Focus, starting, and ADHD

Carry the rough proportions into every ADHD assessment. Executive function difficulty in the great majority, coordination difficulty in around half, dyslexia in something like a quarter to two fifths. A workup that never asks about handwriting, sport or reading is not finished.

The behaviour problem you were called about is often the visible end of an unidentified reading or coordination difficulty. Ask what PE is like, what…

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…

Expect more anxiety, low mood, drinking and drug use in the young people coming through now. And expect the boys to say less about it, so go looking for irritability, trouble and substances instead of waiting to be told.

Ask parents what they are seeing rather than only what they have been told, and ask the young person directly and privately. Screening that rests on…

Parents with one affected child often ask what they might do differently before the next one. Answer honestly: there are lists of suggestions in circulation, the evidence behind most of them is thin, and the question underneath is usually about blame.

Take the question seriously and take the guilt seriously alongside it. Give what is genuinely known, say plainly where recommendations run ahead of…

Keep the tasks short, a couple of minutes each, with results back the same day. A long test given to a child who cannot sustain attention measures how long they can last, not the thing you were trying to measure.

Brevity is not a convenience you are allowing yourself. It is what keeps the data honest, and it keeps the child willing for whatever you ask next.…

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…

When you explain executive function to parents and teachers, four words will do: attention, reasoning, speed, memory. Each one can be worked on, and four is a number people can still repeat at the school gate a week later.

The academic models have a dozen headings and nobody outside the field retains them. A short list gives parents something to hang observations on, so…

Two referrals turn up again and again. A young child being asked to leave a school for behaviour, with no developmental or cognitive information anywhere in the file. And a parent saying something is wrong while the school says everything is fine. Both are describing adult frustration rather than a formulation.

In each case the first job is the same: get some data. Not another opinion, not another meeting, but something measured about how this child thinks…

For the child who flies off the handle at noise, labels and crowded rooms, with no autism diagnosis in the picture, a free parent completed sensitivity questionnaire will tell you more than another behaviour chart.

It gives you a structured way to describe the reactivity without reaching for a diagnosis the child may not have, and it points at what to change:…

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…

Before intensive work ends, turn what you have learned about a child's thinking into things a teacher can actually do on a Tuesday morning. That translation is what decides whether any of the gains survive going back to school.

A profile written for clinicians is no use in a classroom of thirty. Give three or four concrete actions instead: where this child sits, how…

A clinician trained thoroughly in autism and ADHD may know almost nothing about coordination or reading difficulties, and can spend years working above foundations nobody ever checked. Ask yourself which of those categories your own training left out.

Go back over a handful of old cases rather than only reading about it. Where a child made less progress than you expected, ask what you never…

Assessing a child's thinking used to mean a referral, a waiting list and a report some months later. Brief cognitive tools an ordinary clinician can run have changed that, and the gap between noticing something and having a plan can now be a session rather than a season.

Learn one of them properly instead of dabbling in three. Know what it measures, what it does not, and how to talk about a score without turning it…

Processing speed is the stubborn one. It shifts a little with repeated, rhythmically paced practice and hardly at all with explanation, so say that to a family at the start rather than when they are disappointed.

Teaching a strategy will not make a slow processor quick, and telling a child to hurry up only makes the work more unpleasant. Graded practice with…

Assess, make a plan, do the work, and then keep measuring while you do it. Without that last part you have no way of knowing whether to push harder, change direction or stop.

Use more than one stream: your own measures, what parents notice at home, what school reports, and what the child says about it. Children will tell…

You can screen for a processing difficulty with no test at all. Just notice, in ordinary conversation, whether the child is answering what you actually said.

A child who drifts off topic, answers a slightly different question, or needs things said twice may not be avoiding you or daydreaming. The words may…

Behaviour is usually the visible end of a skill that has not been built. What you are watching in a classroom is the shape of the difficulty rather than the shape of the child.

It is a single sentence you can say in a meeting, and it tends to move the conversation away from what to do about the behaviour towards what the…

Most children do not pick up reading by sitting near books. Around a fifth need very structured, repetitive teaching before it clicks, and about half of the rest still need a good deal of deliberate instruction, so structured teaching is the ordinary case rather than a special measure.

It helps to stop asking who qualifies for help and start asking how much teaching each child needs. A child left to fail badly enough to earn support…

When reading results lift across a whole state after every teacher is retrained, the lesson is uncomfortable and hopeful at once. A good part of what looks like children failing is teaching that has not caught up yet.

One state moved from flat to clearly improved reading in years when many others slipped, and what changed was not the children but how teachers were…

Speech arrives on its own if a child is spoken to. Reading, writing and arithmetic do not, and it is no failing that they have to be taught piece by piece.

Children absorb talk from the people around them without lessons. Print is a much later invention and the brain has no ready made place for it, so it…

When a child keeps failing at a task, try reducing what it demands of attention and memory before you increase the practice. Shorter steps, one instruction at a time, the working written down where they can see it.

Attention, holding things in mind and switching between steps all set a ceiling on how much of a lesson gets through. You cannot easily raise that…

Pouring more in does not help while the lid is still on. A child who is exhausted, wound up or not yet settled will keep very little of the lesson, however good the lesson is.

Do the settling first, even when it costs ten minutes of the hour. Sleep, food, movement and a calm start look like the soft part of the day and they…

A child working words out from the pictures and the shape of the sentence is guessing well, not reading yet. It usually holds up until around the third year of school and then gives way, because the pictures stop and the words get longer.

Ask to hear the child read something with no illustrations and no predictable pattern. That is where you find out whether sounds and letters have…

Clapping games, skipping rhymes and silly verses are worth doing. They are good for the ear and they cost nothing, but they will not on their own repair a reading difficulty, and it is kinder to say so early.

Play the games, and separately get the structured teaching that a child with a real decoding problem needs. Families are often told that rhyming…

Invent words together. Say a made up word, pull it apart into its sounds, put it back, then take one sound out and hear what is left. The nonsense is the point, because there is nothing for memory to fall back on.

With a real word, a child who cannot work with sounds can often get by on memory, and you learn nothing about what they can actually do. A made up…

Plenty of children read the equals sign as put the answer here. Write it the other way round sometimes, eight equals three plus five, so they meet the idea that both sides are simply the same amount.

Move the sign about. Leave the gap in the middle, four plus something equals two plus five, and watch what the child does with it. If they add…

The word one does several jobs at once: a digit, a number, a single object, a whole set. A child who has not sorted those out will put figures in the wrong columns and later read a third as a number instead of a part of something.

When digits land in the wrong place, check whether the child knows what is being counted before calling it carelessness. Say the unit out loud: one…

A child who talks well, listens well and seems bright will have their reading failure read as laziness. The strengths are exactly what makes the blame stick.

Strong spoken language, decent attention and an easy manner give an impression of capability that nobody can square with work coming back unfinished.…

When the usual route into reading or arithmetic does not form, children build another one, and it nearly always runs through memory. It works for years, and it costs far more effort than anyone watching realises.

This is the bright child who is somehow always tired, always slow with written work, quietly memorising what everyone else is working out. The route…

In most children attention and memory sit at roughly the same level. When memory is far ahead of everything around it, ask what it has been quietly making up for.

Only fair attention with an unusually strong working memory is a signal rather than a strength to celebrate. The memory is carrying something. Look…

Some people get all the way to university before anything is named, then meet eighty pages of reading a night and cannot do it. Nothing broke that night. The volume simply outgrew a way of coping that had held for years.

The history reads the same way every time afterwards: always needed longer, avoided reading aloud, dreaded timed tests, stomach trouble in exam…

Ask someone to repeat a made up word and memory cannot rescue them. That is exactly why this small task keeps finding difficulties a clever, well practised person hides everywhere else.

Real words can be recalled, and a strong memory will lift a score without the skill underneath being there at all. A word that has never existed…

If a child is behind in reading, the gap rarely closes on its own with another year of the same. Asking for a proper assessment now is kinder than hoping that maturity will do the work.

National figures show reading proficiency barely shifting between primary school and the end of secondary, which tells you that catching up later is…

Before adding more content, look at what the child has to receive it with: attention, memory for what was just said, language. Two children given the same lesson do not take away the same amount, and that difference is usually where the real gap sits.

It is tempting to answer a gap with better materials, since materials are the part that can be bought. But if a child cannot hold a sentence in mind…

Phonological awareness is not one skill. Telling sounds apart, rhyming, breaking a word into its sounds and blending them back are separate jobs, and a child can be fine at one and stuck at another.

Before agreeing that a child needs phonics, find out which piece is missing. Ask them to say the sounds in cat, then to join up sounds you give them,…

A display organised by sound rather than by alphabet gives a child more to hold on to. Let them feel where each sound is made, lips, tongue, teeth, and match that to the letters that spell it.

Reading is learned from speech towards print, so a border running A, B, C tells a child very little about what they are actually doing. Grouping by…

If a parent has been saying since the first year of school that something is wrong with their child's reading, start from the assumption that they are right. They have watched more of it than anyone else has.

The usual story is years of being told the child is fine, a little behind, will catch up, and then a diagnosis at nine or ten when the easiest years…

Before drilling number facts, check whether the child has any feel for how much a number is. Which pile is bigger, is eight nearer to ten or to two, give me three of those.

A child with no sense of quantity can still learn to recite that seven and eight make fifteen, and it will be a string of sounds attached to nothing.…