Focus, starting, and ADHD

When someone says they feel restless inside, ask what the restlessness wants. Restless to move, or restless to do one particular thing until it feels right?

The two feel similar from the inside and point in different directions. With ADHD it is usually undirected: the legs go, the chair is wrong, you need…

A distracted person can be brought back with a nudge. Someone who has gone elsewhere cannot, and the difference shows itself in a couple of seconds.

Say their name, ask something simple, and watch what returns. Attention that has drifted comes back with a small apology and picks the thread up…

Try not to ask why. If the person knew why, they would probably have sorted it out already, and the question tends to land like an accusation.

Ask what happened just before instead. What was going on, what they felt, what came after, what sort of day it had been. Those answers can be worked…

If someone was adopted, or simply does not know their family history, say early and plainly that this is not a problem. It helps to have and it is not needed.

Otherwise the question lands as one more reminder of what is missing, and some people will spend the rest of the appointment feeling they brought the…

Some of what looks like muddle is the system's fault. Our tenth month is named for eight, because two months were added later and nobody renamed the rest.

Worth saying to anyone who feels stupid about dates and forms. A calendar whose numbers are out of step, a tax year starting in April, forms asking…

When someone says their heart races on their medication, ask whether it ever did before they started. It is the cheapest question you have and it usually sorts the answer out.

Go looking for the old settings: waiting to be called on in class, standing outside a room before a difficult conversation, three in the morning with…

While you are taking the family history, ask about seizure disorders and psychosis too, not only about attention. A family carrying other neurological or psychiatric conditions is worth knowing about whatever you end up concluding.

Keep the list short and ask it plainly: epilepsy, psychosis, learning difficulties, head injuries, anything neurological. Some of it will matter for…

Some people simply cannot get a family history. Refugee journeys, destroyed records, closed adoptions, families that did not survive. That is a gap in the paperwork and not evidence against the diagnosis.

Say so out loud, and write it in the notes as a gap rather than as a negative finding, so the next person reading does not mistake silence for an…

One man put his lamps on a timer so the room would go dark at eleven and send him to bed. It worked for a few nights. Then he simply carried on in the dark. A cue can tell you the time. It cannot make you stand up.

Worth remembering before you build anything clever. If the pull of whatever a person is already doing is stronger than the nudge you have designed,…

'I set a reminder and still did not do it' is not a story about a bad reminder. It tells you the missing piece was never information, and a bigger, louder version of the same thing will fail in the same way.

The reflex is to escalate: three alarms, a different app, an entire new system built on Sunday night. What is needed is a change of kind, something…

You can screen for a processing difficulty with no test at all. Just notice, in ordinary conversation, whether the child is answering what you actually said.

A child who drifts off topic, answers a slightly different question, or needs things said twice may not be avoiding you or daydreaming. The words may…

Behaviour is usually the visible end of a skill that has not been built. What you are watching in a classroom is the shape of the difficulty rather than the shape of the child.

It is a single sentence you can say in a meeting, and it tends to move the conversation away from what to do about the behaviour towards what the…

More of the medicine is not automatically better. What you are looking for is a level that sits inside the working range, and going past it usually brings side effects rather than sharper thinking.

It is a natural thought that if some helps a little, double would help twice as much. In practice people describe the higher dose as flat, or wired,…

If sleep has gone since starting, look at what time the dose is being taken before deciding the medicine is the problem. A long acting dose swallowed at one in the afternoon is still working at bedtime.

Extended release preparations are built to cover eight to twelve hours from whenever they are taken, so a late start pushes the whole thing into the…

Do not compare your dose with anybody else's. Two milligrams of one medicine and a hundred milligrams of another can both be perfectly ordinary, because strength per milligram differs from molecule to molecule.

This comes up in waiting rooms and family group chats and it causes real alarm about being on a lot. The number on the box only means something…

If you are living on campus, ask the pharmacist to split the month's supply across two labelled bottles. Then whichever one you are carrying has a valid prescription label on it.

Carrying a controlled medicine loose in a bag, or in an unlabelled tin, is a disciplinary and sometimes legal problem quite separate from any medical…

If a young driver in your house takes medication, the dose and the car keys belong together. Driving is the everyday task where one lost second costs the most.

The gap tends to open at weekends and in the holidays, when the dose gets skipped because there is no school and then someone drives anyway. Make it…

If you open atomoxetine capsules to mix the contents into food, keep it away from your eyes and wash your hands afterwards. The powder stings badly.

The molecule is acidic and cannot be softened without falling apart, so the fix is in the handling rather than the chemistry. Take it with something…

Stand up slowly. Getting off the floor after an hour of gaming, or out of bed in the morning, is where the dizziness tends to catch people.

A drop in blood pressure on standing is common enough with these medicines and it frightens people, because a near faint feels like something serious…

If a question at the counter feels like judgement rather than care, you are allowed to ask which it is. Is this a medical question or a personal one?

Asked evenly it does not start a row, and it returns the conversation to where it belongs. Pharmacists have proper clinical questions to ask about…

If swallowing the capsule is the sticking point, ask whether yours is the bead type that can be opened and tipped onto a spoonful of soft food. The little beads go down unchewed and the medicine still lasts as long as it should.

Inside these capsules sit lots of coated pellets, some with thin coats that dissolve early and some with thicker coats that dissolve later, which is…

The skin patch comes with two things worth knowing before you start. Take it off several hours before bedtime or it keeps delivering and sleep goes, and around one person in six gets a rash bad enough to stop.

The upside is real control over the length of the day. Because the medicine stops arriving soon after the patch comes off, the removal time is yours…

There is now a version taken in the evening that only switches on around nine hours later, so it is already working when you wake. The point of it is the morning, not the night.

Most families know the first hour of the day as the worst one, because the tablet taken at breakfast has not started yet and everyone still has to…

With a bedtime dose, the clock is the dose. Give it too early and the medicine switches on in the small hours, which buys you a child awake at half past four and no appetite at breakfast.

The ordinary effects still apply: appetite tends to dip around the middle of the day and sleep can be harder to come by. What changes is that one…

Notice which word somebody reaches for. Protection sounds like a shield against loss, while what the studies describe is closer to a little extra growth, and those are not the same promise.

The difference is small on the page and large in a consultation. A parent who hears protection may start treating the tablet as a wall they cannot…

The same question has not been asked of the non-stimulants. They reach much of the same circuitry, so you can see why people expect a similar effect over years, but expecting is all it is.

This is a good place to notice the shape of your own reasoning. Going from these drugs touch the same regions to therefore they do the same thing…

People expect to feel wired and often describe feeling settled instead. That surprise is common enough to be worth knowing about before you start.

What tends to quieten is the churn: the half started tasks, the jumping from one thing to another, the low hum of being behind. That can read as calm…

Saying that medication helps is not the same as saying everyone should be on it. If you have walked in braced for a push, it is fine to say so at the start.

Plenty of people do well with sleep, movement, work that suits them and someone in their corner, and plenty of people need all of that and a tablet…

Stimulants have been used for this since 1937. That is a long time for any treatment to survive, and very few do.

Longevity is a different argument from a trial result. It means decades of changing fashion, competing products, repeated safety scares and reviews,…

These medicines do not pour a foreign chemical into you. Mostly they help you hold on to the serotonin your body already makes, so whatever follows is yours.

The worry underneath is usually about authenticity: that any lift will be counterfeit, or that it will not really be you feeling it. Knowing that the…

Writing 'do not substitute' on a prescription tells the pharmacist what to hand over. It does not tell an insurer to pay for it, and that surprise at the counter is where a lot of prescriptions quietly get abandoned.

If a particular brand is being chosen for a reason, say out loud what it might cost and what the fallback is if the price turns out to be impossible.…

Most long acting stimulant capsules hold two sorts of beads, one that dissolves straight away and one coated to dissolve later. That is the whole reason a single morning capsule can do what used to need a lunchtime dose as well.

It matters because the midday dose was the one that got missed, and missing it was rarely carelessness. A dose that has to be remembered in the…

The line about not cutting, crushing or chewing a long acting medicine is a safety instruction with a real mechanism behind it. Break the coating and the whole day's dose arrives in one go.

People sometimes crush a capsule because swallowing is genuinely hard, not because they are misusing it, so ask before assuming. There are usually…

Long acting stimulants are the usual starting point for a plain reason: they cover the most hours and they remove the lunchtime dose, which is the dose ADHD is most likely to swallow whole.

Remembering a tablet in the middle of a busy day is itself an executive task, so asking for it is asking the person to do the thing they came for…

The most useful question about a dose is whether the person can tell. A shrug and 'I think it sort of helps a bit' usually means it is not yet doing its job.

At a dose that suits them, most people can say when it comes on, what the middle of the day feels like, and when it leaves. Vagueness points…

Half the useful health information arrives sideways. Someone says 'I am so tired' on the way into another subject, and that is an opening worth taking gently.

People rarely bring sleep or food to a session as a topic, because they do not file them as symptoms. So the tiredness, the skipped meals and the…

Count good days, not unbroken runs. Whatever yesterday was, brilliant or a write off, the only live question is what can be done with today.

Streaks make one slip cost everything, so the missed night turns into a missed week and then the whole effort gets quietly dropped. Aiming for more…

There is no brain scan, EEG trace or blood test that can tell you whether someone has ADHD. Anything sold as an objective biological test for it is promising more than the science can give.

Group differences do exist, including in the theta to beta balance, but a difference that appears when you average hundreds of people cannot identify…

Balance difficulties do turn up more often in ADHD, by something like half again. That is a fact about company, not about cause, and it does not turn balance training into a treatment.

Plenty of things could sit behind a link like that. More falls and knocks, more risk taken, or genetics feeding both at once. Working on balance…

Protocols that spin a child in a chair or tip them backwards and forwards to train balance do not improve ADHD. What they mainly produce is a dizzy child.

There is a cost beyond the wasted afternoons. Something unpleasant that was introduced as treatment teaches a child what treatment feels like, and…