Clinical Notes

A graduate student recently came in saying they were “just not motivated” to work on their dissertation. At first glance, that formulation seems straightforward enough. The task is important, it is not getting done, and motivation appears to be missing. But as we talked, that explanation started to feel too simple. They cared about finishing. They knew the dissertation mattered. They knew it was not getting done. They could feel the relief that would come with making progress

Two people can look equally stuck and still need very different help. One of the most misleading things about clinical language is how often it makes very different inner experiences sound identical. “I can’t focus.” “I can’t make myself do it.” “I keep avoiding it.” Those phrases get used constantly. Patients say them. Clinicians say them. Partners, teachers, bosses, parents, and friends say them. But they do not always mean the same thing. That matters because if we treat e

Something about the usual way we explain ADHD has never fully matched what I see clinically. We say people with ADHD struggle with attention. We say stimulants help them focus. At a basic level, that’s true. But it has never fully explained what many of us actually see in real patients. Because a lot of people with ADHD can focus extremely well. Just usually not on demand. They can lock into a game, a side project, a business idea, a conflict, a creative obsession, a niche i

A common next question, especially after ADHD has started to seem like a possibility, is whether the problem is really ADHD at all. For many high-achieving students and professionals, the confusion is not about whether something feels wrong. It is about what, exactly, is driving it. A pattern I sometimes see is the person who has functioned well for years, at least from the outside. She may be in graduate school, working in a demanding job, or trying to build a startup. She i

One pattern I have seen in college and graduate students is that ADHD is not always most obvious in the people who struggled early. Sometimes it becomes clearer later in students who have done well for years. They are bright, motivated, academically successful, and outwardly functioning at a high level. For some students, earlier academic environments provide enough external structure to keep things working. Frequent deadlines, clear expectations, built-in accountability, and