Practices

Ask for a number first, then go hunting for exceptions. How is today on a scale of one to ten, and when was it last higher than that?

An assessment can turn into an hour of everything that is wrong, which leaves a person flatter than when they arrived. Exception questions do the…

Find out what they have tried before that did not work. It saves everybody from a plan that failed this person two years ago.

Most people arriving for an assessment have been trying things for years: apps, alarms, lists, an early night, a course somebody recommended.…

Run a short anxiety and depression screener alongside the ADHD measure at every intake, not only when someone mentions their mood.

Mood and anxiety sit beside ADHD often enough that leaving them out means guessing about the concentration difficulty in front of you. Doing it as…

A tick beside 'does your mind race' means less than it looks like. Someone whose mind has raced since they were nine has nothing to compare it against, so ask what changed and when before you let the score speak.

Take the endorsed items one at a time and put a period of time around each one. When did this start? Was there ever a stretch when it was not there?…

Both people will tell you they were up for three nights. The useful question is what they did with those hours: driven and busy points one way, wired and wrecked points another.

In mania the need for sleep falls away and the activity has a purpose behind it, however unrealistic that purpose looks from outside. In ADHD the…

Disruptive mood dysregulation disorder was built partly to keep the bipolar label off children whose future nobody can yet see. Worth remembering when that word lands on a family's paperwork: it describes now, and it does not settle later.

Use it the way it was meant to be used. Review it as the child grows instead of filing it as a fixed fact about their brain, and think about how you…

Ask twice. First, who in the family has an actual diagnosis. Then, who do you look back on now and wonder about. The second question nearly always brings more than the first.

Plenty of families never went near a clinic. Help was not trusted, or the answer at home was to stop complaining and get on with it, so the…

A child who grew up listening for a parent's seizure learns to keep half an ear on the room, and years later that can look a great deal like distractibility. Ask what they were listening out for as a child.

This turns up most often where there was one parent and nobody else to keep watch. The person cannot settle, cannot stay with a task, and has assumed…

Alongside diagnoses, ask how relatives died. Falls from roofs, crashes, deaths with the safety gear left on the ground: these recur in some family lines and they say something a list of diagnoses cannot.

Ask it gently and let people take their time, because you are asking about grief as much as about pattern. What you are listening for is a habit of…

The relative who was shut in a cupboard, tied to a chair or expelled was being managed for the same thing you are assessing now. There was simply no name for it then and no help attached to it.

Told carefully, this changes the story a family tells about itself. Not a line of difficult people, but a trait that has been present for generations…

Before you decide a strategy has failed, check whether the medication underneath it is doing its job. If someone is sitting in front of you still struggling, the honest first answer is usually that it is not, quite.

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…

Before handing anyone a new system, make sure they can say back why it should work better than what they are doing now. A strategy with no reason attached gets dropped the first time it is inconvenient.

Ask them to explain it to you in their own words and listen for whose reason it is. If the logic is only yours, it will hold for about a week. It is…

Strategies for ADHD are visible. A timer on the table, a list on the wall, an alarm going off in a meeting. If someone has not yet made peace with having ADHD, each of those is an announcement, and it will quietly get dropped.

So ask, before handing over another tool: how do you feel about the diagnosis itself? Sometimes the honest answer is that they still half hope it was…

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.

Be specific about the first fortnight, since that is when it is worst and the payoff has not arrived yet. Someone who expected a small effort and met…

When something did not get done, find out which half broke. Did they not know what to do or when? Or was the plan fine, and the moment for doing it came and went?

Ask for the last time it happened, hour by hour, up to the point where it did not happen. A planning failure needs somewhere reliable to catch tasks…

Awareness is knowing what needs doing and when. Motivation is doing it once you know. Nearly every app on the market solves the first one, which is why buying another one so rarely helps.

Test it with one question: at the moment it did not happen, did you know? If the answer is yes, the reminder was never the missing piece, and a…