Focus, starting, and ADHD

Finding out what is needed is progress, not more delay. Ringing to ask which documents they want is starting the job.

People refuse themselves credit for this and then feel they have done nothing all week, which makes the next attempt heavier. Put the question on the…

The real prize for starting early is that you are allowed to stop. At the last minute you have to keep going until it is finished, however late that turns out to be.

That is a reward you can feel this evening rather than a virtue somebody tells you about. Half an hour on Monday and the rest of the night is yours.…

Do not save the treat for when the whole thing is finished. Put something small right after the awkward step: a coffee on the way back from the shop, a sit down once the taping is done.

A reward at the end of a three week project is not attached to anything you do on a Tuesday. Hang small ones off the steps instead, and choose things…

If it has been on the list a year and nothing has moved, consider that you may have already decided. Saying so costs a good deal less than carrying it for another year.

Some items really are waiting for a better month. Others are quietly settled and only the guilt is still going round. You are allowed to say that the…

Decide now what you get if this is done by Friday, and what it costs you if it is not. Tell someone, so it is on the record.

The trouble with most jobs is that nothing happens either way, at least not for weeks. A deal made in advance puts a real consequence next to it: the…

An app can tell you what needs doing. It cannot make you want to do it. That gap is why the next one will disappoint you too.

Reminders, alarms and lists are genuinely good at the first job, so it is easy to assume a better one will finish the second. It will not, because…

Choosing the app, picking the colours, setting up the tags: that is the task avoiding you. It is interesting, it feels like preparation, and by bedtime nothing has been done.

New systems are enjoyable in a way the actual work never is, which is exactly why the evening goes that way. A useful test is whether anything on…

When something does not get written down, go back to that exact moment with curiosity rather than a telling off. What was in your hands, where were you, what did you tell yourself?

The useful information is all in the specifics: the request came in the corridor, the phone was in your other hand, you were already late. That is a…

We all keep a few small stories that let us take the easier option in the moment. Not lies to other people, just the ones we tell ourselves and half believe.

They are not a sign of a bad character. Everybody has a set, and what you have been through shapes which ones you specialise in. The reason to know…

You are allowed to decide not to write things down. What you cannot do is choose that and then be upset with yourself when you forget.

Straddling is the expensive bit: taking the easy option in the moment and the guilt afterwards. Pick one honestly. Either the note gets written, or…

Put the thing you are avoiding early in the day. Anything you place late gets pushed out by whatever the day turns into.

Early has two advantages at once. It is less likely to be shunted, because the day has not yet piled up behind it, and if it does slip it only slips…

Email is the easiest place to hide. It answers back, it never runs out, and by five o'clock it feels like you worked.

What makes it such a good stand-in for real work is that the rewards come in small unpredictable bursts and almost none of it asks much of you. Your…

Turn a vague plan into an if-then: when I sit down after lunch, I will open the one file.

Deciding in advance exactly when and where you will start removes the moment of friction where you usually stall.

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…

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…

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.…

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.…

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…

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…

Damage to the front of the brain can produce something that looks a great deal like ADHD: poor impulse control, blunted judgement, a person their family says has changed.

The nineteenth century railway worker who survived an iron rod through the frontal lobes is the standard illustration, and what altered in him was…

Check the licensing before assuming you cannot afford a good instrument. Some come with permission to photocopy once you have bought the manual.

That detail matters most to the clinicians least likely to have a budget, which usually means the services seeing the families with fewest options. A…

There is more than one decent instrument, and which you use often comes down to what you were trained on. If you have never used one, say so rather than having a view about it.

Several rating scales are in wide circulation for children and for adults, validated by different groups for slightly different purposes. Picking one…

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…

Ask for the old school reports every time. Some people arrive with a folder of every one they ever had, and you cannot tell in advance which people those are.

It is easy to assume that a parent who is disorganised will not have kept anything, and that assumption quietly costs you evidence. Teacher comments…

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…

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…

Run a short anxiety and depression screener alongside the ADHD measure at every intake, not only when someone mentions their mood.

Mood and anxiety sit beside ADHD often enough that leaving them out means guessing about the concentration difficulty in front of you. Doing it as…

A tick beside 'does your mind race' means less than it looks like. Someone whose mind has raced since they were nine has nothing to compare it against, so ask what changed and when before you let the score speak.

Take the endorsed items one at a time and put a period of time around each one. When did this start? Was there ever a stretch when it was not there?…

Both people will tell you they were up for three nights. The useful question is what they did with those hours: driven and busy points one way, wired and wrecked points another.

In mania the need for sleep falls away and the activity has a purpose behind it, however unrealistic that purpose looks from outside. In ADHD the…

Nearly everything on the ADHD list can show up inside a bipolar presentation, and the reverse is not true. So the shared features settle nothing, and the distinctly manic ones carry all the weight.

Put your attention on episodic elevation, grandiosity and a genuinely reduced need for sleep. Those do not belong to ADHD on its own, so they tell…

Disruptive mood dysregulation disorder was built partly to keep the bipolar label off children whose future nobody can yet see. Worth remembering when that word lands on a family's paperwork: it describes now, and it does not settle later.

Use it the way it was meant to be used. Review it as the child grows instead of filing it as a fixed fact about their brain, and think about how you…

How an outburst ends tells you more than how it starts. Give an ADHD storm some room and it often burns itself out. The rage that runs for an hour with the lights out behind the eyes is a different animal, and so is the child who genuinely does not mind what you take away.

Ask the parents to walk you through the last three. What set it off, how long it ran, what stopped it, what the child was like an hour afterwards.…

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…

Ask twice. First, who in the family has an actual diagnosis. Then, who do you look back on now and wonder about. The second question nearly always brings more than the first.

Plenty of families never went near a clinic. Help was not trusted, or the answer at home was to stop complaining and get on with it, so the…

A child who grew up listening for a parent's seizure learns to keep half an ear on the room, and years later that can look a great deal like distractibility. Ask what they were listening out for as a child.

This turns up most often where there was one parent and nobody else to keep watch. The person cannot settle, cannot stay with a task, and has assumed…

Alongside diagnoses, ask how relatives died. Falls from roofs, crashes, deaths with the safety gear left on the ground: these recur in some family lines and they say something a list of diagnoses cannot.

Ask it gently and let people take their time, because you are asking about grief as much as about pattern. What you are listening for is a habit of…