Nico is an 8-year-old boy with ADHD, Combined Presentation, diagnosed at age 6. He takes methylphenidate extended-release 27 mg daily with good symptom reduction on Vanderbilt scales. His parents are meeting with the school team next week to discuss supports. The school coordinator tells them Nico can receive either a 504 plan or be evaluated for an Individualized Education Program (IEP) through the Individuals with Disabilities Education Act (IDEA). Nico's grades are C's and D's. He has received multiple office referrals for impulsive behavior, including pushing a classmate on the playground last month.

Lena is a 10-year-old girl with ADHD, Predominantly Inattentive Presentation. She takes lisdexamfetamine 30 mg daily. Her mother brings a copy of Lena's 504 plan to a follow-up visit. The plan lists three supports: preferential seating near the teacher, extended time (time-and-a-half) on all tests, and permission to use a fidget tool during class. Lena's backpack is chronically disorganized, she loses an average of three homework assignments per week, and her teacher reports she 'daydreams through half the lesson.' Her grades are C's despite average intelligence.

Theo is an 11-year-old boy with ADHD, Combined Presentation, and a Full Scale IQ of 128 on the Wechsler Intelligence Scale for Children (WISC-V), with a Processing Speed Index of 89. He reads two grade levels ahead and scored in the 95th percentile on math achievement testing. Despite this, he turns in approximately half his assignments and his grades are C's and D's. His fifth-grade teacher describes him as 'brilliant but unmotivated' and has recommended that Theo repeat fifth grade to 'develop better work habits.' His parents are considering the school's recommendation.

Ravi is a 7-year-old boy with ADHD, Combined Presentation, diagnosed 6 months ago. He started methylphenidate extended-release 18 mg daily 4 months ago with good symptom reduction at home. His mother reports that his second-grade teacher tells her 'he just needs to try harder' and 'his parents need to be more consistent with discipline.' The teacher has not implemented the Daily Report Card recommended in Ravi's 504 plan, saying she 'doesn't have time for special charts.' At the last parent-teacher conference, the teacher told Ravi's mother that 'ADHD is just an excuse for bad behavior.'

Halima is a 17-year-old girl with ADHD, Combined Presentation, who has been on an IEP under Other Health Impairment since age 9. She takes lisdexamfetamine 50 mg daily with good symptom control. Her IEP includes a Daily Report Card targeting homework submission and Organizational Skills Training. She maintains a 3.2 GPA with these supports and has been accepted to a state university starting next fall. At her transition planning meeting, her parents ask what disability services will look like in college.