Initial Consultation

Clients

• 1. Liam O'Connor (DOB: 14/08/2008, Medicare: 2948 58201 3)
• 2. Sarah O'Connor (Mother)

Presentation

• Appearance: Casually dressed in school uniform, well-groomed, tall for age.
• Behaviour: Fidgety, restless legs, poor eye contact initially, warmed up mid-session when discussing interests.
• Speech: Normal volume, rapid rate when discussing school stressors, coherent.
• Mood: "Stressed out and constantly behind."
• Affect: Anxious, constricted range, congruent with reported mood.
• Thoughts: Logical and goal-directed; preoccupied with academic failure and peer perception. No formal thought disorder or delusions.
• Perceptions: Nil hallucinations or perceptual disturbances reported.
• Cognition: Oriented to time, place, and person. Intact memory; distractible concentration noted during clinical interview.
• Insight: Good; recognises link between procrastination and subsequent anxiety spikes.
• Judgment: Fair; intact regarding personal safety, though makes impulsive decisions regarding homework avoidance.

Presenting Concerns

• 1. Academic anxiety and panic attacks: Experiencing panic symptoms (tachycardia, SOB, sweating) 2–3 times/week for the past 4 months, lasting 15–20 mins, triggered by Year 10 assessment deadlines.
• 2. Executive dysfunction and procrastination: Chronic difficulty initiating tasks, losing track of time, and disorganisation, worsening significantly since transitioning to senior school curriculum.
• Severity/Impact: Falling grades (dropped from Bs to Cs/Ds), frequent school refusal on exam days (4 days missed this term), and sleep-onset insomnia (1–2 hours to fall asleep).
• Mother reports increasing conflict at home over nightly study routines and screen time.

Past/Current Interventions

• Saw school counsellor (Mr David Chen) for 3 sessions in Term 1; taught basic progressive muscle relaxation and box breathing.
• Minimal progress with school counselling; client found breathing exercises ineffective during acute panic states and struggled to implement study schedules independently.

Relevant Background Factors

• Recent Substance Use: Consumes 2–3 caffeinated energy drinks (e.g., Red Bull) daily for the past 3 months to stay awake for late-night studying. Denies alcohol, nicotine/vaping, or illicit substance use.
• Psychiatric Diagnoses: Attention-Deficit/Hyperactivity Disorder (ADHD), Combined Presentation (diagnosed at age 9). Generalised Anxiety Disorder (GAD) (provisional diagnosis by GP).
• Current Stressors: Upcoming Year 10 mid-year exams, recent breakdown of primary friendship group, high perceived parental expectations regarding university entry.

Family History

• Family of Origin: Born and raised in Sydney, Australia. Lives intact with parents and younger sister (age 12). Maternal history of GAD; paternal history of suspected undiagnosed ADHD. High-achieving family culture with tense communication patterns around academic performance. No history of domestic violence or abuse.

Medical History

• Medical history: Mild childhood asthma (well-controlled).
• Hospitalisations: Nil recent psychiatric or medical hospitalisations.
• Operations: Tonsillectomy and adenoidectomy (2015).
• Current Medications: Lisdexamfetamine (Vyvanse®) 40 mg PO daily; salbutamol (Ventolin®) 100 mcg INH PRN.

Developmental History

• Pregnancy - Full-term pregnancy (39 weeks). Mild gestational hypertension in third trimester, managed conservatively. Normal vaginal delivery, no NICU admission.
• Milestones - Walked at 12 months, first words at 14 months, toilet trained by 3 years. Early fine motor difficulties (poor handwriting/dysgraphia traits) noted in Kindergarten; emotionally reactive and hyperactive in early childhood settings.

School History

• Currently in Year 10 at North Sydney Boys High School. Year Advisor: Ms Karen Jenkins; Learning Support Coordinator: Mr Mark Taylor. Previously attended Neutral Bay Public School (K–6).

Occupational History

• Casual retail assistant at Woolworths (1 shift/week, 4 hours on Saturdays) for the past 6 months; coping well with hands-on tasks. Mother is a corporate lawyer; father is a civil engineer.

Risk Assessment and Management

• Suicidal Ideation: Denies current or past active suicidal ideation, intent, or plans. Reports occasional passive thoughts ("wish I could just pause life for a year") when overwhelmed by assignments.
• Homicidal Ideation: Nil reported.
• Self-harm: History of superficial scratching on forearms during severe panic attacks 2 months ago; none in the past 6 weeks.
• Violence & Aggression: Nil history of violence or aggression; occasional verbal outbursts (slamming doors) at home when pressed about schoolwork.
• Addictive Behaviours: Excessive gaming (3–4 hours nightly) used as an avoidance coping mechanism; high daily caffeine intake.
• Risk-taking/Impulsivity: Impulsive task switching and reckless bicycle riding in traffic when running late for school.
• Management Plan: Collaborative safety plan developed with client and mother. Identified early warning signs of panic, agreed on sensory grounding techniques (cold water/ice pack), provided Kids Helpline (1800 55 1800) and Lifeline (13 11 14) contacts, and agreed to gradually taper energy drink consumption to 1/day to reduce physiological anxiety triggers.

Goals

• Reduce frequency of school-related panic attacks from 3x/week to < 1x/fortnight using CBT cognitive restructuring and interoceptive exposure.
• Establish a sustainable, externalised executive functioning system (using visual timers and task-chunking) to reduce homework procrastination.
• Improve sleep hygiene by implementing a 22:00 screen curfew and eliminating afternoon caffeine.

Next Steps

• Next Session: 28/05/2026 at 16:00 (Australia/Sydney). Plan to review baseline DASS-21 scores, construct a fear and avoidance hierarchy for academic tasks, and introduce the CBT model of anxiety.
• Assigned Homework: Complete daily panic and mood monitoring log; trial the Pomodoro technique (15 mins work, 5 mins break) for one subject every second night; limit energy drinks to before 12:00.