Objective and methods: To explore association between prevalence of ADHD and levels of risk for gestational alcohol exposure, the authors reviewed the charts of 2,231 youth referred for fetal alcohol spectrum disorders. Participants were categorized into four groups by different levels of risk for gestational alcohol exposure. For each group, the prevalence rates of ADHD and other selected disorders were determined. Results: The disorder ranking first in overall prevalence was ADHD (41%), followed by learning disorder (17%) and oppositional-defiant/conduct disorder (16%). Prevalence rates of ADHD across the groups generally were high risk greater than some risk greater than unknown risk greater than no risk. Conclusion: The frequency distribution of ADHD cases was according to the levels of risk for gestational alcohol exposure. These results add to a growing body of evidence supporting an association between ADHD and prenatal alcohol exposure. Findings need to be confirmed by definitive studies on ADHD and gestational alcohol exposure. (Contains 2 tables.)