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Areas › Focus, starting, and ADHD › Getting assessed and diagnosed
Ask about the shape of the day rather than the dose alone. When does it come on, when does it wear off, which hours are the hard ones, is there any cover left by the evening. If the difficult hours fall outside the cover, no amount of planning or list making will rescue them, and the person will quietly conclude that they are the problem. Send what you find to the prescriber: adjusting is their work, noticing can be yours.
'and ease my task for me' (Quran 20:26). Moses asks for the load to be made lighter before he sets out, rather than pushing on and calling that strength.
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
In a large multicentre randomised trial in adults with ADHD, methylphenidate did better than placebo, while structured group psychotherapy was not clearly better than individual clinical management. That is one trial with its own design choices and it does not make psychological work pointless. It does suggest the medication question deserves asking early rather than last when someone is not getting anywhere.
Philipsen A, Jans T, Graf E, Matthies S, Borel P, Colla M, Gentschow L, Langner D, Jacob C, Groß-Lesch S, Sobanski E, Alm B, Schumacher-Stien M, Roesler M, Retz W, Retz-Junginger P, Kis B, Abdel-Hamid M, Heinrich V, Huss M, Kornmann C, Bürger A, Perlov E, Ihorst G, Schlander M, Berger M, Tebartz van Elst L, Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study (COMPAS) Consortium. (2015). Effects of Group Psychotherapy, Individual Counseling, Methylphenidate, and Placebo in the Treatment of Adult Attention-Deficit/Hyperactivity Disorder: A Randomized Clinical Trial.. JAMA psychiatry doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Strategies only get their chance during the hours a person can actually use them.
None of this is prescribing: changes to medication belong with the prescriber, and altering or stopping a dose without them can go badly.
Teenage memories of this often come with a sting: the year you worked out how much longer everything took you than it seemed to take everybody else.
Find out what they have tried before that did not work. It saves everybody from a plan that failed this person two years ago.
Ask what they think this will cost them in effort, then say what you think. People rarely give up because a strategy failed. They give up because it turned out to be harder than anyone had told them.