Focus, starting, and ADHD

Put today next to the night before it, out loud and often. How did today go after seven hours of sleep, next to the day that followed staying up until three?

ADHD makes it hard to link a consequence back to a choice made hours or days earlier, so the link has to be supplied from outside until it starts…

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.…

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…

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…

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…

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.…

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…

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…

More clinicians now raise supplements themselves, and more of them will suggest something like omegas. The shift matters less for what gets recommended and more for what it does to disclosure.

People hide what they expect to be laughed at. Someone braced for an eye roll simply does not mention the four bottles in the kitchen cupboard, and…

Omega supplementation for ADHD began with encouraging results, including a Swedish study where about a quarter of inattentive children seemed to improve. Blinded, placebo controlled work did not reproduce it, and a Cochrane meta-analysis found no effect.

The manufacturers themselves largely moved on to other conditions, which tells you something. None of this makes omegas worthless, and levels do run…

Cutting sugar does not improve ADHD, and nor does stripping out additives. Both have been tested repeatedly, including under conditions where nobody knew which child had eaten what.

The belief survives because parties are where children eat sweets, and parties are also loud, crowded and thrilling. The sugar takes the blame for…

Megavitamins, antioxidant products such as pycnogenol and assorted trace minerals have not beaten placebo for ADHD. They stay popular on the strength of a good story about how they ought to work.

The gap between a mechanism and an outcome is the thing worth teaching, because it will still be useful when the next product appears. Ask what…

Sensory integration training is popular and it does not help ADHD. Whatever value it has elsewhere, the capacity it works on is not the one that is impaired here.

What is impaired in ADHD is holding back a response and steering your own behaviour over time. Sensory modulation is a different thing altogether.…

Chiropractic neurologic organisation training, the kind involving manipulation of the skull, has no credible theory behind it for ADHD. The main harm is not the treatment itself but the months and the money that go into it.

Families meet this because it is marketed at them at the exact moment they are most willing to try anything. Naming it plainly, once, is usually…

A child can learn a self control routine beautifully in the therapy room and not use it once all week at school. Knowing the steps and performing them under pressure are two different skills.

This is why supports that sit in the moment tend to beat supports that sit in the mind. A prompt at the point of need, a changed seat, a rule the…

With EEG neurofeedback, the weaker the study, the better the results look. Six large trials using sham feedback, with parents and teachers kept unaware of who received what, found nothing beyond placebo.

That shrinking with rigour is itself the finding. Blinding matters especially here because the outcome is a rating made by adults who have watched…

Brain training makes you better at the game, and at things that resemble the game. It does not seem to reach the parts of life you bought it for.

Cogmed, the several hundred apps, the balance based programmes: they all hit the same wall when someone independent tests them with a proper control…

Remembering to do something later is really two jobs stacked on each other. You have to keep hold of the thing itself, and you have to keep some feel for how the hours are passing, and both have to be working at the same moment.

That is why this fails more often than either piece alone, and why it is the failure other people see. Seeing it as two jobs splits the fix in two as…

Add up what forgetting costs you in money over a year. Late fees, the higher interest that comes with a dented credit score, next day delivery bought at eleven at night for a birthday you have known about since January.

Being told to get organised in the abstract lands on nothing. A number lands. Put last year's late charges and rush postage at the top of the page…

If you are going to ask someone to remind you, tie it to something they want as well. Reminding you to book the car in is much easier when it is also their car.

Asked as a favour it becomes a job they never applied for, and resentment collects quietly on both sides. Asked as a shared arrangement it lasts. Be…

Notice how often a forgotten job turns up in the shower, or halfway up a flight of stairs. That is not coincidence: when nothing is holding your attention, the things you meant to do float up.

Which means those minutes are quietly doing work, and filling every one of them with a phone takes the mechanism away. Keep something to capture with…

When someone hands you a date, the useful move is not writing the date down. Open your calendar there and then and decide the hour the work will actually happen.

A deadline only announces itself at the very end, when there is no room left to do anything about it. Booking the doing rather than the due date…

The standard was never that you drop nothing. It is that the effort is steady and visible, and the misses that remain get some grace.

This matters as much for the person waiting on you as it does for you. Perfection gives them nothing to notice and gives you nothing to reach, so…

If the screen limit in your house is only your preference, every evening turns into a negotiation about your preference. Borrowing a published figure, roughly two hours a day of leisure screen time for a child over two, moves the argument off you.

The carve-outs matter as much as the number. A video call with a grandparent is a conversation, and a laptop open for homework is schoolwork, so…

Fast cuts, saturated colour, constant motion, a level that ticks over just as you were about to stop. Screens are not accidentally gripping for a distractible brain, and preferring them says something about how you are wired rather than about what has gone wrong with you.

There is a second use for knowing this. If those features are what holds attention, they are also the features worth stealing for the things that…

Ask a child how long they were on the tablet and the answer comes back low. Ask their parent and that answer comes back low too. Neither of them is exactly lying to you.

A child does not volunteer that they went over the limit, and a parent doing their best on every other front rounds their own household down. This…

Plenty of people now describe attention that fails, memory that slips and a day sliced into fragments. That description on its own is not ADHD, and it is worth being careful before anyone hands over a label.

The environment is producing a version of these symptoms in people who do not have the condition, and calling that a diagnosis does two things badly.…

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…