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…

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…

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…

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…

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…

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…

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…

Build numbers and break them up again. Seven is five and two, and also six and one, and a child who can see that has the thing mental arithmetic is made of.

Blocks, buttons, coins, anything you can push into two piles and back together. Ask which numbers fit inside other numbers and let the child show you…

In practice, you sometimes have to stop a child using the trick that has kept them afloat, so the weaker skill finally gets used. Expect them to hate it for a while.

If memorising is doing the work, the part that should be doing it never gets a turn. So build short pieces of practice where the workaround is simply…

After a course of intensive work, this student's sound skills moved from the middle of the range to near the top. Average was never the ceiling. It was simply where an untreated difficulty had left them.

Hearing single sounds in a word, holding sounds in memory, repeating made up words: all of them shifted a long way once the teaching was right. That…

One gentle way to name it: those are being used as words to play with, and they were never really words for playing with. Said kindly, it lands without anyone being told off.

The young person in front of you almost certainly says it too, so any version that sounds like a reprimand will close the conversation down. Naming…

After a long stretch online people are often not fully there. Something faintly hypnotic settles in, and things get said and done that the same person would not say or do in a room.

This is not only teenagers. Adults describe it too: an hour that vanished, a message that reads as though somebody else wrote it, a flatness…

More hours on social media goes with more anxiety and low mood. That is a reason to aim at fewer hours, a conversation you can actually have, rather than at none, which usually ends the conversation.

Pick a number genuinely below the current one and low enough to notice, then look at what has changed in a fortnight. Sleep and mood are the things…

Spend long enough online and people start arriving as types rather than as people: brilliant or worthless, with nothing in between. The flattening happens to how you see yourself as well.

Worth naming as something the environment is doing rather than a fact about your character, because what an environment produces can be changed by…

Not every app is doing the same thing to you. The ones that tend to hurt have comments underneath, a feed chosen for you, and a number attached to how you did.

One young woman described a picture site as the safe one, because there was nowhere for anyone to reply to her. That is a useful way to sort your own…

Things posted in ten seconds have got young people excluded from school, and worse. It is worth asking about online conduct in the same routine way you would ask about anything else that could go badly.

Ask what has been posted, what has been sent, what someone would not want read out. Not as an inspection and not as a lecture about permanence, but…

Most children with ADHD can tell you exactly what they should have done. The knowing was never the missing piece, which is why a course teaching the knowing changes so little.

Watch closely and you see the skill appear in quiet moments and vanish in loud ones, when another child has already grabbed the ball and there is…

Gathering disruptive children into one room to learn social skills leaves about a quarter of them worse than before. They pick things up from each other far faster than from the adult at the front.

This is not a reason to give up on helping a child socially. It is a reason to look hard at who else is in the group before you accept a place in it.…

The warning about group social skills work is about loud, disruptive children. A quiet, anxious child who simply has not had much practice with other children is a different case, and a gentle group may be exactly right.

So the question is not whether groups work, but which child is sitting in front of you. If the difficulty really is inexperience, a group offers…

One social approach does have a real evidence base behind it, and what makes it different is who delivers it. Parents do the coaching, in the middle of actual play with actual friends.

In practice it looks small and ordinary. You set up a play date, you stay within earshot, you give a nudge before things tip over, and afterwards you…

A child's reputation is made in the classroom, mostly out of adult earshot, and it follows them from one year to the next. Teachers who work on how the class treats the child, and not only on the child, can move it.

The version that has been trialled has the teacher doing small deliberate things: pairing children with some thought, noticing this child out loud…