It is well documented that adolescents with attention deficit hyperactivity disorder (ADHD) are more likely to smoke cigarettes than their non-ADHD peers (19–46% versus 10–24%, respectively). Adolescents with ADHD start smoking at an earlier age, are more likely to progress to regular use, find it more difficult to quit and find it harder to maintain abstinence. In this article, we aim to look at the evidence to understand why adolescents with ADHD are more likely to smoke, and to review smoking prevention strategies.