Focus, starting, and ADHD

The growth effect is usually small: something like a couple of pounds and a centimetre or two less than expected in the first year or two, with most children catching up afterwards. Knowing the size of it helps, because both blank reassurance and quiet dread are worse than the actual number.

Height and weight get plotted at review appointments for exactly this reason, so ask to see the chart rather than carrying a vague worry between…

Breaks from medication at weekends or over the summer are a tool for a particular problem, usually growth, rather than something everyone ought to be doing. Where growth is fine, a holiday tends to cost more than it gains.

The days without medicine are not neutral days. They are often the days with more accidents, more falling out with people, and more of the shame that…

You may hear that staying on stimulant medication for years can shift the structure of the brain itself, not only the day. It is a real line of research and it is still an open question, so hold it lightly.

The work points at a handful of regions involved in attention and movement, and at a minority of people who stayed on treatment for several years.…

Nobody asks whether you believe in insulin. The language of belief has attached itself to ADHD medication, which happens to be among the more heavily tested treatments in medicine, so the useful question is what the testing found.

This is not a way of saying your worries do not count. Side effects, cost, how you feel about giving a child a drug: all of that is real and worth…

The question that usually matters most is not which molecule but how many hours it covers. A medicine that has worn off by four in the afternoon leaves the hardest stretch of the day uncovered.

Map your actual day before the appointment: when you need to concentrate, when homework happens, when the arguments start. Taken in and shown to a…

Wanting to try everything else first is a normal instinct and worth taking seriously. It is still fair to ask why we would have a child squint for a year before trying glasses.

The cost of waiting is not nothing. A school year is a school year, friendships form or fail to, and a child's sense of who they are is being built…

Most resistance to medication turns out to be something a person heard rather than something they decided. Work out which one you are holding, because the two need different things.

A worry built on a half remembered article tends to dissolve once you find out what was actually studied. A worry that comes from your values, about…

Holding off on treatment can feel like the safe, neutral option. For a child who is struggling now, it is a choice with its own costs rather than an absence of one.

It is completely reasonable to want to try gentler things first, and many of them are worth trying. What is worth resisting is the sense that doing…

A swimming float keeps you at the surface. It does not decide which end of the pool you are heading for, and medication is much the same.

That is a good sentence to have ready before the first prescription. What a drug can hand you is capacity: a little more room to hold your attention,…

Ask for the actual list. Not some side effects, but the specific ones people commonly get in the first week or two, and roughly when they tend to settle.

A vague warning leaves you reading every ache as a sign that something is going wrong. Being told that an unsettled stomach, loose bowels, headache…

Some medicines arrive inactive and only become active once the body has broken them apart. Because that conversion happens at a fixed rate, the peak is blunted, the effect stretches out, and getting the drug in faster does not make it work faster.

That last part answers a fear a lot of families carry quietly, since crushing or snorting such a product gains nothing at all. It also explains why…

Neurofeedback rests on a tidy idea: in ADHD the slower theta rhythm shows up when the faster beta rhythm should be running, so the training rewards you for shifting the balance. Knowing the idea is worth a few minutes, because it is what the brochure is built on.

Electrodes sit on the scalp, a screen animates when the signal moves the wanted way, and the person practises staying in a state of relaxed…

Ask what happens after the course ends, not only what happens during it. A gain that fades once the sessions stop was probably never a change in the person.

Neurofeedback tends to look decent while it is being delivered and then drift back, and the studies that followed people afterwards did not find…

Before committing to a course that runs into thousands, set the same money next to the other things it could buy. Tutoring, a proper assessment, a medication review and a well tested psychosocial programme all sit in the same envelope.

Neurofeedback courses often run for a month or more, insurers rarely pay, and the training of whoever delivers it varies a great deal. The cost is…

When a parent is set on something that will not hold, one honest story often lands better than a pile of studies. A family finished the better part of a year of neurofeedback and watched their child slide back to where he started within weeks.

Told plainly, with no note of triumph in it, a story like that raises durability without telling a parent they were foolish. They were not foolish.…

When you read that a treatment worked, look for who judged the improvement and whether they knew what the child had been given. In much of this literature, they knew.

The design to look for is a sham condition, where everybody goes through the same routine and only some receive the active ingredient, with the…

Brain training games make you better at the game. Sadly, that improvement tends to stay inside the game.

Sorting shapes faster or planning a conveyor belt more smoothly comes from learning the task, not from stretching a capacity, so the classroom and…

Regulators let devices through by several different routes, and only some of them mean what a family assumes. A game cleared for further investigation has not passed the bar a medicine passes.

The word approval carries an authority that advertising borrows freely, and device pathways are shorter and lighter than the ones drugs travel. It is…

The fair test for anything offered alongside medication is whether it adds something on top. In one small imaging study, cognitive training added to a stimulant left inhibition no better than the stimulant on its own.

Add on designs are unkind to hopeful ideas, which is exactly why they are worth running. About twenty children took part, so this is one small piece…

Programmes built on tones through headphones and balance drills have not been shown to help ADHD. If a child does seem steadier during them, the likeliest reason is that something is occupying the part of them that goes looking for stimulation.

That effect is real enough, and it is cheap to get elsewhere. A walk, a job with the hands, background sound they choose themselves, all of it…

If someone has genuine positional vertigo, get it treated, and do not expect the treatment to touch their ADHD. Both things can be true at the same time.

Benign paroxysmal positional vertigo often follows a sinus infection or a bang to the head, and it responds well to repositioning manoeuvres that…

Several professional bodies came together to say that vision therapy is not a treatment for ADHD. A joint statement like that is unusual, and it is worth quoting to a family word for word.

Convergence problems, where the eyes struggle to work together on something close up, are a little more common in ADHD and deserve treating in their…

Saying that something does not work leaves a parent holding the same worry that sent them looking in the first place. Say what the time and money would buy instead, and put exercise at the top of the list.

The energy behind an unevidenced treatment is usually love with nowhere to go, and if it is not given somewhere to go it moves on to the next…

Sensory processing difficulties are real and worth accommodating, and they are not a standalone diagnosis. The proposal for one was turned down for lack of evidence that it stands apart from the conditions it appears with.

In practice it usually shows up alongside ADHD or autism, so it is best written up as a feature of the person: what they cannot tolerate, what they…

Ask which direction a person's sensory difficulty runs before offering anything. Someone who is under responsive needs more input and someone who is over responsive needs less, and the wrong one makes the day harder.

The under responsive child is the one climbing, chewing, pressing into things, hunting for sensation in order to feel settled. The over responsive…

Turn the socks inside out so the seam sits away from the toes, cut the label out and print the size onto the fabric instead, and look at seamless clothing. These cost pennies against a course of therapy and they work by teatime.

A scratchy seam or a stiff tag is a small thing that keeps announcing itself all day, and every announcement takes a piece of attention with it.…

Weight across the body settles a lot of people and sends some of them to sleep quickly. It is a preference though, not a remedy, and for others it feels like being closed in.

If you try it, watch what actually happens rather than what is supposed to happen. Some people have wanted pressure, small dark spaces and being…

Keep something to eat and drink within reach for hard conversations. Handing someone a biscuit and a glass of water often settles a room faster than any instruction does.

Part of why it works is that nobody has to be told how. A person too wound up to follow a breathing exercise can still take a sip and chew. Sharing…

Being told you are too sensitive is usually someone else's comfort talking. Feeling things strongly is not the problem to solve; what to do once the feeling has arrived is.

Both halves have to be said together. Validation on its own leaves a person flooded with permission and no handles. Teaching control on its own joins…

Since 1994, supplements have not had to satisfy a regulator before going on sale. Nobody checked the bottle in your hand the way they check a prescription.

The gap is wider than most people expect. Drug factories get unannounced inspections and can be shut down on the spot; supplement makers do not face…

Natural is not a regulated word: anyone can print it next to a picture of a leaf, on anything at all. Organic in the USDA sense does have a legal definition sitting behind it.

The same goes for the reassuring line about following good manufacturing practices, which describes what a company aims at rather than what an…

Kava, valerian, St John's wort, ginkgo, ginseng and the proprietary blends have not shown benefit for ADHD in trials that matched the amount in every capsule and kept both the person handing them out and the person rating behaviour unaware of who got what.

Those two design details are most of the story. Ordinary use has dose wobble and expectation running through it, and expectation is powerful,…

Ask what someone takes that is not food, rather than asking what medications they are on. People do not file their supplements under drugs, so the usual question comes back empty.

There is a case worth carrying around for this. A liver transplant patient kept rejecting the organ, and it turned out he was quietly taking…

If a stimulant that was working suddenly is not, ask what else the person has started taking before deciding the dose needs to go up.

One woman's Adderall went flat while she was on a herbal supplement and came back to its usual self once she stopped it. Herbs can shift stomach…

If a little helps then a lot must help more is not really a supplement thought. It is an addiction shaped thought that has wandered into the vitamin aisle.

Moderation tends not to be a natural strength with ADHD, and this is one place where that costs something. Name it early, before a safe dose has…

People with ADHD tend to have lower omega-3 in their blood, and bringing low levels up has been linked with some improvement in symptoms. No convincing difference has shown up between DHA and EPA for this.

Omega-3 comes mostly from oily fish and krill, and fish is exactly what many people with texture sensitivity will not eat. Whether the shortfall…

If you are trying omega supplements, give them four to six weeks and then decide. Imaging work has picked up changes in how neurons communicate after around four weeks, which is fast as these things go.

Fixing the end point at the start protects you twice over. It takes the sting out of nothing happening by Thursday, and it stops an open ended habit…

In one trial, children were given omegas with a multivitamin, omegas alone, or neither, and after fifteen weeks everybody got both. The omega groups gained on set shifting and attention, and the children who started with nothing caught up once they crossed over.

Two features of that design are worth understanding. Everyone receiving the treatment eventually shows that the improvement follows the treatment…

Sixty two children took methylphenidate with either vitamin D or a placebo, and both groups improved. The two ADHD rating scales showed no difference between them, which leaves the positive headline resting on the clinician's judgement rather than on what parents reported.

That shape repeats all over this literature, so it is worth learning to spot. When a study reports an effect on one measure and not another, the…

People with ADHD are reported to run low on both tryptophan and homocysteine. Low homocysteine is a good thing to have, since it is the high version that damages hearts.

The reflex to correct any number under the reference range is worth resisting. Levels can be tested where there is a reason to test them. Eating a…