Attention-deficit/hyperactivity disorder (ADHD) is characterized by the inability to regulate attention and/or symptoms of hyperactivity that interfere with some level of daily functioning. Although this disorder is well-recognized in children, it is less frequently diagnosed and treated in adults. The pathogenesis of ADHD is not well understood, but norepinephrine and dopamine appear to play roles in the disorder because they modulate the area of the brain involved in attention and behavior regulation. ADHD has a high comorbidity rate, particularly with substance use disorder. Screening for ADHD can be performed in the primary care setting with tools such as the Adult ADHD Self-Report Scale. Diagnosis should be made based on the Diagnostic and Statistical Manual of Mental Disorders criteria, which lists symptoms of inattention and hyperactivity-impulsivity separately. For adults, diagnosis requires patients to have at least five of the symptoms in either category for more than 6 months. Symptoms must have been present before age 12 and must have occurred in at least two independent settings. Treatment is generally a combination of cognitive behavior therapy and stimulant medications, usually amphetamines, although exceptions exist based on comorbid conditions.

Case 1. HM, a 24-year-old, presents to your office at her family’s urging due to difficulties focusing at work and missing several important deadlines. She recently started a job in accounting after graduating from college. She notes difficulties paying bills on time, remembering important dates, and arriving on time to social functions. She says she has always been “a procrastinator” and had similar problems in school.