The clinical presentation of attention deficit hyperactivity disorder (ADHD), its relationship to other developmental delays, and its association with socioeconomic variables were explored in a multicultural, South African clinical sample. Results indicate that, for this sample, ADHD is manifested by hyperactivity, attention deficits, disciplinary problems, social impairment, aggression, and impulsiveness and that these components cohere in the manner of a unidimensional syndrome. ADHD was found to be most frequently associated with behavior disorders followed by learning disabilities and speech delays. No relationship with socioeconomic variables was found. The findings have implications for the reconstruction of mental health structures in South Africa.