Focus, starting, and ADHD

While you are taking the family history, ask about seizure disorders and psychosis too, not only about attention. A family carrying other neurological or psychiatric conditions is worth knowing about whatever you end up concluding.

Keep the list short and ask it plainly: epilepsy, psychosis, learning difficulties, head injuries, anything neurological. Some of it will matter for…

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…

Long acting stimulants are the usual starting point for a plain reason: they cover the most hours and they remove the lunchtime dose, which is the dose ADHD is most likely to swallow whole.

Remembering a tablet in the middle of a busy day is itself an executive task, so asking for it is asking the person to do the thing they came for…

The most useful question about a dose is whether the person can tell. A shrug and 'I think it sort of helps a bit' usually means it is not yet doing its job.

At a dose that suits them, most people can say when it comes on, what the middle of the day feels like, and when it leaves. Vagueness points…

Half the useful health information arrives sideways. Someone says 'I am so tired' on the way into another subject, and that is an opening worth taking gently.

People rarely bring sleep or food to a session as a topic, because they do not file them as symptoms. So the tiredness, the skipped meals and the…

Count good days, not unbroken runs. Whatever yesterday was, brilliant or a write off, the only live question is what can be done with today.

Streaks make one slip cost everything, so the missed night turns into a missed week and then the whole effort gets quietly dropped. Aiming for more…

Most of what we call memory looks backwards. The kind that actually runs your week is the other sort: a plan that has to show up in your head at the one moment you could still act on it.

So when something gets missed, the question is not really whether you knew about it. You almost certainly did, at the time you agreed to it. What…

When a task is missed it is usually not sitting somewhere being refused. It has gone off the radar altogether, the way a name goes when somebody asks you for it.

The refusal reading is the expensive one, because it turns a lapse into an insult and starts the argument in the one place where nothing can be…

A thought you have in the car about something to say at home is worth nothing until the person is actually there in front of you. Cues have to sit where the action becomes possible, not where you happened to think of it.

Picture where you will be at the moment the thing can be done, and put the reminder there: a note on the front door for something that happens on the…

The moment you think of it is the only moment you are certain to have it. Do the thing, or write it down, or set the alarm, or put something odd in your pocket that will make no sense later until you check.

The two seconds of holding it in mind while you finish what you are doing is usually where it disappears. So make capture the reflex instead of the…

Start the email and then stop: address it, write the subject line, leave it unsent. The half finished thing sits in your drafts looking wrong until you deal with it.

It works because it leaves an odd looking object in a place you already go, and because unfinished jobs nag in a way that quiet decisions do not.…

The bag that has to travel with you tomorrow goes on top of your shoes, not neatly beside the desk. Let the object stand in the way of a route you walk without thinking.

The phrase worth keeping is point of performance: the reminder has to sit where the action happens, at the time it has to happen. A note on the…

Sometimes you cannot write it down. You are driving, your hands are full, you are halfway through a conversation. Then picture the moment in detail instead: the room you will be standing in, the object you will be looking at when you do it.

Make the picture concrete rather than worthy. Not a solemn 'I must ring the surgery' but the desk you will be sitting at, the mug beside the phone,…

A ping about a parcel and a ping about your mother's health feel identical in the second before you look. Give that feeling a name, false urgency, and you get a little room.

The buzz carries no information about importance. It borrows the feeling of importance and lends it to whatever happened to arrive. Naming it in the…

Gaming for an hour before you start the work almost never costs an hour. Do the thing that has to be done first, then the thing you want.

Once something enjoyable is running, whatever you were meant to do afterwards looks duller than it already did, and the hour quietly becomes three.…

Charge the phone in another room overnight and use a proper alarm clock. Small change, and it takes the decision away from you completely.

In bed the phone is right there, and stopping is left to you at the hour you have the least left. Out of the room, there is nothing to resist. Buy…

The aim was never to stop needing the aids. It is to find ways round the parts that do not work well, and then to keep using them.

People tend to treat the alarms, the lists, the whiteboard by the door as scaffolding they ought to take down eventually. That is usually why it all…

Everyone has something about themselves they wish were different, and something they cannot do reliably however much they mean to. Yours has a name and a good deal of research behind it, which is not the same as being uniquely broken.

Say this carefully, because there is a careless version that does real damage. Everyone is a bit ADHD is not what is meant, and it leaves a person…

One man with ADHD described the goal as no longer suffering from it, only having it. The diagnosis had not changed. What it cost him had.

Half of that shift comes from removing particular sources of pain: the job that was never going to work, the arrangement at home that left everything…

When you fall off task, restart without the pile-on. Talk to yourself like a good coach, not a critic.

The lost hour is gone; the next one is not. Skip the self-attack and just begin again.

In the famous test a child is left alone with one sweet and told that waiting will earn them two. Some reach for it almost before the grown up has finished speaking. They understood the offer perfectly. The second sweet simply was not real to them.

That is the whole thing in one image: the knowledge intact, the feeling absent. You can know that filing the return today would save you a fortnight…

A hundred pounds now, or the same hundred pounds guaranteed at the end of the year. Same money, same certainty. One of them pulls at you and the other does not.

Worth sitting with for a moment, because it takes risk out of the picture entirely. There is nothing to lose by waiting, and the near one still feels…

When someone has missed the deadline again, the talk about how they always do this changes nothing except how they feel. If you want a different Friday, the conversation belongs on Monday, and it is about the plan rather than the person.

This is a hard one, because the frustration is real and often fair. But the lecture lands on a system that was never the failure point, and it adds…

Here is a short way to hold the whole difficulty: the now in front of you is too big and the later is too small. It fits in your head at the moment you need it, which longer explanations do not.

Use it as a question rather than a verdict. Standing at the fridge at eleven at night, or with the tab open instead of the form, you can ask whether…

Choosing the dull useful thing over the bright easy one starts with a pause, not with willpower. If the pause never happens, nothing downstream of it gets a chance to happen either.

The chain runs roughly like this: something stops you for a second, you notice what you are doing, the later consequence comes into view, and only…

Getting going is a separate expense from working slowly. Plenty of people move quickly once they are in and still lose forty minutes in the gap between deciding and starting.

It is worth knowing which of the two you are paying, because the answers differ. If the work itself is slow, you want fewer interruptions and simpler…

Time speeds up inside something absorbing and crawls inside something dull, and for many people with ADHD that swing is much wider. Which means your sense of time is least reliable exactly where you need it most.

Two things follow. When the task is dull, expect your sense of how long you have been at it to fall well short of the truth, so use a timer instead…

A clock with hands shows you how much is left. A number only tells you where you are, which is why the hour can vanish while you keep checking it.

Try one on the wall where you work, or the sort that shows a shrinking coloured wedge for the time remaining. What you want is to see the deadline…

If you will not look at clocks, let something tell you instead. A watch or phone that buzzes every fifteen minutes, or on the hour, rebuilds a rough sense of how long you have been at this.

Start with a gentle interval, a quarter of an hour or half an hour, and treat it as a question rather than an alarm: what am I doing, and is this…

Reading the time off a clock does nothing on its own. The useful bit is the question straight after it: where was I meant to be by now, and how much is left.

Try adding one sentence to every glance. It is twenty past two, so I have forty minutes and I am about halfway. Said out loud it sounds laborious,…

Keep one short question and use it everywhere: is this what I should be doing right now. Nothing clever, just the same words often enough that they turn up on their own.

The value is in it being fixed. An intention to monitor yourself is far too vague to survive a busy afternoon, whereas a set phrase can be triggered…

The timer you will actually use is the one that takes two seconds. A dial you twist beats an app with four taps, every time, whatever the app can do.

Keep a cheap kitchen timer where you work and another where you get ready. If speaking to a smart speaker is quicker for you, use that instead.…

If you have ten minutes and the episode is forty, the moment to act is before it starts. Stopping halfway is a much harder ask than never beginning.

This is worth knowing about yourself without shame: once you are inside something absorbing, the pull to stay is enormous and the part of you that…

Fasten a time you keep missing to another person. Go up when your partner goes up. Ask a colleague to knock for you on the way to the meeting.

A person moving is much easier to notice than a number changing. Ask for it as a favour and keep it small and specific, because a vague request to be…

Almost everyone has an alarm to get up and almost nobody has one to go to bed, which is odd, because bedtime is the one with nothing else pushing on it.

Set it for half an hour before you want to be asleep, so it catches the start of the wind down rather than the end. Expect to ignore it for the first…

You do not have to agree that it will take longer. Add the extra time anyway and let the week prove you right or wrong. If you finish early, you have a spare twenty minutes, which is not a punishment.

This matters because the felt sense of duration is stubborn, and waiting until it corrects itself means waiting a long while. So treat the padding as…

Instead of one warning, give several: half an hour, fifteen minutes, five, one. The child then has time to arrive at the ending rather than having it dropped on them.

A single warning asks a child to track the gap on their own, which is the thing they cannot do. A ladder of prompts turns a stretch of time into a…

ADD and ADHD are not two different things. ADD is the older public word for what is now called ADHD, inattentive type, and the quieter presentation is not a lighter version of it.

The mix up matters more than it sounds. Parents sometimes hear ADD and take it to mean something mild that will not need treatment, and school or…