Practices

Let the person facing it choose the first step, and let them choose an easy one. A rung somebody picked gets climbed. A rung assigned to them gets argued about.

Ask which one they would be willing to have a go at this week, not which one they ought to be able to manage. The answer usually sits somewhere in…

No step happens without the person agreeing to it. Not ordered, not dragged, not talked round in a bright voice. Agreement is a condition of the thing working, not a courtesy.

Coerced exposure teaches two lessons at once: that the situation is dangerous, and that you are not safe with the people who arranged it. After that…

What you expect from a treatment shapes what you get from it. That is worth a conversation before you start, not months later when it has not worked.

If you are beginning something new and half of you thinks it is nonsense, say so. A doubt that stays unspoken tends to come out as a missed…

Nobody tolerates something unpleasant for no reason. Before starting anything difficult, get clear about what you want on the other side of it, in your own words.

Something like: I want to sit an exam without being sick, so I am willing to practise feeling uncomfortable. The sentence has to be yours. A goal…

Do not walk into a hard event and improvise. Ten minutes beforehand, work out what is likely to happen, what you will do about it, and how you get out if you need to.

If someone is coming with you, make it a shared plan. What the signal is when one of you needs air, who says what to whom, when you leave. The point…

The age by which symptoms have to have shown up is a number people agreed on, not a line in nature. It moved from seven to twelve when the manual was revised.

That matters if you are an adult wondering whether you would even qualify. The old cut-off was itself a compromise between studies pointing in…

You do not need clinical language at an assessment. Some of the wording in the manual came straight from how families described it in the first place.

Phrases about being permanently on the go are in there because people kept saying them. So use yours: that your head is like a browser with forty…

Not all distraction comes from outside. Some of it is a thought that will not leave, circling while you read the same paragraph four times.

That difference matters at an assessment. Being pulled away by everything in the room, and being held in place by an intrusive thought you cannot put…

Eating that runs away from you, and eating you cannot stop once it has started, turn up alongside ADHD more than people expect. Usually it is doing a job rather than proving a weakness.

The pattern leans towards bingeing rather than restricting, which fits: it belongs with the difficulty of stopping something already in motion. Often…

Trouble with eating, and with how your body looks, gets missed far more often in men. The questionnaires and the expectations behind them were built around women.

In men it runs more towards size and muscle than towards thinness, and towards fixing on one part of the body that everybody else says looks…

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…

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…

Two referrals turn up again and again. A young child being asked to leave a school for behaviour, with no developmental or cognitive information anywhere in the file. And a parent saying something is wrong while the school says everything is fine. Both are describing adult frustration rather than a formulation.

In each case the first job is the same: get some data. Not another opinion, not another meeting, but something measured about how this child thinks…

Start with a couple of minutes of movement before any of the difficult talking. Not a warm up for its own sake: a body that has moved is easier to think in.

Two or three minutes is enough. Roll the shoulders, round and lengthen the spine, turn gently side to side. It also says something without anyone…

With someone grieving, offer your presence more than your words. Sit with them; let silence be enough.

You do not need the right thing to say. Being there, quietly and again and again, is the help.