Focus, starting, and ADHD

Someone running just ahead of the avalanche has nowhere to stand and think. Reflection needs a bit of room, and a life with no room in it cannot make any.

This is why so much sensible advice slides straight off. Before asking what the wisest option is, something usually has to come off the pile: fewer…

Nobody decides well mid-panic. So cutting the number of panics is itself a way of making better decisions, even if nothing about your judgement changes at all.

It is slow work and it is usually the real work: fewer things said yes to, earlier starts, deadlines negotiated before they are sitting on top of…

A bridge year can be a deferred place, a course at the local college, a job, or a stretch of genuinely doing very little. That last one is a real option and not a refusal to choose.

For someone who has just come apart, a fresh demand can restart the same collapse, so a few months with nothing scheduled is sometimes the…

The next step has to be theirs. A job that looks like nothing to you might be the first thing in two years they chose without being pushed, and that is exactly why it holds.

Parents tend to want the step that recovers the lost ground. The young person needs the step they can actually take on Monday. Shifts in a shop, one…

When someone has shut down, pressure to get moving usually pushes them further in. Safety first and activity afterwards, even when the whole household is desperate for a sign of life.

Safety here is ordinary and physical. Food that turns up without being asked for. A room nobody is inspecting. Conversation that is not a progress…

If most of the difficulty is happening at home, most of the work needs to happen with the household in the room. Otherwise the hour of good conversation gets quietly undone by Tuesday.

In a settled stretch, seeing the young person on their own with occasional family time is fine. In a crisis, turn it round: everyone together,…

Sorting goes better fast than carefully. If every item stalls you, ask someone to sit in the room while you work, not to help but to keep the pace up.

A person nearby changes what the hour feels like, and they can be reading their own book the whole time. What they supply is momentum, which is…

Sitting in a room with other people who lose their keys, cry at nothing and hate themselves for both does something no explanation can. You find out you were never the only one.

Groups also do encouragement better than a therapist can. When someone with the same trouble asks whether you managed the homework, it does not land…

Connection does not have to be human. A dog will not judge how your week went, and it will get you out of the door twice a day whether you feel like it or not.

If people currently feel exhausting or risky, an animal is often the easiest place to begin. Part of the good is the company and part of it is the…

If you are permanently behind, short of sleep and scrambling, that is not the backdrop to your short fuse. A good deal of the time it is the cause of it.

This is what makes the dull organisational work worth doing, because it buys you something you actually want. A morning that is not a panic leaves…

If not knowing makes you itch, the work is learning to sit with the itch rather than making it go away. The plan can stay unfinished while you get on with today.

For some of us an unresolved question hums in the background until it is settled, and settling it becomes urgent even when nothing depends on it.…

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…

Ask a struggling ten year old what division actually is and you will often get a blank, or a method with no meaning under it. Going back to what each operation does is usually worth more than another go at this term's work.

Division is sharing out, or taking the same amount away again and again until nothing is left. Multiplication is that same amount repeated. Children…

Being in recovery is not a reason to leave an attention difficulty untreated. The restlessness that made a substance useful is still there once the substance goes.

Clinicians often hold back here, uneasy about a stimulant for someone with a history, and that caution is understandable. The other choice carries a…

For a small number of children the question was never about school reports. A toddler who runs into a road and keeps running, a child who climbs the pool fence: what is being weighed there is whether they stay alive.

Most decisions about treating a very young child are finely balanced and deserve to be taken slowly. Where the behaviour itself is life threatening,…

If the first medicine disappoints, that is information about the first medicine. Plenty of people who get nothing from one class do well on another.

Methylphenidate and amphetamine are not the same drug at different strengths. They work by partly different routes, so a poor result on one says…

Most people who try do find something that helps, but often not the first thing they try. Not responding to one class of stimulant says surprisingly little about the other.

The high response figures you may have read come from people who worked through more than one option, not from one prescription going well. Response…

Unmanaged ADHD wrecks sleep, food and movement, and wrecked sleep, food and movement make the attention worse the next day. The loop feeds itself, which is also the hopeful part: a small repair anywhere in it pays back more than it should.

Short sleep hits the same front part of the brain that is already struggling, so a late night costs you more than it costs other people. Pick the one…

One client took two years of steady work to get a single app off her phone. If you are three weeks in and it is still there, you are not doing this wrong.

Change here is slower than nearly everyone expects, including the people helping. Saying so early protects both sides: you do not read a slow month…

Asked what all the scrolling had done to her most, one young woman did not say sad. She said angry, more or less all the time.

Constant irritability in a teenager usually gets worked up as depression or ADHD, and sometimes that is right. Saturation belongs on the list too,…

For some people the online part is not a side issue sitting next to the depression or the anxiety. It is one of the things holding them in place.

One young woman with a history of being bullied found her platform use feeding the depression, the social anxiety, the fear of leaving the house and…

Try one hour with the phone away and out of reach, then talk about what came up. The hour itself is the information.

What surfaces is usually specific and useful. The twenty minute mark where the hand starts moving. The exact worry about what is being missed. The…

There is a rough ladder for tech overuse. Build a schedule together with some outside control at first, add substitutes once the person can stop for a while, then more intensive care, and residential only when someone is entirely taken over by it.

The order matters more than the rungs. You cannot install a better alternative in someone who has no capacity yet to put the thing down, so a bit of…

Walking away from a course or a job that was never going to fit can be the sensible move rather than a failure of nerve. It is also frightening, particularly when other people are paying for it.

Fit does more work here than effort does. The person who cannot survive a rigid nine to five in an open plan office may be excellent somewhere with…

No food in the house means eating out late, which means a late night, which means a late start, which means no time to shop. It is not a character flaw. It is a loop.

The parts that feel most like personal failure, the takeaways, the extra coffee, the money going nowhere, are mostly downstream of a plan that never…

Think of ADHD as sitting at the centre of an onion. Poor sleep, sleep apnoea, low vitamin levels, allergy, ongoing pain, untreated anxiety or low mood all sit in layers around it, and each one makes the centre look worse than it is.

This explains something that otherwise looks strange: treatments that do nothing whatever for ADHD can still make a real difference, because they…

When a child with ADHD and a parent get stuck in daily rows, the rows themselves start doing damage. Getting the ADHD properly managed early takes some heat out of those exchanges before defiance settles in as a habit.

The chain people worry about runs from constant friction at home to entrenched defiance, and from there to difficulties in the teenage years that are…

The most convincing programme for teenagers does the obvious thing. It runs at school, twice a week, so nobody has to be driven anywhere: homework systems, organisation, some social practice and sport, in the place where the trouble actually happens.

By the teenage years the leverage parents had is thinning, and a clinic appointment is the first thing to fall off the week. Putting the help inside…

People who are sleeping properly, eating properly and moving a bit tend to want each other more. The unglamorous parts of life management run closer to the bedroom than either of you might expect.

It is worth saying out loud when desire has quietly gone from a marriage, because the usual explanations reach for something heavier: he has lost…