Dr Marie Tan-Paredes

My Health North Richmond

Level 1, North Richmond Village

6-16 Riverview St

North Richmond

NSW 2754

07.01.2025

Re: Leila Henshaw (DOB: 17.03.2006)

Dear Dr Tan-Paredes,

Thank you for referring Leila Henshaw for a Wentworth Healthcare plan in July 2024 for “opinion and management”. I write to provide you with a review at the end of her referral.

Leila attended her first appointment of this plan on the 17th of August, 2024. She attended fortnightly to monthly consultations with a total of six. She had her review on the 10th of January, 2025. She is doing well and is about to move to Newcastle to commence university, hence her referral has been closed.

Initial Presentation

At the time of her initial consultation, Leila reported being in “a mental rut” for the past few weeks and was concerned about becoming depressed. She was working as a surveyor assistant, which required early starts. To manage, she was living with her grandfather during the week, which she was finding unsettling. She reported challenges at home, with difficulty meeting parental expectations around the house, and feeling disconnected whilst living away during the week. She reported feeling like she didn’t belong anywhere, (which has been a theme throughout her sessions, and could be attributed to adverse childhood events). Leila expressed guilt for not helping around the house and frustration that the other siblings didn’t have the same expectations on them.

Leila reported a deterioration in functioning, not enjoying things she usually did, and loss of motivation with her studies. She had stopped reading and doing puzzles and instead found herself mindlessly scrolling on her phone. She had reduced her socialising and was ruminating on relationship stressors with her family.

Leila reported a history of not expressing her emotions, and considered she had years of unexpressed emotions which she had compartmentalised. At the time of her initial consultation, she described her mood as “sad”. At other times, she has expressed feeling frustrated and angry about injustice and inequity within the family system, with some siblings getting preferential treatment. She denied suicidal ideation and there was no evidence of psychotic symptoms. She sat calmly in all sessions, with no hyperactivity or restlessness; with good eye contact and easy rapport. Thought form was logical and sequential, with no formal thought disorder and excellent concentration. She was oriented and had reasonable insight and judgement about her emotional wellbeing.

Initial consult on 16.10.24 K10: 41/50

Mental health history

Saw school counsellor previously.

Diagnosed with ADD and anxiety

PTSD being considered by her GP

Developmental history

History of out of home care in childhood. Removed from her biological mother at the age of 6, due to maternal challenges with AOD, leading to childhood neglect. Leila remembers not attending school and having to fend for herself; and periods without food in the house. FaCS (DoCS) were involved and monitored the children for a period of time. Leila reported a history of having to fend for herself from a young age.

Leila’s father had an AVO against him and was not allowed to see the children, however there were occasional visits.

From age 7 – 8, Leila lived with a foster family in Bargo.

Leila and her biological sister have been in the care of their aunty (paternal half sister -TBC), uncle and their two children, since the age of 8.

Leila has the perception that she was less of a priority than other siblings; and that her sister took a lot of the attention because of her behavioural issues; and that she didn’t have a childhood, as she cared for her infant sister from the age of 5

High achieving school student until Year 10. Then felt burnt out and didn’t engage.

Leila reported a history of poor ADLs during high school (hygiene and self-care)

She reported adopting the position of being good and doing her best, until Year 11, where she felt burnt out and her performance went downhill. She regrets not achieving her potential

Medication

Vivance (ADD) (unsure of dose)

Dexamphetamine (prn) (unsure of dose)

Supports

Leila refers to her aunt and uncle as Mum and Dad. They have been her primary carers since age 8.

Leila worked part time as a surveyor assistant for land surveyancing and attended TAFE until the end of 2024, when she resigned from work to pursue studies in Newcastle in February, 2025.

Good social network of friends since Year 7

Paternal grandfather lives in Blacktown – El Salvador refugee. Leila is 3rd generation.

Past medical history

Not known.

Family history

Sister has “behavioural issues” including ADHD and impulsivity.

Mother: substance abuse

Update

Leila was initially reserved to engage, however during each session she was able to open up about her challenges and express emotions. A range of psychodynamic interventions were utilised to help Leila explore underlying causes of distress, and Leila developed considerable insight over the course of the plan. She considers the work has affirmed her own thoughts about the impacts of her childhood.

Over the period of the referral, Leila has become clearer about her future and made decisions to move to Newcastle to study surveying. She has organised her accommodation and is moving this week. She is excited about the next stage, but also anxious about moving to a new area where she has no close friends or family, which is within the normal range to be expected at this stage of life transition.

Formulation:

18 year old female of El Salvadorean descent; student surveyor about to move to Newcastle to attend university, presenting with low mood and anhedonia in background of adverse childhood events.

Impression:

It is outside the scope of my practice to diagnose, and I am unsure that a formal diagnosis is necessary, since Leila’s symptoms are congruent with the adverse childhood events, to which she has coped and survived relatively well. However, there are psychological impacts associated with

childhood neglect and disruption to early childhood attachment that have contributed to feelings of not belonging and questioning her self worth. She has also adopted a coping strategy of not expressing her feelings and trying to be perfect, to ensure her position within the adoptive family remains intact.

The previous diagnoses may relate to the symptoms associated with the childhood trauma and coping strategies adopted as a younger child.

Plan

Referral has been closed.

Should Leila need further support at another time, I would be happy to see her.

Yours sincerely,

Michelle Hookham