Focus, starting, and ADHD

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…

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.…

Attention and impulse problems that appear for the first time in middle age or later are not ADHD arriving late. They need a doctor to look, not a prescription.

Several conditions affecting the frontal lobes can show up first as new disinhibition, poor judgement or a change in personality, and some are…

Ask about food two generations back. What the parents were like about it, what the grandparents were like, what the rules were at the table.

Much of how a person eats was learned long before anybody mentioned a diagnosis, and a fair amount of the shame around it was learned in the same…

The scales worth using are the ones that ask about situations rather than symptoms alone. Home, school, work, and what actually happens in each.

A questionnaire counting how often somebody loses their keys will label half the population. What a diagnosis needs is evidence that the difficulty…

Executive function scales ask how the week actually went. That is often more use than an afternoon of testing in a quiet room.

Office testing happens in the best conditions a person will ever meet: no interruptions, someone sitting with them, a clear finish line in sight.…

Ask about the family properly: parents, brothers and sisters, children, then aunts, uncles and grandparents. Include drinking and drug use, in them as well as in the person sitting with you.

This tends to be the highest yield few minutes of an assessment, because the condition runs strongly in families. Relatives who were never assessed…

Ask for the most frightening moment of their life, then the next one down, then the next, until there is a scale running from one to a hundred. You get the ladder you needed, and they get something they did not expect: fear comes in sizes.

Do it slowly and write it in their words rather than yours. Most people arrive believing anxiety is one solid block that either has hold of them or…

The family history is not the warm up before the real assessment. Give it proper time and it will often tell you more than any single rating scale in the folder.

Walk through the family rather than asking one summary question about it. Who struggled at school, who could never sit through a meal, who changed…

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…

Ask whether anyone kept the old school reports. The same lines turn up generation after generation: not working to potential, talks too much, never has the right books with him.

They were written by teachers who had never heard of ADHD, about children nobody was going to assess, and that is exactly what makes them worth…

If someone is about to send off a saliva kit to fill in the family history they never had, have a conversation first. These tests hand back more than health information, and they hand it back with nobody in the room.

A father who is not the father, a sibling nobody mentioned, a donor conception no one planned to explain: these arrive by email on an ordinary…

'I am disorganised' cannot be treated. 'The post piles up on the hall table until something ends up with a debt collector' can. Spend the time getting the problem down to something that specific.

Push for the particulars: which task, which moment, what was happening just before, what they did instead. Where you can, ask someone who was there…

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…

When a child with attention difficulties is also at war with every instruction, that pairing is worth taking to someone early rather than waiting to see whether it settles.

The two travel together often, and a minority of children follow a path from constant defiance into more serious trouble later. Every stage of that…

When a child truly does not mind losing the privilege, taking more away will not get you anywhere. That is the moment to change approach rather than raise the stakes, usually to a structured parent programme that works on the pattern between parent and child.

Star charts fail with these children because the reward was never the point of the behaviour. What helps is a proper course of parent management…

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…