I'm sure there would be other cases where it'd be much harder to sort out - for younger children, I guess, and maybe also for older children who are less asynchronous. I could imagine someone having trouble if their child didn't have the EF for intellect-appropriate tasks but also found (all) age-appropriate tasks so boring that they couldn't focus on them for that reason; you'd have to watch very carefully to spot that two different things were going on!
My eldest DD is pretty clear cut, she is less able to function than her peers on age appropriate tasks and is not meeting her intellectual potential by any measure. I think, when she finally gets in to see the paed in 9 months time, that we probably well agree to medicate her.
My 2nd DD may be one of these more tricky to figure out cases. She clearly doesn't have the same degree of issues as her older sister, so she seems "Great" to me comparatively, she's not yet at school so I don't know how that will pan out. But our perspective is perhaps skewed as to what "great" looks like. She's likely to be more asynchronous and she's got an ADHD role model... It's amazing how different #2 is when #1 is way (like on camp for 3 days). Which in itself may be a reason to err on the side of treating #1 if it is suggested - the degree to which her chaos is effecting her younger sisters' behavior (and my sanity). For example DD2 has no trouble following instructions and getting ready for school when DD1 is not there, but she is almost as bad as DD1 if DD1 is there. Whereas DD1 is a nightmare to get to school whether DD2 is there or not.
