Not all distraction comes from outside. Some of it is a thought that will not leave, circling while you read the same paragraph four times.

A man who could not get himself to bed kept his bedtime alarm upstairs, where his wife and baby were sleeping. Switching it off meant climbing the stairs, and leaving it meant waking them. The walk to the alarm was the thing he was trying to do anyway.

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.

When a child with attention difficulties is also at war with every instruction, that pairing is worth taking to someone early rather than waiting to see whether it settles.