Studies addressing assessment and treatment of attention deficit hyperactivity disorder (ADHD) have primarily been focused on Caucasian populations, although a growing number of studies have included ethnic minority populations, particularly Hispanic and African American children. Findings regarding the relationship between ADHD diagnosis and race have not been consistent, although Asian Americans generally report lower rates of ADHD compared to Caucasian and other ethnic minority parents. While some researchers suggest that Asian American children and adolescents experience fewer disruptive behaviors relative to the general population due to apparent protective factors (e.g., family stability and clear expectations for behavior), others believe that cultural perceptions of child behavior and ADHD treatment are likely factors that contribute to the underestimation of Asian American children with ADHD and the underutilization of ADHD treatment. Asian American parents often hold high expectations for their child's behavior, and they may be discreet when it comes to reporting children's problems. For example, many Asian American parents believe that personal effort and discipline are important factors leading to academic and personal success. Parents instill these beliefs early in childhood, so children are likely to compensate for behavioral difficulties by exerting effort and concentration in their schoolwork. Chinese and Vietnamese Americans tend to direct their children's attention, produce behavioral and attentional directives, and teach their children to play correctly during parent--child interaction. Although there have been great advances in the research on ADHD in the past few decades, the current literature on Asian American families and ADHD is narrow and inadequate. This present review discusses the challenges faced by researchers and school psychologists in assessment and intervention with Asian American children with ADHD. Although Asian American families may demonstrate specific protective factors (e.g., providing clear parental expectations) that would reduce the risk of the child developing ADHD symptoms, some Asian American families may be reluctant to pursue ADHD assessment and treatment. Being culturally competent is a complex set of skills needed when working with Asian American families. Ethical practice requires the use of cultural adaptations to assessment procedures and evidence-based treatments for ADHD.