YASU ADHD Structured Interview - Parent

Young Adult Support Unit – ADHD Assessment (Parent Collateral Information Gathering) Situation Date: 01/11/2024 Time: 10:30 AM Attendees: Patient (Liam Smith), Mother (Mrs. Sarah Smith), Father (Mr. David Smith) Clinician: Dr. Eleanor Vance, Psychologist Appointment type: In-person consultation, Clinic Room 3 Patient has arrived for the appointment and provided consent for the interview. Background Liam Smith, a 16-year-old male, presents with concerns regarding his attention, concentration, and organisation, as reported by his parents. He uses he/him pronouns. His parents are seeking an assessment for potential Attention-Deficit/Hyperactivity Disorder (ADHD) due to long-standing academic struggles and behavioural challenges at home. Presentation: - Well-groomed, age-appropriate casual attire. - Maintained eye contact throughout the interview. - Affect was generally calm and cooperative, though mother appeared somewhat distressed. - Speech was clear, coherent, and at a normal pace. - Thought content focused on Liam's difficulties and the impact on family life. Early Development - Pregnancy and birth history: Full-term pregnancy, no reported complications. Vaginal delivery, birth weight 3.5 kg. No prematurity. - Early developmental milestones: Achieved motor milestones within typical range (walked at 12 months, first words at 15 months). Communication and social milestones were also met appropriately, though parents noted he was an unusually active toddler. - Early temperament and behaviour: Described as a very active and curious child. Sleep was often irregular in infancy, and he was prone to frequent temper tantrums until around age 5, struggling with mood regulation when frustrated. Childhood Behaviour and Functioning - Attention and concentration: Parents report Liam was easily distracted from a young age, struggled to finish tasks like puzzles or drawing, and often seemed to be in his own world, frequently daydreaming in class. - Activity level and impulsivity: Consistently high activity levels, often described as 'bouncing off the walls'. Would often blurt out answers in class and interrupt conversations. Engaged in some minor risk-taking behaviours, such as climbing tall trees, but nothing severe. - Emotional regulation: Prone to significant tantrums and outbursts when things didn't go his way. Frustration tolerance was low, often giving up on tasks quickly if they became challenging. - Organisation and routines: Consistently struggled with keeping track of belongings, often losing school items. Homework was a constant battle, and daily routines were difficult to establish and maintain. - Social relationships: Had a fluctuating circle of friends. Sometimes struggled to maintain friendships due to impulsivity and difficulty understanding social cues, leading to occasional conflicts. Often preferred solitary play or group activities where structure was provided. School and Learning (Primary and High School) - Academic progress: Demonstrated early reading ability but struggled significantly with maths and written expression. Has had consistent learning difficulties, particularly with organisation and sustained effort. Parents believe he has high potential but underperforms. - Teacher feedback: Frequent comments from teachers about inattention, difficulty staying seated, blurting out answers, and not following multi-step instructions. Often praised for creativity but criticised for effort and inconsistent performance. - Reports of disruptive behaviour: Numerous reports of calling out in class, fidgeting constantly, not sitting still, and difficulties following instructions, leading to frequent detentions in primary school. - School reports or interventions: Received some informal learning support in primary school. Currently has an Individual Education Plan (IEP) focused on organisation and time management strategies, and extended time for exams. Adolescence - Changes with increased demands: Significant increase in difficulties with organisation as academic demands increased. Struggles with managing multiple subjects, transitioning between classes, and maintaining independence in schoolwork. Often forgets deadlines. - Risk-taking behaviour: Has experimented with vaping and occasional alcohol use with friends, but parents report no severe substance misuse. Has shown some unsafe driving habits (speeding) since getting his learner's permit. - Motivation and engagement: A noticeable drop in grades since year 9. Shows struggles with sustained effort in subjects he finds less engaging, leading to a general lack of motivation towards schoolwork. - Peer relationships and family dynamics: Experiences some conflict with peers due to impulsivity. Family dynamics are strained due to constant reminders about schoolwork and chores, leading to withdrawal and reliance on his mother for executive functioning tasks. Medical and Mental Health History History of other diagnoses: No formal diagnoses of learning disorders or autism. Has experienced periods of anxiety, particularly around academic performance, but no formal diagnosis of an anxiety disorder. Medical issues: No relevant medical issues such as thyroid problems, seizures, or head injuries. Parents report chronic mild sleep problems, difficulty falling asleep and restless sleep. Family history: Maternal uncle has a diagnosis of ADHD. Paternal grandmother has a history of anxiety and depression. Protective Factors and Strengths - Areas of talent or special interest: Highly talented in digital art and coding, spending many hours on these hobbies. Enjoys playing team sports (football) where structure is provided. - Supports used successfully in the past: Responded well to one-on-one tutoring for specific subjects in primary school. Benefited from a structured reward system at home for chores and homework completion. - Resilience factors/adaptive strategies: Displays persistence in his areas of interest. Shows creativity in problem-solving within his hobbies. Is generally a kind and empathetic individual. Plans: - Provide psychoeducation about ADHD to parents. - Recommend further assessment for Liam, including cognitive and academic testing. - Refer to a paediatrician for medical assessment and consideration of pharmacological intervention. - Schedule a follow-up appointment with parents in 4 weeks to discuss assessment findings and develop a comprehensive management plan. - Provide resources on ADHD parenting strategies and local support groups.