ADHD is the most common presenting neurobehavioral disorders in children and adolescents. While effective treatments exist, a number of youth do not respond, or can not tolerate our first line treatments. This breakfast will be hosted by Dr. Timothy Wilens, Chief of the Division of Child and Adolescent Psychiatry at Massachusetts General Hospital, who has been researching, writing on, and treating highly comorbid and refractory cases of ADHD for almost three decades. During this session, clinical vignettes and empirically derived data will be used to highlight diagnostic clarification and treatment approaches for youth with ADHD complicated by cognitive and psychiatric comorbidity; as well as nonresponse and/or adverse effects to traditional treatments. Participants are welcomed to provide brief synopses of difficult cases for group discussion.