Attention-deficit/hyperactivity disorder (ADHD) is the most prevalent behavioral disorder among children in the United States. Many of these children continue to experience prominent functional difficulties through adolescence and into adulthood. Specific impairments common to adults with ADHD have only recently come to light. The goal of this article is to discuss the case of a young man, Ralph, who was first diagnosed with ADHD in early childhood. Although pharmacotherapy helped him function better at school as a child, he encountered newfound difficulties as an adult, which reactivated his sense of rejection and failure in virtually every domain of his life. His case illustrates the degree of impairment experienced by many adults with ADHD and the benefit of a multimodal treatment package, which, in Ralph's case, included pharmacotherapy, cognitive-behavioral psychotherapy, and marital therapy modified for adults with ADHD. © 2008 Sage Publications.