Background: Recent studies reported ADHD-like symptoms and cognitive deficits in pervasive developmental disorder (PDD). Because work in dementia documents improvement in executive function deficits with the acetylcholinesterase inhibitor donepezil, the authors reason that similar benefits could be obtained in PDD. Method: The authors describe eight cases of PDD youth ages 10 to 17 treated with donepezil targeting ADHD-like symptoms associated with PDD. Results: Most participants improve ADHD-like symptomatology. In addition, improvement in communication and socialization is noted. Conclusion: Donepezil may have a role in treating ADHD-like symptoms in children with PDD. (Contains 2 tables and 3 figures.)