While doing the research for my books, Learning vs Testing, What's Food Got To Do With It?, and Instant Learning For Amazing Grades, I discovered nearly 20 things that can mimic the symptoms of ADD or ADHD.

According to Frank Barnhill, M.D., and many other of the world's top medical doctors, ADD, now officially referred to as ADHD, is a diagnosis of exclusion first.

Dr. Barnhill and I created this list so you can get a thorough and high quality diagnosis for your child. You may be surprised to discover that your child's ADD symptoms are actually something else in disguise.

1. Thyroid Disease. An underactive thyroid can make a child lethargic or too sleepy to pay attention. An overactive thyroid can make a child appear hyperactive. Either one mimics many of the symptoms of ADD or ADHD. Dr. Barnhill says to ask your doctor to rule this out first.

2. Anemia. Low hemoglobin can cause fatigue, irritability, mood swings, and of course, the poor attention span that goes along with ADD - ADHD symptoms.

3. Hypoglycemia. Low blood sugar in a child looks and acts just like low blood sugar in an adult. Sometimes the symptoms of fatigue, lethargy and poor concentration are even more pronounced. Unfortunately, this often goes undiagnosed in children, because they will bounce back fast and lead parents to believe they were just being lazy.

4. Diabetes mellitus. When your blood sugar is high, you will be on edge and others will perceive you as hyperactive. Sometimes ADHD can be cured by changing a diet, or adding blood sugar lowering medicines.

Check the amount of sugar your child eats and see if his or her behavior changes. Also, there is a type II epidemic in young people these days, so make sure your doctor checks your child thoroughly for any signs of it.

5.Seizure disorders. This is a new topic in behavioral science. Some children labeled ADHD actually suffer from mild seizures and it can make your child appear inattentive or spacey when they occur many times an hour. If your child becomes confused or scared, then periods of hyperactivity may follow.

6. Post- concussion syndrome. Mild cases of trauma to the brain that leave no physical evidence of having occurred, can lead to symptoms of ADHD. Brain cell pathways may have been damaged leading to inadequate higher brain cognitive and executive level thought processing abilities. PET Scans will give you this information.

7. Effects of other drugs. Prescription, over the counter, and legal-illegal drugs can cause symptoms that mimic ADHD.

For example, pseudoephedrine found in cold and cough medicines can cause irritability, difficulty sleeping, inability to focus and concentrate and the appearance of being hyper. It is well known that some children actually self-medicate with amphetamines or speed to slow themselves down. Stimulants used to treat ADHD, such as Ritalin, are a form of amphetamine.

8. Effects of certain foods. Everyone knows how some children get hyper when they eat a lot of sugar. But, have you ever wondered whether too much caffeine causing hyperactive states? Each and every child has a different metabolism.

So some tolerate large amounts of sugar and caffeine without becoming hyper, while others can consume little of these stimulants and start 'bouncing off the wall'.

9. Depression. Mild forms of depression can cause irritability, attitude problems and poor concentration. Other symptoms may include sleepiness, insomnia, appetite changes, crying, and lack of energy and poor self-esteem. All of these can mistakenly lead to an incorrect ADHD diagnosis.

10. Manic depression. This disease is called the rollercoaster of life because one day the affected person will be on the highs of life and maybe the next day or two, will be on the lows. These people have wild mood swings and if not treated, will disrupt classrooms, home life and workplaces.

11. Anxiety, GAD. Anxious kids are almost always hyper in one way or another. It appears that Generalized Anxiety Disorder (GAD) is very common in young ADHD children and girls with ADHD without hyperactivity. If the anxiety is not treated with ADHD, then therapy is likely to fail.

12. Mild psychosis. Most parents are surprised to discover that children can hallucinate. Usually, these problems have a sudden onset after a very stressful event in the family, such as a death, divorce, job loss or feelings of impending doom.

There are cases where day terrors and night terrors occur very slowly and simply disrupt the sleep pattern making a child very moody. Teachers feel these children are not paying attention in class because they appear spacey.

13. Sleep apnea is a condition where a person stops breathing multiple times during the night. It requires special diagnosis and treatment since it can lead to the same problems as psychosis. It has been associated with night terrors as a child (or even an adult) may awaken abruptly with a feeling of choking, drowning or being suffocated.

14. Hormone problems in many diseases can cause ADHD like symptoms. Thyroid and insulin related diseases are not the only endocrine disorders that can cause symptoms that look or act like ADHD.

The adrenal gland sits on top of the kidneys and is responsible for everything from regulation of energy to how stable blood sugars remain after running the two-minute mile.

When these disorders are present, a child can have symptoms almost identical to ADHD, such as fatigue, restlessness, poor concentration, changes in weight, and mood swings. Ask your doctor to screen for these.

15. Lead poisoning. Lead damages bone marrow's ability to make red blood cells, resulting in a terrible anemia. These children can be lethargic and have weird hallucinations. Some can have seizures and eventual kidney failure.

16. Inhalation poisoning. Inhalants such as permanent markers, airplane model glue, paint, fingernail polish and other solvents can cause wild mood swings, periods of intense hyperactivity, irritability and irrational combativeness and defiance.

Abusing inhalants may cause paranoia, seizures, and hallucinations. Using even just a little can create symptoms that can mimic many other conditions including ADD or ADHD.

17. Malnutrition including multiple vitamin deficiencies. No child can adequately focus and concentrate when hungry. With prolonged periods of forced fasting, kids become tired, irritable, and unable to process visual-auditory-tactile sensory input correctly. In addition, vitamin B12 deficiency can cause fatigue, and even depression.

18. Eyesight, vision, hearing and speech and language problems. While these three items may seem obvious, they frequently go unchecked when diagnosing ADHD. Take your child to a developmental optometrist, one who specializes in vision therapy, a speech and language evaluation and full frequency hearing exam.

19. Visual-tactile-auditory integration problems. These are very specialized problems that affect a child or adults ability to interact with one or more aspects of his sensory environment.

20. Other learning disabilities. These include minimal brain damage from birth trauma and low oxygen levels at birth. IQ may actually be affected in these circumstances and special training is usually indicated.

Birth trauma can cause a variety of auditory, visual and sometimes tactile problems. These integration difficulties should be thoroughly assessed to provide a game plan for learning success specific to that child.

21. Pregnancy. Although you may only have a young child right now, teenage pregnancy is so prevalent, yet often never given a second thought when it comes to diagnosing ADHD. The hormonal imbalance alone can make a young woman appear sleepy, agitated and moody.

22. Children learn in many ways, but schools test in one. Check that learning and testing styles match or your child may have a difficult time showing what he or she knows on a written test.

Keep in mind that ADHD is a complex diagnosis to make. Get the best diagnosis possible prior to filling a prescription for a stimulant drug.

Take this list to your doctor and ask if there are any more factors to rule out before deciding that your child has ADD or ADHD. Your family doctor is still the best source of advice for you and you should consult him or her if you have any medical concerns.

No portion of this article is intended to provide medical advice. See your doctor or other health care practitioner for more information.

Copyright 1997-2006 Pat Wyman, M.A., and Frank Barnhill, M.D. All Rights Reserved Worldwide.