Developmental and behavioral disorders grown up: Attention deficit hyperactivity disorder

CLINICAL VINGETTE: Pat was diagnosed with attention deficit hyperactivity disorder-combined type in the second grade and has been treated primarily with stimulants, albeit on an inconsistent basis. Pat is now a 22-year-old male, who is a second year student at a local community college. He attained a 2.1 GPA during his first year of postsecondary studies, doing quite well in several classes yet rather poorly in several others. Pat has a part-time job at a fast food restaurant, a position that he has held for approximately 6 months. Before his current job, Pat worked as a dishwasher at a local restaurant. He was fired from this position due to chronically being late to work. Pat stated that he gets along well with his peers, although his mother reported that Pat has a history of being able to make friends, "yet not keep them." Pat's mother also reported that Pat has traditionally gravitated toward peers who were "not especially good influences." She described various antisocial acts that Pat was involved with during high school. Pat reported that he began experimenting with alcohol and cigarettes in ninth grade and marijuana shortly thereafter. He stated that he drinks less often than he smokes marijuana ("several times a week"). Pat denied legal difficulties, although his mother reported that Pat was asked to leave the dormitory during his first semester due to an alcohol-related incident. Pat is not currently involved in psychotherapy and is prescribed extended release methylphenidate. He reported that he took his stimulant whenever he had to do a lot of work for school.