Practices

Guanfacine and clonidine arrived here sideways. Both were blood pressure medicines that doctors noticed helped with impulsivity, and the formal approval came long afterwards.

They act on receptors at the front of the brain that support working memory and holding a response back, which is a different route from the reuptake…

In practice the non-stimulants turn up more often as an addition than on their own. A stimulant in the morning with guanfacine alongside it is a common shape.

The two act at different points of the same circuit, so they tend to complement rather than repeat each other, and the blood pressure effect of one…

A heart tracing before starting a stimulant is not routinely needed. Some practices still ask for one anyway, and it can hold a child up for months.

What the guidance asks for is a careful history and an examination, with a tracing kept for children whose own or family history warrants it. An…

Canada once pulled a stimulant from the market after four cardiac deaths, then reversed the decision. Three of the four had heart abnormalities from birth and the fourth had been hiking in desert heat without water.

A handful of deaths with nothing to compare them against cannot tell you what caused them. That is an uncomfortable thing to say about people who…

The stimulant shortage is not your pharmacy being disorganised. Regulators set a fixed annual quota of the raw material, and the ceiling has been too low to cover the prescriptions being written.

Knowing that changes what you do with your energy. Ringing round twenty chemists is exhausting and it creates no supply, so spend the effort on…

When a dose wears off, things can feel worse than they ever did untreated. A good deal of that is contrast rather than the medicine leaving a debt behind.

You have spent the day at one level and then meet your own baseline without warning, late in the afternoon, usually with something still to do.…

A small short-acting dose in the afternoon, on top of the long-acting one, is ordinary practice rather than a special case. Homework and the evening drive often fall outside what the morning dose still reaches.

The hours when you most need to hold back are frequently the hours the medicine has stopped covering. Raising the morning dose to solve an early…

Skipping weekends, holidays and summers is a common suggestion and mostly it is the wrong call. The difficulty does not take a holiday when school does.

Unstructured time asks more of planning and self-regulation rather than less: whole days to fill, everyone at home, no timetable holding the shape of…

Licences start at six years old, and that number comes from how trials have to be run rather than from a safety finding. Younger children do get treated where the case is strong.

Trials need the child's own assent alongside a parent's consent, and assent means a form the child can read and understand, so studies stop where…

Rules about ADHD and military service move with recruiting needs. Send a family to a recruiter for the current position rather than answering from memory.

Every version has been seen: medication allowed, medication stopped before basic training, the diagnosis treated as disqualifying, the diagnosis…

No behavioural programme matches what medication does to the core symptoms. It is an uncomfortable sentence for anyone who would rather not medicate, and it is what the trials keep showing.

That does not make the rest of the work pointless, and it does change the order things go in. Where someone is drowning, the fastest reliable help…

Public health messages sometimes say parent training works just as well as medication and carries no side effects. Both halves of that are wrong, and a family who believes it can lose a year.

Parent training is genuinely useful and it is hard work, costing time, money, patience and a good deal of household goodwill. Calling it free of side…

For a fair share of children, medication does more than take the edges off. Their behaviour in class comes back inside the ordinary range, which few treatments in psychiatry manage.

That matters for reasons past the symptoms themselves. A child who is no longer the one named in every staff meeting gets spoken to differently by…

These are among the best studied medicines in psychiatry, in use for decades. Most of the hesitancy around them traces back to how they get covered in the press rather than to the safety record.

Saying that is not the same as saying there is nothing to watch. Heart rate and blood pressure shift a little, appetite and sleep often need…

Medication belongs in ordinary treatment here rather than at the end of the queue. Most people with a clear diagnosis will use it at some point.

Strategies and accommodations do real work while somebody is watching, and they fall away in the settings where nobody is. That is most of adult…

For a family stuck on whether to medicate at all, the comparison with diabetes often unlocks something. Nobody manages diabetes on diet alone, and nobody calls insulin a moral failure.

Offered gently it moves the question from what kind of parent am I towards what does this condition need. Played as a trump card it makes people…