As someone diagnosed with ADHD in their mid 30's, I've had plenty of environment changes over the years (including with a Psychiatrist who understood my then-reluctant view on meds); honestly none helped me nearly as much as meds.

Eight year olds can't change the environment much. But if we are making a lot of eight year olds struggle when we put them in an artificial environment, I hope we're considering whether we've make mistakes designing that environment.

agreed. I assume you are talking about the school environment?

I would add home environment (parents and siblings especially), culture, entertainment, friends, religion, sleeping habits, socioeconomic status... etc.