**Family History**
Parents: Both parents are alive and well, no significant medical history.
Siblings: One older sister, no known issues.
Family history of ADHD or other psychiatric conditions - Mother diagnosed with anxiety.
**Developmental History**
Pregnancy: Uncomplicated pregnancy.
Birth: Vaginal delivery at term, no complications.
Developmental Milestones: Met all milestones within expected ranges.
**Educational History**
Primary Education: Attended mainstream school, achieved average grades.
Secondary Education: Attended mainstream school, struggled with organisation and time management.
**Employment History**
[Patient's Name] currently works as a software engineer.
**Social History**
Relationships: Good relationships with family and friends.
**Medical History**
Conditions: No significant medical conditions.
**Psychiatric History**
Anxiety: Reports occasional anxiety, particularly in social situations.
**Alcohol & substance use/addictions**
Caffeine Use: Drinks coffee daily.
**Risk**
To self: No current suicidal ideation.
**Mental state**
Appearance & Behaviour: Appears well-groomed and appropriately dressed. Calm and cooperative during the interview.
Speech: Clear and coherent speech.
Mood: Reported mood is generally stable.
Affect: Affect is congruent with reported mood.
**Assessment of ADHD Symptoms**
**ADHD Diagnostic Criteria: Inattention**
Fails to pay close attention to details, makes careless mistakes: Frequently makes careless mistakes at work.
Has trouble sustaining attention on tasks or play: Struggles to focus on tasks that are not of interest.
issues following instructions - Difficulty following multi-step instructions.
**ADHD Diagnostic Criteria: Hyperactivity/Impulsivity**
Fidgets with hands/ objects; moves feet or squirms in chair: Taps fingers when thinking.
**Assessment of Autistic Symptoms**
**Observations of [Name]'s strengths and difficulties on the ADOS were as follows:**
Language and communication – including verbal skills (frequency and type of communication, quality of language, echolalia, jargon, intonation and pitch, stereotyped and idiosyncratic use) and non-verbal skills (pointing, gestures, use of others' body to communicate).
- Observations related to language and communication skills, including verbal and non-verbal communication: Good verbal skills, but struggles with non-verbal cues.
Reciprocal Social Interaction – including eye contact, social smile, facial expression, gaze interaction, shared enjoyment, response to name, requesting, giving and showing, joint attention (response and initiation), quality of social overtures
- Observations related to reciprocal social interaction, including eye contact, facial expressions, shared enjoyment, and quality of social interactions: Avoids eye contact.
Imagination - including imagination and creativity
- Observations related to imagination and creativity during play and storytelling: Limited imagination during play.
Stereotyped behaviours and restricted interests – including complex mannerisms, unusual sensory interests, self-injurious behaviour, repetitive interests & stereotyped behaviours
- Observations related to stereotyped behaviours and restricted interests, including sensory seeking behaviour, mannerisms, and unusual or highly specific interests: Intense interest in computer programming.
**SOCIAL COMMUNICATION DIFFERENCES**
A1: Social Approach and Interaction
[Describe the social approach, play behaviour at home, at social gatherings, and specific interests.]
(Include observations on social engagement and interaction styles.)
A2: Nonverbal Communication
[Outline understanding and use of eye contact, gestures, facial expressions, and body language.]
(Include specifics on how these nonverbal cues are used in communication.)
A3: Play Style and Friendships
[Describe play style, and the ability to make and maintain friendships.]
(Include any relevant details on peer interactions.)
RESTRICTED AND REPETITIVE BEHAVIOURS
B1: Repetitive Behaviours
[Describe repetitive speech, body movements, and use of items.]
(Include observed repetitive actions or speech patterns.)
B2: Routines and Transitions
[Detail routines, rituals, and how the patient manages transitions.]
(Include any noted difficulties with changes in routine or unexpected transitions.)
B3: Special Interests and Collections
[Outline specific interests, collections, and any obsessions with particular topics or items.]
(Include only if these are significant in daily activities.)
B4: Sensory Processing Differences
[Describe sensory processing differences, including hypersensitivities or hyposensitivities across various senses.]
(Include only if relevant sensory patterns are observed.)
AUTISM QUOTIENT SCORING
[Include the results of Autism Quotient (AQ) scoring, with details on each domain scored, such as Social Skills, Attention Switching, Attention to Detail, Communication, and Imagination. Provide the total score and interpret the result based on standard scoring thresholds.]
(Include only if the Autism Quotient scoring was completed and provide clear, interpretable results for the reader.)
**Family History**
Parents: [describe parents] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Siblings: [describe siblings and birth order] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Children: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Wider Family: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Family history of cardiovascular or other neurological conditions - [document family history of heart attack, stroke, epilepsy or other cardiovascular conditions in first-degree relatives] (only include document family history of ADHD or other psychiatric conditions in first-degree relatives if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Family history of ADHD or other psychiatric conditions - [document family history of ADHD or other psychiatric conditions in first-degree relatives] (only include document family history of ADHD or other psychiatric conditions in first-degree relatives if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
**Developmental History**
Pregnancy: [document perinatal history including pregnancy] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Birth: [document details of birth] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Developmental Milestones: [document details of milestones] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Sensory differences: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Early Year (0-5 years): [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Early life adversities (ACEs): [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Neurodevelopmental Diagnoses: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
**Educational History**
Primary Education: [document primary educational history including academic performance, behavioural issues, supports, and discrepancies between ability and achievement] (only include document educational history including academic performance, behavioural issues, supports, and discrepancies between ability and achievement if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Secondary Education: [document secondary educational history including academic performance, behavioural issues, supports, and discrepancies between ability and achievement] (only include document educational history including academic performance, behavioural issues, supports, and discrepancies between ability and achievement if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Educational Qualifications: [Details of exam results and any problems with exam taking] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Learning Support: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Further education: [Details of college] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
University: [Details of university or post-graduate education] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Professional Training: [Details of professional training and apprenticeships ] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
**Employment History**
[Patient's Name] currently works as [job title]. (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Previous jobs included [list of previous jobs]. (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Employment history - [document employment history including job stability, performance feedback, and task-related difficulties] (only include document employment history including job stability, performance feedback, and task-related difficulties if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Employment strengths as [list of strengths]. (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Employment weakness they summarised as [list of weaknesses]. (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
**Social History**
Relationships: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Daily Life, problems: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Finances: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Driving: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Criminal Justice Involvement: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
**Medical History**
Conditions: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Sleep: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Diet/Exercise: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Hormonal Changes: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
**Psychiatric History**
Previous psychiatric diagnoses - [document previous psychiatric diagnoses, treatments, and response to interventions] (only include document previous psychiatric diagnoses, treatments, and response to interventions if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Anxiety: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Mood: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Trauma: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Personality Issues: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
**Alcohol & substance use/addictions**
Alcohol Use: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Drug Use: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Caffeine Use: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Gambling Use: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Internet Use: [Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
**Risk**
To self:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
To others:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
From others:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Vulnerability:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Diversion of medication:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
**Mental state**
Appearance & Behaviour:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Speech:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Affect:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Mood:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Thought – form:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Thought - content:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Perception:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Orientation:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Insight:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Appearance & Behaviour: [describe the patient’s appearance and behaviour during the interview] (only include describe the patient’s appearance and behaviour during the interview if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Attention and concentration during the interview: [describe the patient’s attention and concentration during the interview] (only include describe the patient’s attention and concentration during the interview if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Speech: [describe the patient’s speech patterns] (only include describe the patient’s speech patterns if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Mood: [describe the patient’s mood] (only include describe the patient’s mood and affect if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Affect: [describe the patient’s affect] (only include describe the patient’s mood and affect if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Thought processes: [describe the patient’s thought processes] (only include describe the patient’s thought processes if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Thought - content:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Perception:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Orientation:[Details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Insight:[Details] only include describe the patient’s level of insight into their difficulties if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
**Assessment of ADHD Symptoms**
**ADHD Diagnostic Criteria: Inattention**
Fails to pay close attention to details, makes careless mistakes: [describe any issues with attention to detail or careless mistakes in significant activities in adulthood and childhood] (only include describe any issues with attention to detail or careless mistakes in significant activities if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Has trouble sustaining attention on tasks or play: [describe any difficulties sustaining attention in tasks, whether work or leisure in adulthood or childhood] (only include describe any difficulties sustaining attention in tasks, whether work or leisure if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Doesn't seem to listen when spoken to directly: [describe whether patient seems not to listen when spoken to directly in adulthood or childhood] (only include describe whether patient seems not to listen when spoken to directly if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
issues following instructions - [describe issues following instructions or completing important tasks] (only include describe issues following instructions or completing important tasks if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Fails to follow through on instructions and fails to finish schoolwork or chores: [describe issues following instructions or completing important tasks in adulthood or childhood] (only include describe issues following instructions or completing important tasks if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Has trouble getting organised: [describe difficulties organising tasks and activities in adulthood or childhood] (only include describe difficulties organising tasks and activities if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Avoids or dislikes doing things that require sustained focus/thinking: [describe any avoidance or reluctance to undertake tasks requiring sustained mental effort or severe issues with procrastination in adulthood or childhood] (only include describe any avoidance or reluctance to undertake tasks requiring sustained mental effort if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Loses necessary things frequently: [describe any tendency to lose items necessary for tasks and activities, misplace items frequently in adulthood or childhood] (only include describe any tendency to lose items necessary for tasks and activities if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Easily distracted by other things: [describe frequency and nature of distractions in adulthood or childhood] (only include describe frequency and nature of distractions if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Forgetful of everyday events: [describe forgetfulness in day-to-day activities, forgetting appointments in adulthood or childhood] (only include describe forgetfulness in day-to-day activities if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
**ADHD Diagnostic Criteria: Hyperactivity/Impulsivity**
Fidgets with hands/ objects; moves feet or squirms in chair: [describe presence of fidgeting, tapping, or squirming in adulthood or childhood] (only include describe presence of fidgeting, tapping, or squirming if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Frequently leaves chair when seating is expected: [describe any leaving seat inappropriately in settings where remaining seated is expected or struggling to remain seated without stress in adulthood or childhood] (only include describe any leaving seat inappropriately in settings where remaining seated is expected if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Often feels restless: [describe feelings of internal, external restlessness or thoughts moving too fast that are hard to control in adulthood or childhood] (only include describe feelings of restlessness that are hard to control if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Trouble playing/engaging in activities quietly: [describe difficulty engaging in quiet social or leisure activities in adulthood or childhood] (only include describe difficulty engaging in quiet social or leisure activities if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Acts "on the go" or excessively busy: [describe sense of being “on the go” or “driven by a motor” always having to be busy, not being able to stop in adulthood or childhood] (only include describe sense of being “on the go” or “driven by a motor” if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
talking excessively - [describe excessive talking] (only include describe excessive talking if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Talks excessively: [describe excessive talking] (only include describe excessive talking if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Interrupts conversation; blurts out answers before questions are completed: {describe any tendency to blurt out answers before questions are completed in adulthood or childhood] (only include describe any tendency to blurt out answers before questions are completed if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Trouble waiting or taking turns: [describe difficulties waiting turns in adulthood or childhood] (only include describe difficulties waiting turns if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Interrupts or intrudes on what others are doing: [describe instances of interrupting or intruding on others in adulthood or childhood] (only include describe instances of interrupting or intruding on others if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
**Assessment of Autistic Symptoms**
** **
**Observations of [Name]'s strengths and difficulties on the ADOS were as follows:**
Language and communication – including verbal skills (frequency and type of communication, quality of language, echolalia, jargon, intonation and pitch, stereotyped and idiosyncratic use) and non-verbal skills (pointing, gestures, use of others' body to communicate).
- [Observations related to language and communication skills, including verbal and non-verbal communication] (describe verbal communication like frequency of speech, echolalia, and quality of language, as well as non-verbal communication like gestures and pointing)
Reciprocal Social Interaction – including eye contact, social smile, facial expression, gaze interaction, shared enjoyment, response to name, requesting, giving and showing, joint attention (response and initiation), quality of social overtures
- [Observations related to reciprocal social interaction, including eye contact, facial expressions, shared enjoyment, and quality of social interactions] (note behaviours like response to name, gaze interaction, and social overtures)
- [Observations related to understanding and retelling a story from a picture book] (note the ability to comprehend, narrate, and engage with visual storytelling)
- [Observations related to understanding and expressing emotions] (describe ability to recognize, express, or react to emotions in social interactions)
- [Observations related to understanding social relationships and own social difficulties] (include observations on how the individual perceives their social interactions and challenges)
- [Observations related to understanding adult relationships] (note any understanding or commentary on relationships with adults or authority figures)
- [Overall observations related to rapport, enjoyment in joint interaction, and insight into emotions and social relationships] (summarise the individual's overall engagement, rapport with the examiner, and insight into social dynamics)
Imagination - including imagination and creativity
- [Observations related to imagination and creativity during play and storytelling] (describe creative play, use of imagination, or pretend play abilities)
Stereotyped behaviours and restricted interests – including complex mannerisms, unusual sensory interests, self-injurious behaviour, repetitive interests & stereotyped behaviours
- [Observations related to stereotyped behaviours and restricted interests, including sensory seeking behaviour, mannerisms, and unusual or highly specific interests] (note behaviours like hand-flapping, repetitive actions, and fixations on specific topics or objects)
**SOCIAL COMMUNICATION DIFFERENCES**
A1: Social Approach and Interaction
[Describe the social approach, play behaviour at home, at social gatherings, and specific interests.]
(Include observations on social engagement and interaction styles.)
A2: Nonverbal Communication
[Outline understanding and use of eye contact, gestures, facial expressions, and body language.]
(Include specifics on how these nonverbal cues are used in communication.)
A3: Play Style and Friendships
[Describe play style, and the ability to make and maintain friendships.]
(Include any relevant details on peer interactions.)
RESTRICTED AND REPETITIVE BEHAVIOURS
B1: Repetitive Behaviours
[Describe repetitive speech, body movements, and use of items.]
(Include observed repetitive actions or speech patterns.)
B2: Routines and Transitions
[Detail routines, rituals, and how the patient manages transitions.]
(Include any noted difficulties with changes in routine or unexpected transitions.)
B3: Special Interests and Collections
[Outline specific interests, collections, and any obsessions with particular topics or items.]
(Include only if these are significant in daily activities.)
B4: Sensory Processing Differences
[Describe sensory processing differences, including hypersensitivities or hyposensitivities across various senses.]
(Include only if relevant sensory patterns are observed.)
AUTISM QUOTIENT SCORING
[Include the results of Autism Quotient (AQ) scoring, with details on each domain scored, such as Social Skills, Attention Switching, Attention to Detail, Communication, and Imagination. Provide the total score and interpret the result based on standard scoring thresholds.]
(Include only if the Autism Quotient scoring was completed and provide clear, interpretable results for the reader.)
(Never come up with your own patient details, assessment, or observations—use only the transcript, contextual notes, or clinical data as a reference for the information included in this report. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes, or clinical data, leave the relevant placeholder or section blank. Use as many sentences or sections as needed to fully capture all provided information.)
