Focus, starting, and ADHD

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…

Headsets have become cheap enough to sit in an ordinary consulting room, and the use with the best backing is graded exposure. You can set the intensity exactly and repeat it as often as the person needs.

The value is in the control. A feared situation can be dialled up in small steps, run again the moment it stops being frightening, and ended without…

A weighted vest seems to do its work in roughly the first quarter of an hour. Twenty minutes did not beat fifteen, so longer is not more help.

Use it as a tool for a moment rather than a garment for the day: on before the piece of work that needs the most sitting still, off once that is…

With some sensory routines, the part doing the work may be a parent's steady hands and full attention rather than the technique itself. Worth knowing, because contact carries into the rest of the day and a protocol does not.

Views differ on this and the research has not sorted it out. What follows practically is that a family who cannot keep the exact routine going has…

When a test trips a child on something it was never meant to measure, change how they answer rather than what is asked. A spelling test spoken aloud is still a spelling test.

One girl saw letters as solid three dimensional shapes that would not sit together on a page, so writing them was a perceptual problem rather than a…

Ask for photographs of every bottle rather than a list from memory, then pass that list to the prescriber. Recall is patchy about names and hopeless about doses.

Intake forms catch some of it and a photo of the shelf catches the rest, including the two things nobody mentions because they seem too minor to…

Food colouring is the one narrow exception in this area. Large studies suggest it may mildly wind up some very young children, so a trial removal in a preschooler is a reasonable thing to do.

Keep it in proportion though. This is a minor irritant in a subset of little children, nowhere near the sweeping dietary cause that was claimed…

The restrictive elimination diet has real methodological problems, and it is expensive and exhausting to run. If a family still wants to try it, they can, because unproven and dangerous are different words.

There is usually more to lose by forbidding it. A family who feels blocked either does it anyway without telling you or spends another year…

Play therapy and insight based psychotherapy do not treat ADHD. There is no buried, unexpressed feeling driving it that talking will let out.

The difficulty sits in executive control and how it develops, not in hidden conflict. That said, a child with ADHD can also be anxious, grieving or…

Most of what we call memory looks backwards. The kind that actually runs your week is the other sort: a plan that has to show up in your head at the one moment you could still act on it.

So when something gets missed, the question is not really whether you knew about it. You almost certainly did, at the time you agreed to it. What…

A thought you have in the car about something to say at home is worth nothing until the person is actually there in front of you. Cues have to sit where the action becomes possible, not where you happened to think of it.

Picture where you will be at the moment the thing can be done, and put the reminder there: a note on the front door for something that happens on the…

The moment you think of it is the only moment you are certain to have it. Do the thing, or write it down, or set the alarm, or put something odd in your pocket that will make no sense later until you check.

The two seconds of holding it in mind while you finish what you are doing is usually where it disappears. So make capture the reflex instead of the…

Start the email and then stop: address it, write the subject line, leave it unsent. The half finished thing sits in your drafts looking wrong until you deal with it.

It works because it leaves an odd looking object in a place you already go, and because unfinished jobs nag in a way that quiet decisions do not.…

The bag that has to travel with you tomorrow goes on top of your shoes, not neatly beside the desk. Let the object stand in the way of a route you walk without thinking.

The phrase worth keeping is point of performance: the reminder has to sit where the action happens, at the time it has to happen. A note on the…

Sometimes you cannot write it down. You are driving, your hands are full, you are halfway through a conversation. Then picture the moment in detail instead: the room you will be standing in, the object you will be looking at when you do it.

Make the picture concrete rather than worthy. Not a solemn 'I must ring the surgery' but the desk you will be sitting at, the mug beside the phone,…

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…

Take one of the gaps you already have, the commute or the walk or the shower, and use it to ask what is coming up this week and what might be slipping. No new tool, no new app, just the question.

That turns something accidental into something you can count on. It works best in the same place each time, so that the place starts asking the…

A ping about a parcel and a ping about your mother's health feel identical in the second before you look. Give that feeling a name, false urgency, and you get a little room.

The buzz carries no information about importance. It borrows the feeling of importance and lends it to whatever happened to arrive. Naming it in the…

One gentle way to name it: those are being used as words to play with, and they were never really words for playing with. Said kindly, it lands without anyone being told off.

The young person in front of you almost certainly says it too, so any version that sounds like a reprimand will close the conversation down. Naming…

When you wave off what your child is into, they rarely hear a comment about gaming. They hear something about themselves.

At that age a good part of who someone is gets built out of what they love, so a shrug at the thing usually lands as a shrug at the person. You do…

Gaming for an hour before you start the work almost never costs an hour. Do the thing that has to be done first, then the thing you want.

Once something enjoyable is running, whatever you were meant to do afterwards looks duller than it already did, and the hour quietly becomes three.…

Charge the phone in another room overnight and use a proper alarm clock. Small change, and it takes the decision away from you completely.

In bed the phone is right there, and stopping is left to you at the hour you have the least left. Out of the room, there is nothing to resist. Buy…

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…