hardstimulant diversionADHD assessmentASRSsubstance seekingdiagnostic validity
A 22-year-old male college student presents requesting evaluation for ADHD. He reports difficulty concentrating during lectures, procrastination on assignments, and poor academic performance this semester. He states that a friend gave him Adderall before a final exam last semester and 'it helped me focus for the first time.' He does not report childhood symptoms of inattention or hyperactivity and states his academic performance was strong through high school without accommodations. His developmental and family history are unremarkable. On the Adult ADHD Self-Report Scale (ASRS), he endorses five of six Part A screening items at the 'often' or 'very often' level. Urine drug screen is positive for amphetamines. Which constellation of assessment findings most strongly suggests stimulant-seeking behavior with diversion risk rather than genuine ADHD?