the room would go dark at eleven and send him to bed. It worked for a few nights. Then he simply carried on in the dark. A cue can tell you the time. It cannot make you stand up.

Worth remembering before you build anything clever. If the pull of whatever a person is already doing is stronger than the nudge you have designed,…

'I set a reminder and still did not do it' is not a story about a bad reminder. It tells you the missing piece was never information, and a bigger, louder version of the same thing will fail in the same way.

The reflex is to escalate: three alarms, a different app, an entire new system built on Sunday night. What is needed is a change of kind, something…

An ADHD diagnosis usually arrives with two extra words attached: which presentation it is, and how severe. Both are descriptions of what gets in your way, not a grade you were awarded.

Inattentive, hyperactive and impulsive, or the two together, and then mild, moderate or severe. Mild means you met the threshold and the effect on…

The age by which symptoms have to have shown up is a number people agreed on, not a line in nature. It moved from seven to twelve when the manual was revised.

That matters if you are an adult wondering whether you would even qualify. The old cut-off was itself a compromise between studies pointing in…

Teenage memories of this often come with a sting: the year you worked out how much longer everything took you than it seemed to take everybody else.

That is usually why adolescence is the period people can describe in detail. The work got harder, the scaffolding of primary school fell away, and…

Hyperactivity and impulsiveness almost never turn up alone. When restlessness appears with no attention difficulty beside it, that is a reason to ask what else might be going on.

In practice the two run together, and over the years the visible restlessness tends to settle while the attention side stays. So a picture that is…

You do not need clinical language at an assessment. Some of the wording in the manual came straight from how families described it in the first place.

Phrases about being permanently on the go are in there because people kept saying them. So use yours: that your head is like a browser with forty…

The diagnostic manual is a document people sat in rooms and argued over. That is no reason to dismiss it, and it is a good reason not to treat it as the last word on you.

Committees weigh how reliably clinicians can agree on a criterion, what the field trials show, what a particular wording will do out in the world.…

There is a difference between low mood you have carried all your life and low mood that grew out of years of working twice as hard for half the result. Both are real, and they need treating in a different order.

If the second describes you, the picture often lifts a fair way once the attention difficulties are being managed and the daily experience of falling…

The checklists were built around the loud version of this, and girls are more often the quiet version. If she is struggling and nobody has ever suggested an assessment, that is worth pressing on.

Defiance in girls can look like refusal, withdrawal or a long-running argument about friendships rather than the disruption a teacher would report.…

Not all distraction comes from outside. Some of it is a thought that will not leave, circling while you read the same paragraph four times.

That difference matters at an assessment. Being pulled away by everything in the room, and being held in place by an intrusive thought you cannot put…

Most autistic people also meet the criteria for ADHD. The other direction is much thinner: only a small minority of people with ADHD meet the criteria for autism.

That is mostly arithmetic rather than mystery. ADHD is the more common of the two, so one overlap looks large from one side and small from the other.…

Autism and ADHD share some surface features and are still two different things. The social difficulty in each arrives by a different road.

With ADHD it tends to be impulsiveness and missing what was going on: the interruption, the thing said too fast, the friend never rung back. With…

Eating that runs away from you, and eating you cannot stop once it has started, turn up alongside ADHD more than people expect. Usually it is doing a job rather than proving a weakness.

The pattern leans towards bingeing rather than restricting, which fits: it belongs with the difficulty of stopping something already in motion. Often…

Trouble with eating, and with how your body looks, gets missed far more often in men. The questionnaires and the expectations behind them were built around women.

In men it runs more towards size and muscle than towards thinness, and towards fixing on one part of the body that everybody else says looks…

Very sweet, very salty, very fatty food acts on the reward system in a way that has more in common with a drug than with dinner. Reaching for it when you are flat is self-medication, not greed.

Knowing that changes what you do about it. Counting calories and resolving to try harder both aim at willpower, which was never the mechanism in the…

With gambling machines the pull may be the lights and the noise as much as the chance of winning. That changes what you actually need to stay away from.

If the sensory buzz is doing the work, the triggers are not only the betting shop. They are the phone games built with the same flashing and chiming,…

A reward that comes every time is easy to walk away from. A reward that turns up unpredictably is the one you cannot put down, and that is exactly how your phone is built.

Sometimes there is something good in the notifications and usually there is not, and it is that uncertainty which keeps you checking. Willpower is…

When you read that some proportion of people with ADHD have a particular problem, the number tells you nothing until you know the figure for everybody else.

Twenty percent sounds alarming until you learn what the rate is in the general population. What matters is the multiple, how many times more likely,…

Check the licensing before assuming you cannot afford a good instrument. Some come with permission to photocopy once you have bought the manual.

That detail matters most to the clinicians least likely to have a budget, which usually means the services seeing the families with fewest options. A…

There is more than one decent instrument, and which you use often comes down to what you were trained on. If you have never used one, say so rather than having a view about it.

Several rating scales are in wide circulation for children and for adults, validated by different groups for slightly different purposes. Picking one…

The manual now asks for signs by age twelve rather than age seven, and it added wording that fits adult life, including restlessness felt on the inside.

The older cut-off quietly excluded a familiar group: bright children, or well supported ones, who managed until the demands rose and only visibly…

Nearly everything on the ADHD list can show up inside a bipolar presentation, and the reverse is not true. So the shared features settle nothing, and the distinctly manic ones carry all the weight.

Put your attention on episodic elevation, grandiosity and a genuinely reduced need for sleep. Those do not belong to ADHD on its own, so they tell…

How an outburst ends tells you more than how it starts. Give an ADHD storm some room and it often burns itself out. The rage that runs for an hour with the lights out behind the eyes is a different animal, and so is the child who genuinely does not mind what you take away.

Ask the parents to walk you through the last three. What set it off, how long it ran, what stopped it, what the child was like an hour afterwards.…

When someone cannot let go of the old rule after the rules have changed, that is the same machinery that loses their keys and drops the thread of a sentence. Stuck, not stubborn.

It shows up in small places. The game changes and they argue for the old version. The usual road is closed and the whole trip falls apart. A plan…

Where a relative has taken ADHD medication, take the details: who they are to your patient, what they were given, what it did, and what was tried and dropped. Then put it in the referral letter.

No blood test tells a prescriber where to start, so a brother's clear response to one drug, or a mother's bad reaction to another, is one of the few…

There is no box you type 'always late' into and get the answer out of. When a sensible strategy is not landing, the work is finding out what is blocking it rather than producing another strategy.

If you notice yourself handing over the fourth tool for the same problem, stop and ask a different kind of question. What happened the last time they…

A man who could not get himself to bed kept his bedtime alarm upstairs, where his wife and baby were sleeping. Switching it off meant climbing the stairs, and leaving it meant waking them. The walk to the alarm was the thing he was trying to do anyway.

That is the part worth copying. Put the cue somewhere that costs something to answer, and make answering it land you where you meant to be. Anything…

Time management is only the fit between tasks and the hours you have: planning them against time, then doing them against time. It is a skill with parts, not a verdict on what kind of person you are.

Most people arrive having already decided they are lazy, and that decision is doing them no good at all. Describing it mechanically gives you both…

If you cannot remember much about being six, you are in the majority. Early childhood comes back poorly for most adults, while the teenage years are far easier to describe.

So do not sit in an assessment feeling you have failed a test because the early years are a blur. Bring what you can find instead: old school…

A list of symptoms on its own does not make a diagnosis. What counts is that they cost you something real in at least two areas of ordinary life.

That means work or school, money, home, friendships, driving, getting through the week. Almost everyone loses keys and drifts off in meetings, so the…

Much of the symptom wording was written with children in mind. If a question sounds like it is about someone climbing the furniture, translate it into your adult life rather than answering no.

Restlessness at forty is rarely running about. It is being unable to sit through a film, the leg going under the table, two jobs left out of boredom.…

Note who is a first degree relative and who is a second, instead of writing 'runs in the family'. Parents, children and siblings sit in one ring. Grandparents, aunts, uncles and cousins sit in the next.

A simple grid helps: names down the side, then relation, what they were like, what was ever diagnosed, what was ever treated. The picture comes out…