Attention deficit/hyperactivity disorder (AD/HD) is a serious illness that probably. afflicts at least 2% of adults . It often goes unrecognized. When it is not properly treated, it creates great suffering, and it may account for a significant number of psychotherapeutic treatment failures.

The purpose of this discussion is twofold. We will present clinical material about AD/HD, particularly as it involves adult patients. We also intend to show how the principles of self psychology can integrate the elements of the biopsychosocial model (Engel, 1977) of psychiatry. AD/HD offers a clear example of how biological, intrapsychic, and social factors can be synthesized into a coherent etiologic explanation and comprehensive treatment plan.