Focus, starting, and ADHD

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…

The age by which symptoms have to have shown up is a number people agreed on, not a line in nature. It moved from seven to twelve when the manual was revised.

That matters if you are an adult wondering whether you would even qualify. The old cut-off was itself a compromise between studies pointing in…

Teenage memories of this often come with a sting: the year you worked out how much longer everything took you than it seemed to take everybody else.

That is usually why adolescence is the period people can describe in detail. The work got harder, the scaffolding of primary school fell away, and…

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…

You do not need clinical language at an assessment. Some of the wording in the manual came straight from how families described it in the first place.

Phrases about being permanently on the go are in there because people kept saying them. So use yours: that your head is like a browser with forty…

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.…

There is a difference between low mood you have carried all your life and low mood that grew out of years of working twice as hard for half the result. Both are real, and they need treating in a different order.

If the second describes you, the picture often lifts a fair way once the attention difficulties are being managed and the daily experience of falling…

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.…

Not all distraction comes from outside. Some of it is a thought that will not leave, circling while you read the same paragraph four times.

That difference matters at an assessment. Being pulled away by everything in the room, and being held in place by an intrusive thought you cannot put…

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…

Eating that runs away from you, and eating you cannot stop once it has started, turn up alongside ADHD more than people expect. Usually it is doing a job rather than proving a weakness.

The pattern leans towards bingeing rather than restricting, which fits: it belongs with the difficulty of stopping something already in motion. Often…

Trouble with eating, and with how your body looks, gets missed far more often in men. The questionnaires and the expectations behind them were built around women.

In men it runs more towards size and muscle than towards thinness, and towards fixing on one part of the body that everybody else says looks…

Very sweet, very salty, very fatty food acts on the reward system in a way that has more in common with a drug than with dinner. Reaching for it when you are flat is self-medication, not greed.

Knowing that changes what you do about it. Counting calories and resolving to try harder both aim at willpower, which was never the mechanism in the…

With gambling machines the pull may be the lights and the noise as much as the chance of winning. That changes what you actually need to stay away from.

If the sensory buzz is doing the work, the triggers are not only the betting shop. They are the phone games built with the same flashing and chiming,…

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,…

Hypervigilance after trauma and ADHD scanning look much alike from outside. Often the honest answer is that both are present, and the real question is how much of each.

Watching that comes from threat is aimed at something and tends to switch on in particular situations. ADHD distraction is not fussy about where it…

Not every bout of eating too much belongs to an eating disorder. Ask whether how the body looks is part of it, because that is where the two paths separate.

When bingeing comes out of ADHD it is often boredom, or the food simply being there with nothing stepping in to stop it, and the person is not…

Home DNA tests turn up relatives nobody expected. If someone is thinking of taking one to fill in a blank family history, it is worth saying out loud that it may hand them more than they asked for.

People find half siblings. Sometimes they find that the story they were told about their birth was not the story. That is a great deal to receive by…

When you need a date, hand people events rather than months. Was that before or after the holiday? Same year as the move?

Asking whether something happened between October and January invites a guess. Asking whether it was before or after a wedding, a house move or a…

Ask for a number first, then go hunting for exceptions. How is today on a scale of one to ten, and when was it last higher than that?

An assessment can turn into an hour of everything that is wrong, which leaves a person flatter than when they arrived. Exception questions do the…

Find out what they have tried before that did not work. It saves everybody from a plan that failed this person two years ago.

Most people arriving for an assessment have been trying things for years: apps, alarms, lists, an early night, a course somebody recommended.…

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…

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…

The relative who was shut in a cupboard, tied to a chair or expelled was being managed for the same thing you are assessing now. There was simply no name for it then and no help attached to it.

Told carefully, this changes the story a family tells about itself. Not a line of difficult people, but a trait that has been present for generations…

Before you decide a strategy has failed, check whether the medication underneath it is doing its job. If someone is sitting in front of you still struggling, the honest first answer is usually that it is not, quite.

Ask about the shape of the day rather than the dose alone. When does it come on, when does it wear off, which hours are the hard ones, is there any…

Before handing anyone a new system, make sure they can say back why it should work better than what they are doing now. A strategy with no reason attached gets dropped the first time it is inconvenient.

Ask them to explain it to you in their own words and listen for whose reason it is. If the logic is only yours, it will hold for about a week. It is…

Strategies for ADHD are visible. A timer on the table, a list on the wall, an alarm going off in a meeting. If someone has not yet made peace with having ADHD, each of those is an announcement, and it will quietly get dropped.

So ask, before handing over another tool: how do you feel about the diagnosis itself? Sometimes the honest answer is that they still half hope it was…

Ask what they think this will cost them in effort, then say what you think. People rarely give up because a strategy failed. They give up because it turned out to be harder than anyone had told them.

Be specific about the first fortnight, since that is when it is worst and the payoff has not arrived yet. Someone who expected a small effort and met…

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…

When something did not get done, find out which half broke. Did they not know what to do or when? Or was the plan fine, and the moment for doing it came and went?

Ask for the last time it happened, hour by hour, up to the point where it did not happen. A planning failure needs somewhere reliable to catch tasks…

Awareness is knowing what needs doing and when. Motivation is doing it once you know. Nearly every app on the market solves the first one, which is why buying another one so rarely helps.

Test it with one question: at the moment it did not happen, did you know? If the answer is yes, the reminder was never the missing piece, and a…

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…

Time management is only the fit between tasks and the hours you have: planning them against time, then doing them against time. It is a skill with parts, not a verdict on what kind of person you are.

Most people arrive having already decided they are lazy, and that decision is doing them no good at all. Describing it mechanically gives you both…