Objective: Adolescents with autism spectrum disorders (ASD) are increasingly attending college. This case report highlights the nature of the psychiatric difficulties these individuals may face and the potential role for college mental health practitioners. Participants: A case of a female student with ASD presenting with significant inattentive symptoms. Methods: The authors describe the unique features of this patient's clinical presentation, discuss relevant diagnostic considerations, and make recommendations about how to best approach treatment. Results: This student presented with symptoms of attention-deficit/hyperactivity disorder (ADHD), which were first relevant during her time at college, owing to increased demands on planning and other executive functions. She was eventually responsive to treatment with a stimulant, but had more side effects early on. Conclusions: As individuals with ASD attend college, their mental health needs will require treatment. However, such treatment draws on a comparatively limited evidence base, and providers need to be aware of potential challenges that may arise.