Dr John Flett Paediatrician

11/04/2026

First term often reveals something parents weren't expecting. Their child is lonely.

The birthday party invitations that didn't arrive.

The friend group that seemed to quietly close around everyone but him.

The child sitting at the edge of the playground — not in trouble, not upset, just... not quite inside the circle.

These are the things children don't always tell you directly. But they show up in the eyes when you ask how school was, and the answer is a shrug.

Social difficulties are one of the least discussed aspects of childhood ADHD — and one of the most painful.

The Pause Button that helps regulate impulses in conversation develops more slowly in the ADHD brain. A thought arrives and it is out — before the social consequences have been calculated. The Interest Engine can make it genuinely hard to engage with topics that don't feel compelling. And the emotional response to perceived exclusion can feel completely overwhelming to a child who has no idea why friendships seem harder for him than for everyone else.

He is not difficult. He is wired differently — in a way that makes the unwritten social rules much harder to read.

This holiday, I want to give you one practical thing.

Create one low-pressure, one-on-one social opportunity for your child. Not a party. Not a group. One child, a structured activity with something to actually do together, and a defined time limit.

That is the environment where social skills genuinely develop for children with ADHD.

Small. Structured. Safe.

If social and emotional concerns came up this term, please reach out — these conversations are important.
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11/04/2026

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10/04/2026

10/04/2026

Teacher feedback from this term is valuable — but only if you do something with it before term 2 starts.

Write down the two or three most specific things your child's teacher mentioned. Not the general impressions — the concrete observations. "She forgets her reader every day." "He shouts out in class." "She seems very anxious during assessments."

Then, before the new term begins, share those observations with whoever manages your child's care — whether that's a paediatrician, a therapist, or the school's learning support team. Specific observations are the building blocks of a better plan.

Don't let the holidays wash it away. Write it down while it's fresh.

I have written more about how to use teacher feedback effectively on my blog if you would like the full picture: drflett.com

https://courses.drflett.com/dont-let-teacher-feedback-disappear-over-the-holidays/

10/04/2026

Two weeks of "freedom" can quietly unravel months of progress. Here's why structure still matters.

Day one of the holidays — everyone exhales.

No alarm clocks. No packed lunches. No rushing.

By day three, your child is waking at 10am, screen time has tripled, and there's a low, unnameable irritability moving through the house like a weather front.

This is not a parenting failure. This is neurology.

The ADHD brain depends on external structure more than the neurotypical brain does. When the scaffold of the school routine is removed without a replacement scaffold, the Now/Not Now brain takes over completely.

Every moment becomes Now.

Screens. Food. Stimulation. Sensation. The sleep-wake cycle begins to drift within 48 hours. Appetite shifts. Mood follows. By the second week, the child who was excited about the holiday is bored, dysregulated, and harder to reach.

I am not suggesting you replicate a school timetable in the holidays. That defeats the purpose.

But the research is clear: two anchors per day make a measurable difference for children with ADHD.

A fixed wake time. A fixed mealtime.

Just two. Build everything else — activities, outings, screen time, rest — loosely around those two fixed points.

You don't need a full schedule. You need a shape.

That shape is what keeps the holiday from becoming something everyone needs to recover from.

More guidance on managing ADHD at home is available on my blog and courses platform.
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10/04/2026

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09/04/2026

Should you stop the medication over the holidays? It's the question every April brings.

The tablets are there on the shelf.

School is out. There's no homework, no classroom, no need to sit still for six hours.

And someone — a family member, a friend, a voice in your own head — has suggested giving your child a break.

It sounds reasonable. But let me give you the full picture.

This is one of the most common questions I hear every single April — and one of the most misunderstood.

The medication doesn't accumulate in the body. There is no reservoir to clear. What changes when the medication stops is simply that the brain chemistry reverts to its baseline. For some children, that is perfectly manageable during an unstructured holiday period. For others, it significantly affects sleep, appetite, mood regulation, and the ability to actually enjoy the holiday.

The question isn't really "should he have a break?"

The question is: what does your specific child need during these specific two weeks?

A child who struggles to fall asleep without medication may find the holiday genuinely harder without it. A child whose appetite is noticeably suppressed may benefit from a brief break to recover weight and appetite. These decisions are individual — not universal.

Before making any change to your child's medication over the holidays, have a five-minute conversation with your doctor first.

Not a general rule. A conversation about your child.

Have questions about medication management over the holidays? I'm available.
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09/04/2026

70% of children with ADHD respond to stimulant medication.
That number comes directly from South Africa's new ADHD guidelines. And it is worth sitting with for a moment.
Seven out of ten children respond to stimulant medication. When you add the children who respond to the other stimulant class — because a child who does not respond to methylphenidate may respond to amphetamines — the effective response rate is even higher.
But the guidelines go further than just confirming that medication works.
They say treatment interruption is not recommended. Drug holidays are only justified for catch-up growth or weight. And they should never coincide with transitions like a new school year or exams.
They confirm that weight does not determine dose. You titrate against clinical response, not kilograms.
They list multiple generic long-acting methylphenidate options now available in South Africa alongside Concerta — improving access and affordability.
And they confirm that lisdexamfetamine is now available in South Africa. A fourteen-hour pro-drug amphetamine with lower misuse potential. Registered for thirteen years and older.
Your child's brain is not broken. It is wired differently. And when you combine genuine understanding with evidence-based treatment, the trajectory changes.
Read the full guideline analysis: https://courses.drflett.com/42588-2/
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08/04/2026

https://courses.drflett.com/can-my-child-take-adhd-medication-if-they-have-epilepsy/

08/04/2026

Shout out to my newest followers! Excited to have you onboard!

Este Fourie, Tracey Iyappen, Galeboe Matome, Sam Pather, Tienie Van Loggerenberg, Nadine Dunn, Ingrid Bredell, Roslynne Hill Toerien, Kelly Michelle Saint, Ronel Oelofsen, Yolandie Fouché, Joy Mthethwa, Sam Harvey

07/04/2026

Structure is not punishment. Structure is the scaffolding his brain needs.

Parents often tell me: 'I don't want to over-structure him. I want him to be free.' I understand. But there is a profound misunderstanding here.

The ADHD brain does not experience structure as restriction. It experiences it as relief.

When you say 'Homework happens at 4 o'clock, at the kitchen table, with a ten-minute break after the first page,' you are not punishing him. You are removing the thousands of micro-decisions his brain would otherwise have to make. You are giving it permission to focus.

The child with ADHD is not lazy. He is exhausted. His executive functions are running a constant background process — time management, task initiation, working memory, the gap between knowing and doing. Routine removes the background noise. It frees up the processing power for actual learning.

When structure is warm, consistent, and clear — when it comes with your presence and understanding — it becomes an expression of care. Structure is love. Not because it limits him. Because it supports him.

💡 QUICK WIN: Pick one routine that currently feels chaotic — morning preparation, homework time, bedtime, or transitions. Tomorrow, add one specific structure: a visual checklist, a set time, a consistent location, a rhythm. Not as punishment. As scaffolding. Watch what happens when the decision-making burden lifts. Often, the behaviour improves not because you've enforced harder, but because his brain suddenly has room to breathe.

🔗 Discover the specific routines that work best for the ADHD brain at courses.drflett.com

Questions? Contact Dr Flett:
📞 031 1000 474 | ✉️ support@drjohnflett.com
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