Focus, starting, and ADHD

If it has been on the list a year and nothing has moved, consider that you may have already decided. Saying so costs a good deal less than carrying it for another year.

Some items really are waiting for a better month. Others are quietly settled and only the guilt is still going round. You are allowed to say that the…

Decide now what you get if this is done by Friday, and what it costs you if it is not. Tell someone, so it is on the record.

The trouble with most jobs is that nothing happens either way, at least not for weeks. A deal made in advance puts a real consequence next to it: the…

An app can tell you what needs doing. It cannot make you want to do it. That gap is why the next one will disappoint you too.

Reminders, alarms and lists are genuinely good at the first job, so it is easy to assume a better one will finish the second. It will not, because…

Choosing the app, picking the colours, setting up the tags: that is the task avoiding you. It is interesting, it feels like preparation, and by bedtime nothing has been done.

New systems are enjoyable in a way the actual work never is, which is exactly why the evening goes that way. A useful test is whether anything on…

When something does not get written down, go back to that exact moment with curiosity rather than a telling off. What was in your hands, where were you, what did you tell yourself?

The useful information is all in the specifics: the request came in the corridor, the phone was in your other hand, you were already late. That is a…

We all keep a few small stories that let us take the easier option in the moment. Not lies to other people, just the ones we tell ourselves and half believe.

They are not a sign of a bad character. Everybody has a set, and what you have been through shapes which ones you specialise in. The reason to know…

You are allowed to decide not to write things down. What you cannot do is choose that and then be upset with yourself when you forget.

Straddling is the expensive bit: taking the easy option in the moment and the guilt afterwards. Pick one honestly. Either the note gets written, or…

Put the thing you are avoiding early in the day. Anything you place late gets pushed out by whatever the day turns into.

Early has two advantages at once. It is less likely to be shunted, because the day has not yet piled up behind it, and if it does slip it only slips…

Email is the easiest place to hide. It answers back, it never runs out, and by five o'clock it feels like you worked.

What makes it such a good stand-in for real work is that the rewards come in small unpredictable bursts and almost none of it asks much of you. Your…

Turn a vague plan into an if-then: when I sit down after lunch, I will open the one file.

Deciding in advance exactly when and where you will start removes the moment of friction where you usually stall.

Sorting a pile of receipts is not difficult. Sitting with how dull it is, that is the difficult part, and it helps to say so out loud.

Once you know boredom is the real demand, you stop trying to simplify a task that is already simple and start making the dullness bearable instead. A…

Sometimes the last minute really does produce your best work. Often it produces your worst, and those nights are much easier to forget.

That is what keeps the belief alive: it pays out just often enough. Rather than arguing about it, count. Take the last ten things you left to the…

Paint the room is not a task. Fill the holes, tape the edges, buy the rollers, do one wall. That is four tasks, and each one ends.

A big undivided job sits in the head as one enormous demand, which is why looking at it tires you before you have lifted anything. Write the steps in…

Go down the list and find the two items that have been sitting there for months. One of them needs doing this week. The other needs deleting, honestly and out loud.

A list full of things that never move quietly drains everything else on it, because you meet all of them each time you look. Clearing in either…

Keep your clearest hours for the work that needs a clear head. Fold the laundry when you are half awake, not at ten in the morning when you have finally come alive.

Most of us have a window or two in the day when thinking is genuinely cheaper, and we spend it on email and tidying because those are easy to pick…

Pick a system that is good enough, spend one evening on it at most, and then use it for a month without changing anything.

You can spend a very long time sharpening tools and never get round to the woodwork. An ordinary calendar used every day beats a beautiful one used…

The other way through fog is to walk into it. Start badly, on purpose, and let the shape of the thing appear while you are working on it.

With some jobs you genuinely cannot know what you are doing until you are inside them, and waiting for clarity first just keeps you outside. Give…

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,…

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…

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…

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.…

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.…

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…

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…

It runs the other way as well. Among children referred for dyslexia, a sizeable minority also have ADHD and many have coordination difficulties too. Whatever is written on the referral, treat it as one part of the picture.

Where the reading difficulty is severe, motor involvement is more likely to be there alongside it, which is why the first look should be wider than…

Dyspraxia and developmental coordination disorder are the same thing carrying different passports. Search only the American term and you will miss a large European literature on assessing and helping these children.

Search both, and try the older names while you are there. It matters most when you are looking for what actually helps, since much of the…

When a bright, talkative autistic child arrives looking mainly behavioural, look underneath for a coordination or reading difficulty. Once the first label is in place, whatever comes after tends to get filed under it and never assessed on its own.

Watch for the child who does well in conversation and badly on paper, or who is fine in class and miserable at PE. Those gaps are usually a second…

Choose the subtests that answer the question you were actually asked, and read whatever reports the family already has before adding anything of your own. Children arrive with thick folders, and they also arrive with nothing at all.

Where occupational therapy, speech and language or neuropsychology have already covered ground, do not cover it again for the sake of a complete…