Although stimulant medications are the mainstay of effective intervention for attention-deficit/ hyperactivity disorder (ADHD), their use presents a daunting scenario for psychiatry, nursing, and custody staff in correctional settings, where reported prevalence rates range from 9% to 45%. The reported rates, however, may overestimate actual prevalence in general and need for treatment in particular. Under a monitored protocol that required documentation of history, diagnosis, lack of response to nonstimulant treatment, and significant functional impairment, less than 1% of male inmates in the Massachusetts state prison system met criteria for treatment with stimulants. Although this protocol did not attempt to determine overall ADHD prevalence rates, the relatively low number of inmates with compelling reasons for stimulant treatment may provide a more realistic idea of the likely consequences of allowing access to this intervention.