In this chapter, we synthesize the theoretical reconceptualizations, contextual insights, and equity considerations presented throughout this volume into a unified framework for understanding and addressing gifted underachievement. Rather than treating divergent perspectives as competing alternatives, we examine areas of convergence and productive disagreement across chapters, identifying where the field has achieved consensus and where tensions remain. We identify four major areas of agreement: the complexity and dynamic nature of underachievement, the limitations of traditional definitions, the critical role of contextual factors, and the need for integrated interventions. Simultaneously, we explore key tensions about the relative importance of academic skills versus psychosocial factors, the role of labeling, definitional boundaries, and appropriate units of analysis. From this synthesis, we suggest a multi-pathway framework that accommodates diverse manifestations of underachievement while providing practical guidance for identification and intervention. We summarize unresolved questions that require continued investigation, focusing on this integrative framework as a foundation for future scholarship rather than a final word on this complex phenomenon.