Case history

Case history #1

A 26-year-old man presents with difficulty functioning at work, leading him to recently lose his job. He was treated for attention deficit hyperactivity disorder (ADHD) in childhood, beginning at 12 years of age. He could not focus at school and got into trouble for talking loudly, leaving his desk, and bothering his peers during class. His teachers commented that he was not achieving according to his abilities. With methylphenidate treatment, his schoolwork and behaviour improved and he was able to finish school with results that allowed him to enter university. However, at the age of 18 his medication treatment was stopped because he felt he didn't need it now that he was an adult. After 6 months at university, he started fearing he would not be able to finish the year. His academic performance deteriorated, he started to procrastinate, and he was not able to organise himself to attend lectures or complete his coursework on time.

Case history #2

A 54-year-old man presents as his current partner threatens to terminate their relationship due to his volatile and chaotic behaviour. The patient is a successful professional man who does not seem to have any problems. His partner, however, who gave a collateral history of inability to focus, impulsive behaviour, inability to finish off projects, disorganisation, and forgetfulness, has a grandchild who was recently diagnosed with ADHD and saw much resemblance in his presentation. The patient had an educational history characterised by difficulty in sitting in the classroom, daydreaming, bad time management, inability to revise for lessons, and underachievement. He found it difficult to maintain employment when employed by others due to feeling constrained, so he set up his own business where he was able to manage his working hours and conditions. As the business grew, he hired people who helped him to organise himself because, for example, he would file accounts late and get penalised. His impulsive behaviour was problematic as he would speak without thinking and as a result lose lucrative contracts. He insisted that if he was not an 'airhead' he would have done much better with his work.

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