Practices

Think of ADHD as sitting at the centre of an onion. Poor sleep, sleep apnoea, low vitamin levels, allergy, ongoing pain, untreated anxiety or low mood all sit in layers around it, and each one makes the centre look worse than it is.

This explains something that otherwise looks strange: treatments that do nothing whatever for ADHD can still make a real difference, because they…

Think of it the way you would think about diabetes. Something to manage with several things at once, most days, for as long as it is there.

That frame does a lot of quiet work. It says the treatment is ongoing rather than a course you finish, it explains why things slide back when…

There is no single treatment that covers all of this. What works looks more like five things running alongside each other, and understanding the condition comes first.

Each piece reaches a different part of the day. Medication does something the environment cannot, changing what a room asks of someone does something…

The stack goes: understand it, medicate where that is right, change what the adults do, change what the day asks, and keep arguing the child's corner. Each layer does a job the others cannot.

None of them stands in for another, which is why swapping one out leaves a gap rather than a smaller plan. Medication does not reorganise a…

Behaviour work for ADHD is mostly about changing what the adults do. The child's behaviour shifts afterwards, as a consequence.

Consequences live in other people's responses, and a child who cannot yet hold a reward in mind across three days cannot supply them for themselves.…

When a child with ADHD and a parent get stuck in daily rows, the rows themselves start doing damage. Getting the ADHD properly managed early takes some heat out of those exchanges before defiance settles in as a habit.

The chain people worry about runs from constant friction at home to entrenched defiance, and from there to difficulties in the teenage years that are…

A child's reputation is made in the classroom, mostly out of adult earshot, and it follows them from one year to the next. Teachers who work on how the class treats the child, and not only on the child, can move it.

The version that has been trialled has the teacher doing small deliberate things: pairing children with some thought, noticing this child out loud…

The therapy that helps adult ADHD is not really about arguing with your thoughts. It is practical work on how your week is built, and it works because you are the one who can go and rebuild it.

Sessions tend to circle the same handful of things. Where the list lives, what the calendar actually does when you are not looking at it, how a large…

The most convincing programme for teenagers does the obvious thing. It runs at school, twice a week, so nobody has to be driven anywhere: homework systems, organisation, some social practice and sport, in the place where the trouble actually happens.

By the teenage years the leverage parents had is thinning, and a clinic appointment is the first thing to fall off the week. Putting the help inside…

The trouble now is not that nothing works. It is that the things which work are spread unevenly, and whether a family gets any of them depends heavily on where they happen to live.

Medication travels reasonably well, since a prescriber can be found in most places. The psychological and behavioural work travels badly, because it…

Paying someone to help sort the house will not mend the marriage. It will remove one of the things you fight about most weeks, and that counts for more than it sounds.

Nobody should pretend this reaches anything deep. The point is arithmetic. A couple has a certain number of rows in them, and if the living room is…

People who are sleeping properly, eating properly and moving a bit tend to want each other more. The unglamorous parts of life management run closer to the bedroom than either of you might expect.

It is worth saying out loud when desire has quietly gone from a marriage, because the usual explanations reach for something heavier: he has lost…

An exam is a task with requirements. It is not a ruling on whether you are capable, however much it feels like one while you are sitting inside it.

Saying that once changes very little. The person this comes from took a long time to arrive at it, and that is worth knowing so you do not expect it…

Look for something genuinely hard that sits on top of something you are already good at. Too easy and your attention wanders off. Too far beyond you and it just becomes another thing you failed at.

The narrow band in between is where you stay engaged without noticing you are trying. It is usually a bit further up than feels comfortable when you…

For a lot of people with ADHD, making things is not a hobby but closer to an appetite. The itch to start something is always there, and when nothing is being made it does not go quietly.

Read that way, the restlessness that arrives when you have no project on is information rather than a character flaw. The same drive that gets called…

When the right piece of work finally has you, you are entirely there. Hours go, nothing intrudes, and the difficulty that flattens you elsewhere is nowhere in the room.

That state is the same machinery as the hyperfocus that gets you into trouble, pointed at something worth doing. Worth noticing so you can go looking…