Persistence of childhood ADHD symptoms into adolescence and adulthood is common. However, persistence is not simply a continuation of early high severity ADHD. Rather, it is the product of influences from individual-level genetic liability, one’s environmental context, and their interplay. The field has often focused on cross-sectional ADHD severity and genetic load. However, environments – such as one’s socioeconomic context – exert their own influence over development independently of genetics, as well as modulate genetic influences. Importantly, these genetic and environmental effects vary significantly between inattention and hyperactivity/impulsivity symptom domains, emphasizing the need to consider these domains separately when studying persistence risk. This article outlines a unifying persistence framework reflecting the changing contributions of genes, environmental context, and their interaction over time, offering a path to a more complete understanding of risk for symptom persistence.