MBS Item 291 Compliant Clinical Summary • Client: AlexChen
Clinical Psychologist • ADHD Strategist • Lived Experience
AHPRA Reg: PSY0002188432 • Medicare Provider: 5839211A • MAPS, FCCP
Uniquely You Psychology Collective
23 Terry St, Albion Park NSW 2527
Telehealth Services Nationwide (Australia)
Phone: 0404 077 179 • Web: skymareesteele.com.au
Prepared for Consultant Adult Psychiatrist evaluation and ongoing GP management.
Date Compiled: 15 September 2026
Verification Hash: F696E625FDD5D5C8
This comprehensive diagnostic dossier was compiled under the supervision of Sky Maree Steele (Clinical Psychologist) to provide the assessing psychiatrist with structured DSM-5-TR developmental evidence, psychometric scores, sensory profile parameters, and corroborating witness statements.
| DSM-5-TR Criterion | Child | Adult | Clinical Corroboration & Lived Examples |
|---|---|---|---|
| careless mistakes | YES | YES | Primary school reports frequently note rushed homework, missing final questions on exams. In workplace, submits drafts with misplaced decimal points despite proofreading. |
| sustaining attention | YES | YES | Cannot sustain attention in meetings exceeding 20 minutes unless actively taking kinetic notes or fidgeting. |
| does not listen | YES | YES | Partners report having to say name 3 times before orienting; appears lost in vivid internal daydreaming. |
| fails to finish | YES | YES | Dozens of unfinished projects, craft supplies, courses started at 90% completion and abandoned. |
| difficulty organizing | YES | YES | Severe time blindness; estimates 15-minute commute takes 5 minutes; chronic doom piles at home. |
| avoids sustained effort | YES | YES | Tax returns delayed for 2 years; extreme physical dread when opening administrative mail. |
| loses necessary things | YES | YES | Lost 4 pairs of prescription glasses, keys, wallet; now relies on 6 Apple AirTags. |
| easily distracted | YES | YES | Distracted by ticking clocks, fluorescent hum, notifications; derailed by minor ambient sounds. |
| forgetful daily activities | YES | YES | Forgets wet laundry in washing machine 3 times consecutively; misses medical appointments unless given 2 alarms. |
| DSM-5-TR Criterion | Child | Adult | Clinical Corroboration & Lived Examples |
|---|---|---|---|
| fidgets taps | YES | YES | Restless legs during sedentary desk work; constant skin picking or clicking pens in meetings. |
| leaves seat | YES | YES | Reprimanded in Year 3 for walking around classroom; now uses standing desk and frequent bathroom breaks. |
| runs climbs | YES | - | Internalized into persistent motor tension and inability to relax on weekends. |
| quiet leisure | YES | YES | Cannot watch movies without secondary screen, crochet, or mobile device in hand. |
| on the go | YES | YES | Internal feeling of motor revving; people describe patient as high-energy but easily exhausted. |
| talks excessively | YES | YES | Rapid speech when hyperfocusing on special interests; infodump tendencies. |
| blurts out | YES | YES | Interrupts conversation partners, finishes their sentences due to working memory anxiety. |
| difficulty waiting turn | YES | YES | Extreme internal distress in grocery checkout queues or slow highway traffic. |
| interrupts intrudes | YES | YES | Interjects into nearby discussions; takeover impulse when colleagues struggle with tasks. |
5 / 6
Highly consistent with adult ADHD symptomatology (positive threshold ≥4).
134 / 175
Elevated camouflaging score indicative of delayed diagnosis and chronic burnout.
Auditory: 8/10 • Visual: 9/10
Pronounced fluorescent flicker sensitivity and open-plan workplace overload.
"Alex was brilliant but disorganized. Teachers wrote every term: "Capable of top marks if only he applied himself and stopped gazing out the window." He lost his school blazer twice in one winter."
"Alex struggles enormously with transition periods. If hyperfocusing on a creative project, he will forget to eat for 9 hours. If interrupted, he experiences intense emotional dysregulation."
Marked improvement in task initiation, sustained focus, and reduction of internal noise. Slight afternoon appetite suppression.
Prescribed for perceived Generalized Anxiety. Reduced panic attacks but had zero efficacy on executive dysfunction or task paralysis.
"Based on clinical interview, corroborating collateral evidence from multiple observers, historical school report cards, and self-report symptom inventories, the client meets DSM-5-TR diagnostic criteria for Attention-Deficit/Hyperactivity Disorder (Combined Presentation, F90.2). Childhood onset is evidenced prior to age 12 with chronic impairment continuing into adult occupational and relational domains."
Recommended Next Steps: Formal psychiatric evaluation under MBS Item 291 for clinical diagnosis endorsement, cardiovascular clearance, and PBS authority for stimulant pharmacotherapy (Lisdexamfetamine / Methylphenidate). Pre- and post-diagnosis executive coaching and neurodiversity-affirming psychotherapy will continue with Sky Maree Steele.