ADHD Assessment

MSE

• Behaviour: Restless throughout the 50-minute session; frequently shifted posture and bounced right leg. Good eye contact maintained, cooperative, rapport easily established.
• Mood: Reported feeling "scattered and overwhelmed"; affect was euthymic, reactive, and congruent.
• Thoughts: Logical and goal-directed, though occasionally tangential when providing historical examples. Oriented to time, place, and person. No delusions or hallucinations.
• Cognition: Intact gross memory, though required prompts to recall multi-part questions during the interview (indicative of working memory strain).

Observations

• Arrived 10 minutes late due to misplacing car keys and forgetting clinic level. Brought collateral school reports from Years 3 to 6, which were loose and unorganised in a tote bag.

Reason for assessment

• Referred by GP (Dr Alan Vance) on 12/05/2026 for diagnostic clarification regarding lifelong attentional and executive functioning difficulties, currently impacting performance as a junior accountant.

Background

• Family members: Lives in Sydney with partner (Liam, 29). Parents (Margaret and David) reside in regional NSW; one younger brother (Sam, 24).
• Family history: Younger brother diagnosed with ADHD (Combined Presentation) at age 10, currently prescribed lisdexamfetamine (Vyvanse®) 50 mg PO daily. Maternal uncle suspected neurodivergent (formally undiagnosed). Mother has a history of GAD.
• School and Year level: N/A (Adult client, age 27).
• Pregnancy and Birth History: Full-term NVD, birth weight 3.4 kg. No prenatal complications, maternal substance use, or neonatal distress reported.
• Childhood History: Developmental milestones met within normal limits. No history of childhood trauma, significant head injury, or chronic medical illness. Experienced mild bullying in Year 5 related to social immaturity.
• Education and work history: Completed HSC at Parramatta High School (2016) with average grades; teacher comments consistently noted "capable of more if she applied herself". Completed Bachelor of Commerce at UNSW (took 4.5 years due to failing two subjects from missed submission deadlines). Employed as a graduate accountant for 18 months; currently on a performance improvement plan (PIP).

A) Inattention

1) Frequently overlooks details or makes careless errors in schoolwork, employment, or other activities

• Frequently transposes numbers on client spreadsheets and overlooks missing GST fields, despite knowing the tax rules well.
• Year 4 school report notes: "Rushes through mathematics worksheets, making simple calculation errors."

2) Frequently struggles to maintain attention during tasks or play

• Unable to sustain focus during 1-hour client meetings or training webinars; reports mind wanders after 10 minutes.
• Starts watching movies or reading books but rarely finishes them due to losing track of the plot.

3) Frequently appears not to hear or attend when spoken to directly

• Partner frequently complains that she looks "blank" or "zoned out" when he speaks to her in the evenings, requiring him to wave a hand to get her attention.

4) Frequently does not complete instructions, schoolwork, chores, or workplace responsibilities

• Initiates multiple household chores simultaneously (e.g., unloading dishwasher, folding laundry) and leaves all of them half-completed when side-tracked by another task.
• Starts drafting client emails but leaves them in the "Drafts" folder without sending.

5) Frequently finds it difficult to organise tasks and activities

• Struggles to prioritise daily work tasks, often spending hours on minor administrative formatting while missing major tax lodgement deadlines.
• Desk and computer desktop are severely cluttered with hundreds of unsorted files.

6) Frequently avoids or dislikes tasks requiring prolonged mental effort, or is reluctant to undertake them

• Procrastinates heavily on complex quarterly reconciliation reports and personal tax returns, stating it feels "physically painful to force my brain to start".

7) Frequently misplaces items needed for tasks or activities

• Misplaces phone, swipe card, and keys daily. Has replaced work security pass four times in the past year and lost three umbrellas this winter.

8) Is frequently distracted by unrelated or external stimuli

• In the open-plan office, cannot work without noise-cancelling headphones due to distraction from colleagues' conversations or keyboard typing.
• Distracted by internal tangential thoughts while trying to read professional documents.

9) Is frequently forgetful in everyday activities

• Frequently forgets scheduled appointments (missed two dental check-ups this year), forgets to reply to text messages for weeks, and regularly leaves wet washing in the machine for days.

B) Hyperactivity and Impulsivity

1) Frequently taps or moves the hands or feet, or shifts around while seated

• Constantly clicks pens, taps feet, or plays with hair/jewellery during work meetings and throughout today's assessment.

2) Frequently gets up when remaining seated is expected

• Finds excuses to leave her desk every 20–30 minutes at work (e.g., making tea, going to the bathroom, printing single pages) to relieve physical restlessness.

3) Frequently runs or climbs in contexts where this is unsuitable

• Experiences a persistent internal sense of restlessness and agitation when forced to remain still, particularly on long flights or in cinema seats.

4) Frequently cannot take part in leisure activities quietly

• Struggles to relax silently at home; requires background podcasts or music playing constantly while cooking or reading.

5) Is frequently active as though constantly driven by a motor

• Described by partner as "always on the go" on weekends, over-scheduling social activities and feeling uncomfortable with unstructured downtime.

6) Frequently speaks at excessive length

• Year 5 school report states: "Chloé is a chatterbox who frequently distracts her peers." Continues to talk excessively when anxious or excited, struggling to keep stories concise.

7) Frequently gives an answer before the question has been finished

• Regularly finishes sentences for her partner and colleagues because she anticipates what they are going to say and feels impatient waiting for them to finish.

8) Frequently struggles to wait for their turn

• Experiences intense frustration and irritability when waiting in slow queues at supermarkets or stuck in Sydney traffic, occasionally abandoning full shopping baskets rather than waiting.

9) Frequently interrupts or intrudes into other people's activities

• Frequently blurts out thoughts or questions to colleagues while they are on the phone or visibly busy, fearing she will forget the thought if she waits.

Symptoms interfere with or reduce the quality of

• Social Functioning: Experiences guilt and social anxiety due to chronically forgetting friends' birthdays, arriving late to dinners, and unintentionally dominating conversations.
• Academic Functioning: Historical underachievement relative to intellect in high school and university; delayed university graduation due to failed units from missed deadlines and poor exam preparation.
• Occupational Functioning: Currently placed on a formal PIP at her accounting firm due to data-entry errors, missed client deadlines, and disorganisation, causing significant distress and fear of job loss.
• Home Functioning: Ongoing relationship tension with partner, who feels burdened by carrying the "mental load" of household bills, scheduling, and cleaning up unfinished chores. Overdrawn bank fees incurred twice this year due to forgotten bill payments.