Attention-Deficit/Hyperactivity Disorder

When SSRIs improve mood but organizational impairment, chronic lateness, forgetfulness, and difficulty initiating tasks persist unchanged, the residual symptoms may be undiagnosed ADHD rather than treatment-resistant anxiety or depression. Ask what the anxiety is about - if it centers on executive dysfunction failures (missing deadlines, losing things, being disorganized), the anxiety may be secondary to the ADHD.

The inattentive presentation - quiet, compliant, daydreamy rather than hyperactive and disruptive - is systematically underdiagnosed in female patients. These patients compensate through conscientiousness, social compliance, and elaborate organizational systems until demands exceed capacity. Many women are first diagnosed in their 30s or 40s, often prompted by a child's ADHD diagnosis.

ADHD requires evidence of symptoms prior to age 12. New-onset attention difficulty in adulthood with no childhood history should prompt evaluation for depression, anxiety, sleep disorders, thyroid dysfunction, substance use, or early cognitive decline - not ADHD. The developmental history is the diagnostic anchor. Note that parental scaffolding masking symptoms counts as childhood history.

Chronic sleep deprivation produces attention difficulty, poor concentration, irritability, and impaired executive function that is indistinguishable from ADHD on surface presentation. Ask about sleep quantity, quality, snoring, and daytime sleepiness before diagnosing ADHD. Address the sleep first and reassess.

High IQ does not protect against ADHD. Intelligent patients compensate through raw cognitive ability, performing adequately while expending far more effort than peers. The impairment becomes visible when environmental demands increase (college, professional work, parenthood). A high GPA does not rule out ADHD - the functional cost required to maintain performance is the clinically relevant question.