So, I'm a little torn here. This grandmother is a nitpicky, over-observant perfectionist.

On the other hand, there does seem to be some actual factual neglect going on here, to a degree the grandmother may actually be *minimizing*. If Katie is actually dirty and with clothes that don't fit on a consistent basis, that's a warning sign of potential abuse and neglect, and not just "this person has ADHD and forgets things sometimes." So... pay attention to that.

If it is just them being spacey and the grandmother being a nitpicking perfectionist, then the last paragraph is gold and I heart it.