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A 32-year-old female graduate student requests evaluation for ADHD. She reports difficulty concentrating on her dissertation, procrastination, forgetfulness, and feeling overwhelmed by tasks. She states these problems began about 18 months ago when she started her doctoral program. She performed well academically through college with no behavioral or attention concerns. She sleeps 4-5 hours per night due to anxiety about her program, drinks 6 cups of coffee daily, and reports persistent worry about academic performance, finances, and her relationship. There is no family history of ADHD.
Explanation
The central diagnostic question in adult ADHD evaluation is whether the age-of-onset criterion is met (symptoms before age 12). When adult-onset concentration problems are present, anxiety, depression, sleep deprivation, and substance use should be considered as underlying causes. The onset timeline is the most reliable diagnostic tool.
Key Takeaway
Adult ADHD diagnosis requires evidence of symptoms before age 12; new-onset concentration difficulties in adulthood should prompt evaluation for anxiety, mood, sleep, and substance-related causes first.