Practices

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.…

The manual now asks for signs by age twelve rather than age seven, and it added wording that fits adult life, including restlessness felt on the inside.

The older cut-off quietly excluded a familiar group: bright children, or well supported ones, who managed until the demands rose and only visibly…

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…

Nearly everything on the ADHD list can show up inside a bipolar presentation, and the reverse is not true. So the shared features settle nothing, and the distinctly manic ones carry all the weight.

Put your attention on episodic elevation, grandiosity and a genuinely reduced need for sleep. Those do not belong to ADHD on its own, so they tell…

When someone cannot let go of the old rule after the rules have changed, that is the same machinery that loses their keys and drops the thread of a sentence. Stuck, not stubborn.

It shows up in small places. The game changes and they argue for the old version. The usual road is closed and the whole trip falls apart. A plan…

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…

Where a relative has taken ADHD medication, take the details: who they are to your patient, what they were given, what it did, and what was tried and dropped. Then put it in the referral letter.

No blood test tells a prescriber where to start, so a brother's clear response to one drug, or a mother's bad reaction to another, is one of the few…

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…

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…

There is no box you type 'always late' into and get the answer out of. When a sensible strategy is not landing, the work is finding out what is blocking it rather than producing another strategy.

If you notice yourself handing over the fourth tool for the same problem, stop and ask a different kind of question. What happened the last time they…