Practices

Email is the easiest place to hide. It answers back, it never runs out, and by five o'clock it feels like you worked.

What makes it such a good stand-in for real work is that the rewards come in small unpredictable bursts and almost none of it asks much of you. Your…

Turn a vague plan into an if-then: when I sit down after lunch, I will open the one file.

Deciding in advance exactly when and where you will start removes the moment of friction where you usually stall.

An ADHD diagnosis usually arrives with two extra words attached: which presentation it is, and how severe. Both are descriptions of what gets in your way, not a grade you were awarded.

Inattentive, hyperactive and impulsive, or the two together, and then mild, moderate or severe. Mild means you met the threshold and the effect on…

Hyperactivity and impulsiveness almost never turn up alone. When restlessness appears with no attention difficulty beside it, that is a reason to ask what else might be going on.

In practice the two run together, and over the years the visible restlessness tends to settle while the attention side stays. So a picture that is…

The diagnostic manual is a document people sat in rooms and argued over. That is no reason to dismiss it, and it is a good reason not to treat it as the last word on you.

Committees weigh how reliably clinicians can agree on a criterion, what the field trials show, what a particular wording will do out in the world.…

The checklists were built around the loud version of this, and girls are more often the quiet version. If she is struggling and nobody has ever suggested an assessment, that is worth pressing on.

Defiance in girls can look like refusal, withdrawal or a long-running argument about friendships rather than the disruption a teacher would report.…

Most autistic people also meet the criteria for ADHD. The other direction is much thinner: only a small minority of people with ADHD meet the criteria for autism.

That is mostly arithmetic rather than mystery. ADHD is the more common of the two, so one overlap looks large from one side and small from the other.…

Autism and ADHD share some surface features and are still two different things. The social difficulty in each arrives by a different road.

With ADHD it tends to be impulsiveness and missing what was going on: the interruption, the thing said too fast, the friend never rung back. With…

A reward that comes every time is easy to walk away from. A reward that turns up unpredictably is the one you cannot put down, and that is exactly how your phone is built.

Sometimes there is something good in the notifications and usually there is not, and it is that uncertainty which keeps you checking. Willpower is…

When you read that some proportion of people with ADHD have a particular problem, the number tells you nothing until you know the figure for everybody else.

Twenty percent sounds alarming until you learn what the rate is in the general population. What matters is the multiple, how many times more likely,…

Hypervigilance after trauma and ADHD scanning look much alike from outside. Often the honest answer is that both are present, and the real question is how much of each.

Watching that comes from threat is aimed at something and tends to switch on in particular situations. ADHD distraction is not fussy about where it…

Damage to the front of the brain can produce something that looks a great deal like ADHD: poor impulse control, blunted judgement, a person their family says has changed.

The nineteenth century railway worker who survived an iron rod through the frontal lobes is the standard illustration, and what altered in him was…

Check the licensing before assuming you cannot afford a good instrument. Some come with permission to photocopy once you have bought the manual.

That detail matters most to the clinicians least likely to have a budget, which usually means the services seeing the families with fewest options. A…

There is more than one decent instrument, and which you use often comes down to what you were trained on. If you have never used one, say so rather than having a view about it.

Several rating scales are in wide circulation for children and for adults, validated by different groups for slightly different purposes. Picking one…

Home DNA tests turn up relatives nobody expected. If someone is thinking of taking one to fill in a blank family history, it is worth saying out loud that it may hand them more than they asked for.

People find half siblings. Sometimes they find that the story they were told about their birth was not the story. That is a great deal to receive by…