In this chapter the author provides a case study of Joshua, treated for both attention deficit hyperactivity disorder (ADHD) and Asperger syndrome. Joshua came with his mother for an initial consultation with the author when Joshua was 11 years old and enrolled in fifth grade at a very small private school where each student was in a separate cubicle to work at his own pace with little social interaction between students. Two years prior to his evaluation in the clinic, while he was in third grade in a mainstream public school, Joshua was referred by his parents for a neuropsychological evaluation. Joshua felt special because his parents repeatedly praised him for being “gifted” and highly intelligent, much smarter than other children. The author's evaluation of Joshua clearly indicated that he fully met diagnostic criteria for ADHD of the combined type. One major area of strength where Joshua’s ADHD impairments were not evident was making music.