Soren is a 4-year-old boy brought to your clinic after being asked to leave two preschool programs for aggressive behavior and "inability to sit still for even 30 seconds." His parents describe constant running, climbing on furniture, explosive tantrums when redirected, and an inability to follow two-step instructions. Symptoms have been present since age 2.5 and occur at home, at preschool, and at his grandparents' house. His father was diagnosed with ADHD at age 9. Developmental milestones are otherwise on track. After a comprehensive evaluation including cross-setting rating scales, you diagnose ADHD, predominantly hyperactive-impulsive presentation, moderate to severe.

Mei is an 8-year-old girl brought by her mother, who says "I think something is going on, but nobody will listen." Mei earns B's and C's and her teacher describes her as "quiet, a bit dreamy, but no behavior problems." At home, homework takes 2.5 hours nightly with frequent tears. Mei has started saying "I'm dumb" and bites her nails. She was evaluated by a school psychologist last year who found no learning disability. Her mother was diagnosed with ADHD at age 34. Mei's pediatrician suggests the school evaluation rules out ADHD.

Idris is a 16-year-old boy diagnosed with ADHD Combined Type at age 8. He has been prescribed OROS methylphenidate 54 mg each morning for the past 4 years. He obtained his learner's permit 3 months ago. His mother reports that his grades have dropped this semester and that he seems "unfocused and irritable" in the evenings. She also found that he has been skipping his medication on weekends. During the individual portion of the interview, Idris says the medication "makes me not feel like myself" and that he wants to "just handle it on my own." He denies substance use but acknowledges his friends use cannabis.

Vera is a 42-year-old marketing manager and mother of three who presents to your office after her 9-year-old daughter was diagnosed with ADHD. While completing her daughter's assessment forms, Vera recognized herself in the symptom descriptions. She reports lifelong difficulty with organization, chronic lateness, and "always working twice as hard as everyone else." She graduated from college with a 3.2 GPA but describes it as "brutal." She has been treated for anxiety since age 24 (partial response to escitalopram) and depression since age 31. She reports that her focus and emotional regulation have worsened significantly over the past 18 months, coinciding with missed periods and hot flashes. She notes her concentration is notably worse in the week before her period.

Kavi is a 17-year-old boy with ADHD diagnosed at age 7, currently well-managed on lisdexamfetamine 50 mg daily. He is a high school junior planning to attend a 4-year university. His pediatrician has been managing his ADHD since diagnosis. At today's visit, his mother asks when they should "start thinking about transitioning him to an adult doctor."