Questions have been raised about the implications of the use of the psychiatric diagnosis of attention deficit hyperactivity disorder (ADHD) in the decision process for serving children in special education programs for either learning disabilities (LD) or serious emotional disturbance (SED). In this two-stage study children in LD and SED programs were first screened for ADHD risk using parent and teacher ratings. High-risk students subsequently underwent a comprehensive follow-up assessment for ADHD and comorbid conditions, including oppositional defiant disorder, conduct disorder, depression, anxiety, and low self-esteem, using child self-report measures and a diagnostic interview. A higher proportion of children with SED were under treatment for ADHD compared to students in LD programs. Based on multiple informants, children at high risk for ADHD did not differ in symptomatology or comorbidity by special education program. Children within both LD and SED programs who met diagnostic criteria for ADHD generally had more severe impairments than children who met only initial screening criteria for ADHD. Further refinements of pathways to appropriate educational interventions for children with ADHD are needed. Policy implications of the findings are discussed.