Julia, a 19-year-old female college student, came to a school clinic for help with academic problems. Since starting college six months earlier, she had done poorly on tests and could not manage her study schedule. Her worries about flunking out of college were causing her poor sleep, poor focus and lost hope. After a week of low grades, she returned home and told her family she should drop out of college. Her mother brought her to the clinic where she and her older brother had been treated for ADHD when they were younger. She wondered if his ADHD might be causing his problems, or whether he had outgrown it.

Julia had been to the clinic when she was 9 years old and had been diagnosed with ADHD. Notes from that evaluation showed Julia had been in trouble at school for getting out of her seat, losing things, not following instructions, not completing homework and not listening.

A psychologist also confirmed reading problems during the evaluation. Because Julia’s problems did not meet the standard for a learning disability diagnosis, she could not receive special education services. Julia’s primary care doctor had proposed medication, but her mother refused. Instead, she hired a tutor to help her daughter “with concentration and reading.”

Since starting college, Julia said he often had trouble staying focused while reading and listening to lectures. Because of his stress at school, she had trouble falling asleep, had poor energy and didn’t “have fun” like his peers.

Julia’s older brother had ADHD. Her father, who died when Julia was seven, had dyslexia (a reading disorder). Her father had dropped out of community college after one semester.

Julia was referred to a psychologist for more testing, and the doctor diagnosed her with ADHD. The report stated that Julia had certain problems with reading fluency and comprehension (reading quickly and know the correct meaning), as well as spelling and writing. When she was first assessed at age 9, the standards for ADHD required six of nine symptoms. She had been diagnosed with the combined type of ADHD, because the specialty clinic had found at least six symptoms in inattention and hyperactivity/impulsivity. With DSM-5, only five symptoms are needed for people age 17 and older. At age 19, Julia met the standards for ADHD and for a specific learning disorder. With the correct diagnosis, he was able to receive services for academic support for her college studies.

American Psychiatric Association. (2021). ADHD patient stories. Understanding Mental Disorders: Your Guide to DSM5. American Psychiatric Publishing, Inc.

What is your diagnosis and treatment plan for this case? Include the following:

Pharmacological tx

Non-pharmacological to

Patient Education

Referral to other providers

Follow-up