Assessment Report

12 June 2026

This is a draft post. It's useful but still needs work.

Introduction

This is a slightly redacted/tidied up version of my ADHD assessment report received in May of 2026 after providing written evidence and conducting a 1 hour interview with a clinician.

I have removed the names of the doctor and clinician.

I’m sharing here for reference by others to understand my own symptoms and what they can expect a report to contain.

NOTE Nothing in this report should be taken as medical advice. It was specifically created for my own diagnosis and treatment.

Clinical Management Plan

Prescribing medication and monitoring of response during titration will be undertaken by Harrow Health.
Patients will have their blood pressure, heart rate and weight checked prior to being issued any stimulant medications.
Please inform us if systolic BP is more than 140, diastolic is more than 90, or if resting pulse is more than 100 or is irregular (the patient should self-monitor blood pressure and heart rate).
He will be referred to our medication titration service to start stimulant medication. The risks and side effects of this group of medication include nausea, headaches, a lack of sleep, a lack of appetite and other side effects have been discussed and will be explored further when treatment commences.
He has been given detailed information of the common side effects of medication and any red flag symptoms that would mean medication should be discontinued and that they should seek further medical assistance.
Once stability of the dose is achieved, we will arrange a final follow-up appointment with our Clinician to inform you of the need for ongoing medication and management and ask for your consideration of a shared care agreement.

Medication Plan

In accordance with the NICE Guidelines (NG87) for the management of Adult ADHD, we plan to commence stimulant medication, which is the first-line treatment recommendation.

Original plan (Affenid XL):

Week 1 and 2: Affenid XL 18mg tablets. Take one tablet once a day in the morning after food for 15 days.
Week 3 and 4: Affenid XL 36mg tablets. Take one tablet once a day in the morning after food for 15 days, following satisfactory review of vital signs.

Update — 17 May 2026: Peter has opted for pharmacological treatment. Due to national shortages of Affenid XL, Methylphenidate MR will be prescribed instead.

Week 1 and 2: Methylphenidate MR 18mg tablets. Take one tablet once a day in the morning after food for 15 days.
Week 3 and 4: Methylphenidate MR 36mg tablets. Take one tablet once a day in the morning after food for 15 days.

Monitoring

Regular mental and physical health monitoring.
If patient presents to your clinic with high blood pressure, heart rate and significant weight loss, prolonged palpitation or abnormal cardiovascular symptoms, please inform Harrow Health.

Treatment Discussion

Treatment options for ADHD were discussed.
The first-line treatment option for Harrow Health of a stimulant medication, specifically Affenid XL (methylphenidate extended-release), was recommended.
The proposed titration plan is to commence with 18mg tablets once daily for 15 days, then increase to 36mg once daily for a further 15 days, followed by a review. The patient was given seven days to consider this treatment plan and will communicate his decision via email to the administration team.
If he chooses to proceed, the first prescription will be issued of Affenid XL (subsequently changed to Methylphenidate MR — see update above).
Other treatment options of stimulants such as Lisdexamfetamine and non-stimulant (atomoxetine) were discussed; potential side effects were discussed. The risk of mixing medication with alcohol and other substances were discussed and the need to reduce any stimulants such as nicotine and caffeine were also discussed.

Patient Summary


Diagnosis	ADHD — Combined type (in accordance with DSM-5 criteria)
Pre-assessment forms used	ASRS; Informant report; Weiss Functional Impairment Rating Scale
Medication Before Assessment
ADHD Medication	Nil
Other Psychotropic Medication	Nil
Other Medication	Multivitamin; over-the-counter antihistamines for hay fever; Mometasone furoate nasal spray
Changes to Medication	17 May 2026 — Peter has opted for pharmacological treatment. To prescribe Methylphenidate MR due to national shortages of Affenid XL. Week 1 and 2: Methylphenidate MR 18mg tablets. Take one tablet once a day in the morning after food for 15 days. Week 3 and 4: Methylphenidate MR 36mg tablets. Take one tablet once a day in the morning after food for 15 days.
Requests for GP
Harrow Health Plan	Week 3 and 4: Affenid XL 36mg tablets. Take one tablet once a day in the morning after food for 15 days, following satisfactory review of vital signs. (Superseded by Methylphenidate MR — see Changes to Medication.)
Physical Observations	Date taken: 01/05/26 BP: 109/61 Pulse: 62 Weight: 75.9 kg Height: 185.4 cm BMI: 22.1
ID Presented	Driving License
Allergies	Reports allergies to moulds, dust, dogs, and cats, resulting in hay fever. No known drug allergies.

Baseline Adult ADHD Self Report Scale (ASRS) Scores

	Never	Rarely	Sometimes	Often	Very Often
Pre-treatment			2	6	10

Reason for Referral

Peter is a 48-year-old male who was referred by his GP for an ADHD assessment following longstanding difficulties with concentration, focus, organisation, and completing tasks. These issues have impacted on his personal and professional life. He has attempted to manage these symptoms by reading self-help literature but is now seeking assessment for possible medication treatment. He notes that these difficulties have been present since childhood, with reports of being easily distracted in kindergarten. Feedback from family is that he is “all over the place,” and he has noticed increasing challenges at work in recent years, describing a lack of coherence in his consultancy advice.

History of Presenting Complaint

DIVA 5 Questionnaire: Inattentive Symptoms

The Adulthood informant is wife. The Childhood informant is the mother and father.

In adulthood, he reports significant difficulties with inattention. He loses things frequently, a pattern that has persisted since childhood. He is anxious about forgetting things and relies heavily on written notes, calendars, and timers to manage daily tasks and appointments. He describes this as requiring a huge amount of effort to appear organised. He experiences ’time blindness’ and is often late. He finds it difficult to follow multi-step instructions unless they are broken down and written, a strategy he uses extensively in his professional life as a project manager. He is easily distracted by both external stimuli and his own thoughts. He describes how his symptoms worsen with stress and fatigue, leading to increased tension in his relationship with his wife. He requires reminders for daily activities like taking medication. He hyper-focuses on tasks that interest him, to the exclusion of all else, a trait which is also present in childhood.

The mother, Carol Kappus, reported that Peter was a very intelligent child who always performed well academically, however homework assignments were always a struggle. It would take him a very long time to work through a small mathematics assignment. In fourth grade, students were required to write a short story every Thursday night, and the entire household experienced significant distress during these assignments. He would have considerable difficulty getting started and equal difficulty reaching completion. When his mother asked him in frustration whether he could simply write something, he responded that he knew he should but that his stories were always very good and when it was his turn to read to the class, everyone applauded when he stood up to begin reading. This was very frustrating for his very efficient and focused father, though the mother stated she understood completely as she had been exactly the same way throughout her own schooling.

Regarding appearing not to listen when spoken to directly, the mother confirmed this was true. If he was engaged in something that fascinated him, he would sometimes seem off in space. He is a gifted pianist and would often become deeply involved in composing pieces on his electronic keyboard. The mother recalled his college roommates reporting that at approximately two o’clock they would suggest going to get something to eat, Peter would cheerfully agree, but approximately three hours later they still had not managed to get him away from what he was doing. One college friend recounted this story at Peter’s wedding. He would hyperfocus on activities he enjoyed. He always completed his schoolwork, but it would take hours and hours to do assignments, whereas the mother is certain other children finished theirs in fifteen minutes. Peter’s first experience with school was preschool when he was three and a half years old, and at the first parent-teacher conference the teacher’s initial comment was that Peter was very easily distracted.

The father, Hans Peter Kappus, reported that Peter typically needed either the father or the mother sitting with him before homework could commence. The father frequently used the term earth to Peter if he needed to get his attention. There was a fancily embroidered Chinese cloth hat termed the homework hat, and it was understood that when wearing the hat, one concentrated on homework. Peter loved being read to but had trouble reading independently. The father employed various strategies to encourage him to read, including purchasing classic comic books of classic literature. The family had a collection of approximately one hundred of these. Additionally, when reading was required in high school, the family made available the Cliff’s Notes series of the assigned reading. The father believes Peter was strongly dyslexic, however US schools in the early eighties did not test for this. Peter did not really read for pleasure until well into his thirties. Peter was famous for putting off school assignments until the last possible moment and required close parental supervision. However, once he got going on a task, he would produce superior work. Starting was the problem. He was always interested in creating and solving mazes, and this took precedence over tasks he was supposed to be doing. Peter benefited from close supervision and did not reject advice, so he needed close supervision to be able to complete his schoolwork. He would receive remuneration for assigned chores, which served as motivation to complete them.

Hyperactivity and Impulsivity Questions

He endorses all symptoms of hyperactivity and impulsivity in both childhood and adulthood, although he has developed coping strategies like mindfulness and meditation to manage them as an adult. He describes his mind as constantly ’lighting up’ with ideas, which he feels compelled to express simultaneously. He has a history of interrupting others and finishing their sentences, which he has learned to control with effort. He reports being a high-energy individual who finds it difficult to relax, preferring to engage in creative activities like making music or art unwind. He fidgets, paces, and often feels restless. In childhood, he was always talking to himself and found it difficult to wait his turn in group activities. He enjoys busy, chaotic environments like city centres and festivals, which he finds calming, though he remains socially shy in these settings.

The father stated that Peter was a high energy child but could be reasoned with. Peter relished playtime that challenged his imagination. He was a champion at Apple’s Dark Castle and Space Invaders. The father endorsed two questions in the hyperactivity and impulsivity domain.

Impact on Functioning

In the family domain: His symptoms have created significant friction in his marriage. His difficulty with decision-making, procrastination (e.g., delaying making dinner when asked), and forgetfulness are sources of frustration for his wife. He describes her feeling that he does not listen or care. His tendency to change his mind at the last minute also causes conflict. The relationship with his parents and sister is good, although his difficulties with homework and focus caused frustration for his father during his childhood.

In the work domain: He works as a project manager and Agile coach. He thrives in complex, chaotic environments but struggles with tasks that require following a rigid, uninteresting process. He has received feedback about getting distracted and going off topic during workshops. He notes his work performance, focus, and patience deteriorated significantly during a period of high personal stress when █████████████ (redacted to protect the privacy of another). He currently holds three different jobs.

In the school domain: His parents provided detailed reports of his childhood. He was considered intelligent and achieved good grades, but homework was a constant struggle requiring hours of effort and close parental supervision. He had significant difficulty initiating tasks and procrastinated until the last minute, though the final work was of high quality. His first preschool teacher noted he was “very easily distracted.” He had trouble with independent reading, and his parents used strategies like classic comic books and Cliff’s Notes to help. He graduated from university with honours.

In the life skills domain: He puts significant, conscious effort into managing daily life. He uses extensive reminder systems for chores and personal care. He finds that without these systems he would forget tasks. His wife has previously expressed frustration about his lack of contribution to household chores, which has improved with his deliberate use of coping strategies. He manages his finances but with a great deal of anxiety, fearing he has forgotten to pay a bill or manage his accounts correctly. He has hired a bookkeeper for his business to help with this.

In the social domain: He has a small group of close friends whom he has maintained through conscious, scheduled effort, such as putting reminders in his calendar to contact them which is exhausting. He reports that making and keeping friends does not come naturally. He has recently found a community of musicians where he feels more comfortable. He feels a need to be around people and enjoys crowds but finds direct social interaction exhausting and difficult to initiate.

In the emotional domain: He reports experiencing anxiety and depression, particularly in the winter. He is highly self-critical and can have very negative self-perceptions when he feels he has failed or disappointed someone, leading to thoughts that he is a “rubbish person.” His self-esteem is linked to his ability to contribute, which makes him vulnerable to negative feedback. He takes criticism, especially from loved ones, very personally, feeling completely deflated and like failure. He also notes that he can bounce back from these low moods relatively quickly. He has found mindfulness to be very helpful in becoming more aware of his emotional state.

Past Psychiatric History

No formal psychiatric diagnoses were reported, and he has no history of self-harm. He has, however, engaged in mindfulness which he found helpful.

Drug and Alcohol History

He has tried marijuana in the past but found it induced anxiety rather than relaxation, so he does not use it…He now drinks alcohol very rarely (e.g., one or two units per month), as he finds it negatively impacts his sleep. He has completely stopped consuming caffeine as it leads to overstimulation. He does not smoke tobacco.

Personal and Developmental History

He was born in Surrey, UK, to American parents and moved to the US at age two or three. He grew up in St. Louis, Missouri, in what he describes as a rough neighborhood and school. He attended a private school for four years and found a diverse group of friends. He had friends in primary school, but he found it hard in the 5th and 6th grade as he struggled to fit in. He lived in New York and Seattle before moving back to the UK in 2009 with his wife. He has a sister who is nine years younger; they have a good relationship as adults. There were no reported complications during his mother’s pregnancy or his delivery. Developmental milestones were presumably met.

Medical History

He had childhood epilepsy, with seizures occurring between the ages of 10–12 and the last known seizure at 15 or 16. The seizures occurred as he was falling asleep. He was briefly on medication which he found made it harder to focus. He has had no seizures in adulthood. He suffers from hay fever and frequent sinus infections secondary to post-nasal drip. He has had two car accidents, which he attributes to inattention and driving too fast. He denies any past or present psychosis. He denies any past or present seizures.

There is no history of thyroid disease, no cardiac symptoms, no history of Raynaud’s phenomenon or glaucoma.

Forensic History

No arrests were reported. He has received a couple of speeding tickets.

Family Medical and Psychiatric History

His 13-year-old son has been diagnosed with both ADHD and Autism Spectrum Disorder (ASD). His mother is suspected of having ADHD; she reported being “exactly the same way” in school and has coping strategies for forgetfulness. His father is also suspected of having neurodivergence, with traits such as being talkative and interrupting others. His younger sister suspects she has autistic traits. His mother has a history of atrial fibrillation (onset in her 70s), hypertension, and kidney stones. His father has a history of lymphoma (in remission), diabetes, and polycythaemia. There is no family history of sudden cardiac death in a first-degree relative under the age of 40.

Mental State Examination

Appeared well, calm, and cooperative throughout the virtual consultation. He was articulate and able to provide detailed examples of his experiences. His mood appeared euthymic, though he reported a tendency towards anxiety and low mood. There was no evidence of psychosis. His thought process was coherent, though he described a tendency for his thoughts to race. He demonstrated good insight into his difficulties and their impact on his life.

He was assessed as having full capacity to participate in the assessment and to consent to potential treatment. He understood the information provided and was able to weigh the risks and benefits.

Follow Up

If the patient decides to proceed with treatment, he will be reviewed by the titration team in approximately three to four weeks after starting medication. A link to book this follow-up will be sent with the prescription details. Reviews will continue monthly during the titration period.

Update — 17 May 2026: Peter has opted for pharmacological treatment (see Medication Plan).

Other Recommendations

Non-pharmacological treatments such as ADHD coaching and talking therapies were discussed. The patient is aware that these are not offered by Harrow Health but may be available via GP referral if commissioned locally. He has been advised to reduce intake of all stimulants to avoid overstimulation.

If no contact is made about treatment within seven days, please proceed with discharge.

Risk Assessment / Safeguarding

There are no immediate risks of self-harm or suicide. He has a history of two car accidents related to inattention, and the DVLA guidelines regarding ADHD and driving have been noted. There are no safeguarding concerns for him or his child. The risks of stimulant medication, including interaction with alcohol and illicit substances, have been discussed. The history of childhood epilepsy has been noted; while it is a remote history, he has been advised to be aware of the small risk of lowering the seizure threshold and to report any concerns.

Diagnostic Formulation

Based on the information provided in the rating scales completed, his symptoms meet the DSM-5 diagnostic criteria for ADHD.

He scored 7/9 for symptoms of inattention and 8/9 for symptoms of hyperactivity and impulsivity in adulthood.
He scored 9/9 for symptoms of inattention and 9/9 for symptoms of hyperactivity and impulsivity in childhood.
His clinical presentation is of ADHD of Combined type.

He was pleased and relieved to have had the consultation today and agreed to the above formulation. He reported that having a diagnosis of ADHD has given him understanding and clarity of why he struggles so much in his day-to-day life.

No single test/information is diagnostic for ADHD on its own. Therefore, a diagnosis of ADHD is more reliable if different tests/information is collected from different sources and is consistently indicative of ADHD. I assessed the five criteria for a diagnosis of adult ADHD based on DSM-V. You have been administered the Adult ASRS scale which is suggestive of ADHD.

Following a comprehensive assessment, using DIVA (and DSM diagnostic criteria), backed by cogent collateral information from childhood and adulthood and subjective findings during the interview, your presentation satisfies the criteria for ADHD.

Summary of A1 and A2 Symptoms

The following table shows a summary of the main symptom clusters and their presence during adulthood and childhood as found by the DIVA interview, split by Attention Deficit and Hyperactivity/Impulsivity symptoms:

Criterion	Symptom	Adult	Child
A1(a)	A1. Often fails to give close attention to details, or makes careless mistakes at work or during other activities	x	x
A1(b)	A2. Often has difficulty sustaining attention on tasks	x	x
A1(c)	A3. Often does not seem to listen when spoken to directly	x	x
A1(d)	A4. Often does not follow through on instructions and fails to finish chores or duties in the workplace		x
A1(e)	A5. Often has difficulty organising tasks and activities	x	x
A1(f)	A6. Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort	x	x
A1(g)	A7. Often loses things necessary for tasks or activities	x	x
A1(h)	A8. Often easily distracted by extraneous stimuli	x	x
A1(i)	A9. Often forgetful in daily activities		x
	Total number of criteria Attention Deficit	7/9	9/9
A2(a)	H/I 1. Often fidgets with or taps hands or feet or squirms in seat	x	x
A2(b)	H/I 2. Often leaves seat in situations when remaining seated is expected	x	x
A2(c)	H/I 3. Often feels restless	x	x
A2(d)	H/I 4. Often unable to play or take part in leisure activities quietly	x	x
A2(e)	H/I 5. Is often “on the go” acting as if “driven by a motor”	x	x
A2(f)	H/I 6. Often talks excessively	x	x
A2(g)	H/I 7. Often blurts out an answer before a question has been completed	x	x
A2(h)	H/I 8. Often has difficulty awaiting his or her turn		x
A2(i)	H/I 9. Often interrupts or intrudes on others	x	x
	Total number of criteria Hyperactivity/Impulsivity	8/9	9/9

DSM-5 Criteria

These results are mapped against the diagnostic criteria for ADHD, based on the various stipulations in DSM-5, as follows:

Criterion A: ADHD symptoms

a. The assessment confirmed that 3 or more symptoms of Attention Deficit and Hyperactivity/Impulsivity were present in childhood, i.e. 9 and 9 respectively.

b. There were 5 or more characteristics of Attention Deficit found in adulthood, i.e. 7.

c. There were 5 or more characteristics of Hyperactivity/Impulsivity found in adulthood, i.e. 8.

d. Symptoms in adulthood have persisted for over 6 months.

e. Symptoms occur in multiple settings e.g. work, social, education etc.

Criterion B: Age of onset

There are signs of a lifelong pattern of symptoms (starting before age 12).

Criterion C: Pervasiveness

The symptoms are expressed in at least two domains of functioning in adulthood and childhood.

Criterion D: Impairment

The impairments are expressed in at least two domains of functioning in adulthood and childhood.

Criterion E: Exclusionary conditions

The symptoms could not be better explained by the presence of another neurological (or psychiatric) disorder.

When to Stop Taking Medication

Acute reported symptoms such as difficulty in breathing and/or chest pain. If indicated, please also follow the F.A.S.T. Test guidelines, which helps identify the common signs of a stroke:

F — Face drooping: Ask the patient to check for drooping on one side of the face.
A — Arm weakness: Ask the patient to check if one arm is weak or drifts down when raised.
S — Speech difficulty: Listen to the patient for slurred or strange speech, or difficulty repeating a simple sentence.
T — Time to call emergency services immediately.

If you display the following behaviours such as a potential psychotic episode (mania or psychotic symptoms hence grossly elevated mood, bizarre behaviour, hearing voices, seeing things that are not there), or are extremely aggressive to others or experience suicidal ideation, please stop your medication immediately and inform us.

Driving Status

The DVLA states: “You must tell DVLA if your attention deficit hyperactivity disorder (ADHD) affects your ability to drive safely.”

Further information: https://www.gov.uk/adhd-and-driving

Additional Resources

Access to Work allows people to get support in work if they have a disability or health condition, which includes ADHD. This service can offer support based on your needs, which could include adaptations and ADHD coaching. ADHD Coaching is not currently commissioned by the NHS. Funding can be obtained if you are in employment via the government Access to Work Scheme for coaching.

More information: https://www.gov.uk/access-to-work

Alcohol and Illicit Drugs

Do not drink alcohol while taking stimulant medicines. Alcohol may make the side effects of stimulants worse. Remember that some foods and medicines contain alcohol; please discuss this further with your consultant, if required. Also, it is potentially fatally dangerous to use illicit drugs, such as cocaine and amphetamines, when prescribed ADHD medication.

Harrow Health Admin Team — Action

a. Please send this report to the patient and his GP.

b. Please note the patient has seven days to decide on treatment.

c. If he contacts us within seven days to proceed, please notify me to issue the initial prescription for Affenid XL (or Methylphenidate MR per update).

d. If no contact is made within seven days, please proceed with discharge.

Discharge: If the patient does not make contact within seven days to confirm his decision on treatment, he will be discharged back to the care of his GP.