This commentary addresses the case of Sam, analyzed by Dr. Kristin Whiteside. It suggests that a possible reason for the patient’s premature and unilateral decision to terminate his analysis after only a short period of time was due to his analyst focusing excessively on impulse–defense conflicts. The analytic literature on attention deficit hyperactivity disorder (ADHD) is reviewed to suggest heuristically that it might have been more fruitful to consider his difficulties with the analytic frame as related to a variety of ADHD developmental limitations and his shame at having them seen. Problems with affect regulation, object constancy, and narcissistic regulation are emphasized as compromised mental functions that affected his approach to the analytic encounter. The value of integrating adult and child psychoanalytic training in institutes is suggested as a way to teach analysts to consider multiple determinants in pathogenesis in a manner consistent with dynamic, nonlinear systems theory.