Rarely is it 'just ADHD'. Diagnostic ambiguities, comorbid medical and psychiatric conditions, and phase-of-life concerns are the rule, not the exception. Unfortunately, clinicians are left with little guidance on how to help real-life patients navigate this complexity. In this session, we will begin by identifying common factors that complicate treatment. We will then turn our attention toward a transdiagnostic approach based on six core principles: (1.) Pattern recognition to identify the functional drivers of symptoms. (2.) Prioritizing treatments based on speed of response and symptom relationships. (3.) Titration strategies matched to the individual's nervous system. (4.) Appreciation of risk tolerance- when to be aggressive versus cautious. (5.) Therapeutic stance as an active treatment ingredient. (6.) Lifestyle medicine as neurochemical optimization. Drawing heavily on real-world clinical experience, this session will teach attendees how to think flexibly about complex ADHD presentations rather than following rigid protocols. Case studies will illustrate these principles in action, and there will be time for questions and answers.