associated with ASPD. In addition, research shows that, although gambling usually begins early in life, gambling problems generally occur later. Yet ASPD begins relatively early in life with childhood conduct disorder. It is also true that much pathological gambling may also be illegal gambling and as such might be associated with one or more DSM criteria for a diagnosis of ASPD.

Little is known about the association of anxiety disorders and problem gambling. Only two studies of pathological gamblers in treatment have reported an increased prevalence of anxiety among pathological gamblers, yet the numbers are so small that the meaning is questionable: namely, 12.5 percent in 24 cases of pathological gamblers in treatment (Roy et al., 1988) and 28 percent in 25 cases of Gamblers Anonymous members (Crockford and el-Guebaly, 1998).

Evidence is mounting to suggest an increase in attention-deficit hyperactivity disorder (ADHD) among pathological gamblers compared with nonpathological gamblers. In one study, Rugle and Melamed (1993) found that the groups differed on attention measures, with gamblers showing more attention deficits. Subjects had previously been screened to rule out head trauma, drug abuse, and other medical conditions that might contribute to attention problems. The gamblers also reported more childhood behaviors of ADHD than controls. However, as the authors pointed out, a specific diagnosis of ADHD was not assessed. Further evidence for an association between childhood ADHD and later pathological gambling comes from Specker et al. (1995), who found that pathological gamblers compared with controls were more likely to meet criteria for ADHD. These studies, though conducted with small samples and weak because of their potential retrospective bias, cannot be ignored. They indicate a potential association between early attention problems and later pathological gambling and should be replicated in larger, more representative samples. The data also speak to the need for longitudinal studies of young people, to determine the progression from attention problems to later problems, including pathological gambling.