Kofi is a 7-year-old boy referred by his second-grade teacher after she completed a Vanderbilt rating scale that met symptom thresholds for combined presentation. His mother describes him as "always on the go since he could walk." At school, he leaves his seat repeatedly, talks over classmates, loses materials daily, and has started getting into scuffles at recess. At home, he cannot sit through dinner, drifts from homework within minutes, and needs constant supervision for basic routines. He sleeps 10 hours nightly with no snoring or restless sleep. He eats normally and has no medical concerns. His father was diagnosed with ADHD as a child and still takes medication. His mother has a history of anxiety.

Sadie is a 14-year-old girl whose therapist refers her for ADHD evaluation after two years of treating generalized anxiety with limited improvement. Sadie was a straight-A student through middle school but her grades have dropped to B's and C's in ninth grade. She reports "zoning out" in class, rereading textbook pages without absorbing content, and staying up past midnight to finish homework her classmates complete in an hour. She describes her mind as "always somewhere else" but cannot say where it goes. She loses her phone, jacket, and water bottle almost daily. Teachers describe her as "quiet and pleasant" and have raised no behavioral concerns. Her mother was diagnosed with ADHD at age 38.

Rafael is a 9-year-old boy placed in foster care eight months ago after removal from a home with documented domestic violence and physical neglect. His foster mother reports he "cannot sit still for one second," constantly scans the room, has explosive outbursts when corrected by adults, and is failing third grade. His school requests an ADHD evaluation so he can start medication. His foster mother adds that he startles at loud noises, has nightmares several times per week, and sleeps poorly. His biological father has a documented history of ADHD and substance use disorder (SUD). Prenatal exposure history is unknown.

Harper is an 8-year-old boy whose parents are concerned about inattention. His teacher reports that he is "in another world" during reading and writing activities: he stares at his paper, erases repeatedly, avoids written assignments, and frequently asks to go to the bathroom during language arts. In contrast, he participates eagerly during science demonstrations, class discussions, and hands-on math activities. He reads at a first-grade level despite average cognitive ability on group testing. His parents report that he sleeps 9 hours per night but snores loudly, occasionally gasps, and is difficult to wake. He is often described as "wired" and hyperactive in the morning despite appearing exhausted.

Nia is a 22-year-old Black woman presenting for an ADHD evaluation at a university counseling center. She reports lifelong difficulty with organization, time management, and sustained attention that worsened when she started graduate school. She was evaluated once at age 15 by her pediatrician, who told her she "doesn't fit the profile" and diagnosed her with generalized anxiety disorder (GAD). She has been treated with sertraline for seven years with partial benefit for worry but no improvement in executive function. Her older brother was diagnosed with ADHD at age 7 and received stimulant treatment through high school. Her Adult ADHD Self-Report Scale (ASRS) administered at the counseling center was strongly positive.