Compared to other areas of the world and other Chinese societies such as Hong Kong and Taiwan, little is known about psychiatric conditions in Macao, a Special Administrative Region of China. There is growing evidence of the cross-national and cross-cultural validity of attention deficit hyperactivity disorder (ADHD), but there are no studies of ADHD symptoms in Macao. This study compared "Diagnostic and Statistical Manual of Mental Disorders" (4th ed., text rev.) ADHD symptoms of Macao postsecondary students (N = 459) to U.S. peers (N = 261). Based on symptom counts, Macao students reported higher rates of ADHD. With regard to recent problems, 7.01% of Macao students and 2.69% of U.S. students reported enough symptoms to meet the cutoff for 1 of the 3 subtypes. Requiring that enough symptoms be recalled to meet childhood criteria, recent rates dropped to 3.74% (Macao) and 1.15% (United States), which are within expectations based on worldwide estimates. Comparisons using other methods of calculating rates are also provided. This research adds to the limited knowledge of ADHD symptoms in postsecondary students across countries, and provides the first account of such symptoms in Macao. Assessment of ADHD symptoms in Macao is complicated by the high level of overall distress reported by students.