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.

Prescribers usually begin below the dose likely to work and build upwards. That means the first weeks can be underwhelming by design, and it is not the moment to decide the whole thing has failed.

When appetite disappears at lunchtime, work with the child's rhythm instead of against it. Feed them properly at the hours they are actually hungry, which is usually breakfast and then the late afternoon and evening.

A child who has spent years being told they are careless will often say yes to whoever finally seems glad of them. Work on how they see themselves is not a soft extra to the clinical work.