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AD/HD may be overlooked as well as too zealously and concretely overdiagnosed. When this condition is properly identified, it is most fruitfully understood in a balanced manner that is integrated with an appreciation of its inevitable shaping influence on the patient's perceptions, self-experience, and psychodynamic constellation, including central unconscious fantasies. This exploration is necessarily multifaceted: the patient's internal experience of states of distractibility, impulsivity, and hyperactivity, their incorporation in unconscious fantasies, and their employment in the service of both self-punitive urges and defenses against the “unpleasure” (Brenner, 1982) associated with psychic conflicts. Psychoanalysts are in a unique position to grasp these complex relationships. Familiarity with diagnostic issues, the developmental impact of AD/HD, common difficulties such patients present in treatment, and typical countertransference responses will enrich their psychoanalytic work. Interrelationships between AD/HD and the patient's psychic world are presented as they arose in the analysis of a child and an adult.