in a chair.The client's ability to rest comfortably for a longer period of time has increased.
7 Lack of Follow-Through (7)The client reported struggling to follow through on instructions and failing to finish duties.Family members reported frustration at the client's pattern of failing to finish duties.The client has shown progress in following through and completing duties.
8 Inability to Engage QuietlyThe client reports an inability to engage in leisure activities quietly.The client has identified problems with others owing to inability to engage in leisure activities quietly.The client has improved in ability to engage in leisure activities at an appropriate noise level.
9 Disorganization (9)The client has a history of disorganization in many areas of their life.The client's disorganization is evident in areas related to home and work, leading them to be less efficient and less effective than they could be.The client has made significant progress in increasing organization and is using that organization to become more efficient.The client uses lists and reminders to increase organizational ability.
10 On the Go (10)The client is often described as “on the go” or acting as if “driven by a motor.”The client has identified problems with overall functioning because of “on the go” behaviors.The client has been able to improve in functioning as they have reduced their “on the go” behaviors.
11 Avoidance (11)The client often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.The client has struggled to maintain employment or struggles in school owing to avoidance of tasks that require sustained mental effort.The client has reduced their avoidance of difficult tasks and reports improved functioning in a variety of areas.
12 Excessive Talking (12)The client talks excessively.The client's family and friends have reported frustrations because of excessive talking.The client has improved in ability to talk an appropriate amount.
13 Losing ItemsThe client often loses items necessary for tasks or activities.The client identified problematic functioning due to losing items necessary for day-to-day tasks.The client has managed self better in order to reduce loss of necessary items.
14 Interrupting (14)The client often interrupts, doesn't wait for their turn, or blurts out answers before a question has been completed.The client's friends and family have identified problems related to the client's inability to function appropriately in social situations.The client's work relationships have suffered owing to an inability to function appropriately.The client has reduced the need to interrupt others, now waits for others, blurts out answers less, and has identified positive results from this improvement.
15 Distractibility (15)The client reported being easily distracted and attention is drawn away from the task at hand.The client gave evidence of distractibility within today's session.The client's distractibility is diminishing and focused concentration is increasing.
16 Forgetfulness (16)The client identified often being forgetful in daily activities.The client's day-to-day functioning has suffered because of forgetfulness.The client has identified ways to be less forgetful and identified positive experiences.
17 Increased Vulnerability to Addiction Behaviors (17)The client reported a history of increased vulnerability to addiction behaviors due to ADHD traits.The client's ADHD traits were observed to create an increased vulnerability to addiction behaviors.As the client's ADHD traits have been appropriately treated, vulnerability to addiction behaviors has decreased.
INTERVENTIONS IMPLEMENTED
1 Build Trust and Establish Rapport (1)*Caring was conveyed to the client through support, warmth, and empathy.The client was provided with nonjudgmental support and a level of trust was developed.The client was urged to feel safe in expressing ADHD symptoms.The client began to express feelings more freely as rapport and trust level have increased.The client has continued to experience difficulty being open and direct about the expression of painful feelings; the client was encouraged to use the safe haven of therapy to express these difficult issues.
2 Focus on Strengthening Therapeutic Relationship (2)The relationship with the client was strengthened using empirically supported factors.The relationship with client was strengthened through the implementation of a collaborative approach, agreement on goals, demonstration of empathy, verbalization of positive regard, and collection of client feedback.The client reacted positively to the relationship-strengthening measures taken.The client verbalized feeling supported and understood during therapy sessions.Despite attempts to strengthen the therapeutic relationship the client reports feeling distant and misunderstood.The client has indicated that sessions are not helpful and will be terminating therapy.
3 Conduct Psychosocial Assessment (3)A thorough psychosocial assessment was conducted, including the past and present symptoms of ADHD and their effects on educational, occupational, and social functioning.The psychosocial assessment reflects significant concerns related to ADHD, and this was communicated to the client.The psychosocial assessment reflects minimal concerns related to ADHD, and this was reflected to the client.
4 Coordinate Psychological Testing (4)The client was administered psychological testing in order to establish or rule out the presence of ADHD problems.The Connors Adult ADHD Rating Scale (CAARS) was administered to the client.The Substance Abuse Subtle Screening Inventory–4 (SASSI-4) was administered to the client.Psychological testing has established the presence of an ADHD problem.Psychological testing has identified other possible psychopathology.Psychological testing has ruled out other psychopathology.The psychological testing failed to confirm the presence of ADHD.
5 Refer to a Specialist to Remediate Learning Disabilities (5)The client was referred to an education specialist to design remedial procedures for learning disabilities present in addition to ADHD.The client reported meeting with the educational specialist, who has been able to design remedial procedures for learning disabilities.The client described benefits from the remedial procedures used to counter the effects of learning disabilities.The client has not yet met with an education specialist and was redirected to do so.
6 Refer for Physician Assessment Regarding Etiology (6)The client was referred to a physician to rule out nonpsychiatric medical etiologies for ADHD.The client was referred to a physician to rule out substance-induced etiologies for the client's level of ADHD.The client has complied with the referral to a physician and the results of this evaluation were reviewed.The client has not complied with the referral for a medical evaluation and was redirected to do so.
7 Process Medical and Psychological Evaluation (7)Results and recommendations of the medical evaluation were processed with the client and all questions were answered.The results and recommendations of the psychological evaluation were processed with the client and all questions were answered.As a result of the physician's evaluation, the client was prescribed medication to assist in the control of ADHD symptomatology.As a result of the psychological evaluation, the client was provided with several different techniques to assist in the control of ADHD symptomatology.
8 Hold a Conjoint Session to Give Evaluation Feedback (8)A conjoint session was held with the client and significant others in order to present the results of the psychological and medical evaluations.All questions regarding the evaluation results were processed.The client's family members were solicited for support regarding compliance with treatment for ADHD symptoms.The client's family members were verbally reinforced as they gave strong support to the client regarding medical and psychological treatment for ADHD symptoms.
9 Arrange Substance Abuse Evaluation (9)The client's use of alcohol and other mood-altering substances was assessed.The client was assessed to have a pattern of mild substance use.The client was assessed to have a pattern of moderate substance use.The client was assessed to have a pattern of severe substance use.The client was referred for a substance use treatment.The client was found to not have any substance use concerns.
10 Assess Level of Insight (10)The client's level of insight toward the presenting problems was assessed.The client was assessed in regard to the syntonic versus dystonic nature of their insight about the presenting problems.The client was noted to demonstrate good insight into the problematic nature of the behavior and