DD has ADHD and we put her in a highly gifted program where she is mixed with kids from different grades (so some kids are 2 years older). The program seems to have similar expectations of all the kids regardless of what grade they are in or if they had been accelerated, however the teachers (so far) have been flexible and willing to put up with a lot. It has been a big shock to the executive functioning system, I think, because it is a lot of independent work, self-organization, etc. If you go ahead with this with a child with ADHD you will want to make sure the teacher she is with is understanding and willing to work with her. Otherwise you'll probably be in for more stress. But maybe not--I don't think one grade level up is a big deal. DD was accelerated so she was 8 going into fourth grade, and in classes with some 5th graders, all of them highly gifted, so she just isn't at the same level in terms of EF, maturity, attention, etc. But that's not what you would be dealing with and it would probably be Ok just going up one grade placed with "regular" kids. So she has to score in the 75th percentile, or get 75 percent correct, or what? I hope it goes well.