http://adhdparentssupportgroup.homestead.com/50conditionsmimicingADHD.html

! 1.) Hypoglycemia (Low Blood sugar) Low blood sugar can stem from thyroid disorders, liver or pancreatic problems, or adrenal gland abnormalities, or even an insufficient diet. Hypoglycemia can display the same ADHD like sypmtoms. 2.(! 2.) Allergies: 15 to 20 percent of the world has some type of allergy. A person can be allergic to nearly anything so check for all forms. Food is one of the primary causes of allergic reactions. Just like the Car and human analogy stated above. If a child eats food they are allergic to, the body will not run properly and that may affect behavior. Everyone has different sensitivities to allergens so just because you aren't affected does not mean your child won't be also.



3.(! 3.) Learning disabilities: If the primary place of behavior problems is at school, learning disabilities may be the cause of ill behavior. One of the main things that affect a child's self-esteem is how well they do in school. If a child has an undiagnosed learning disorder that makes school much harder and sometimes impossible. Children with undiagnosed learning disabilities are labeled as lazy, stupid, and many other downgrading opinions that affect self-esteem.



4.(! 4.) Hyper or hypothyroidism: An imbalance in metabolism that occurs from an overproduction or underproduction of thyroid hormones. This imbalance may cause a variety of behaviors and may affect all body functions.


5.(! 5.) Hearing and vision problems: If a child can't see or hear properly, school and daily things in life are nearly impossible and it may cause ADHD like symptoms especially in educational settings.


6. (! 6.) Mild to high lead levels, even in the absence of clinical lead poisoning: research shows that children with even mildly elevated lead levels suffer from reduced IQs, attention deficits, and poor school performance. Lead is the leading culprit in toxin-caused hyperactivity..




7.(*1.) Spinal Problems: Some spinal problems can cause ADHD like symptoms because if the spine is not connected to the brain properly nerves from the spinal cord can give the brain all of signals at once making a child rambunctious and always on the go.


8.(*2.) Toxin exposures: Children are more vulnerable to toxins than adults. Such as pesticide-poisoning (Eating vegetables and fruit not washed thoroughly, they can be exposed to them by playing outside on the ground), also by gasoline fumes, and herbicides. Inside there are also many toxins. Disinfectants, furniture polishes and air fresheners are toxins that can affect some children's behaviors. Beds and carpets are one of the most dangerous places in the house because they are full of different types of dust, and other toxins. Toxins can cause hyperactivity, attention deficits, irritability, and learning problems.


9.(*3.) Carbon Monoxide poisoning : Thousands of children each year are exposed to toxic levels of this gas each year. Sources include gas heaters, and other gas appliances such as fireplaces, dryers, and water heaters.


10.(*4.) Seizure disorders: The most overlooked is the absence Seizures. During an absence seizure, the brain's normal activity shuts down. The child stares blankly, sometimes rotates his eyes upward, and occasionally blinks or jerks repetitively, he drops objects from his hand, and there may be some mild involuntary movements known as automatisms. The attack lasts for a few seconds and then it is over as rapidly as it begins. If these attacks occur dozens of times each day, they can interfere with a child's school performance and be confused by parents and teachers with daydreaming.


11.(*5.) Metabolic disorders: They reduce the brain's supply of glucose, the bodies fuel and can cause ADHD like symptoms.


12. (*6.) Genetic defects: Some mild forms of genetic disorders can go unnoticed in children and display some of the same symptoms of ADHD. Mild forms of Turner's syndrome, sickle-cell anemia, and Fragile X syndrome are some examples. Almost any genetic disorder can cause hyperactivity or other behavior problems, even if the disorder isn't normally linked to such problems. Many genetic diseases disrupt brain functions directly, through a variety of paths.


13.(*7.) Sleeping disorders or other problems causing fatigue and crankiness during the day.


14.(*8.) Post-traumatic subclinical seizure disorder: It causes episodic temper explosions. These fits of temper come out of the blue for no reason. Some of these seizures can be too subtle to detect without a twenty-four-hour electroencephalogram (EEG).

15.(*9.) High mercury levels: One of the most interesting things regarding high mercury levels is that it can relate to dental fillings. Children who have mercury amalgam fillings in their mouth and grind their teeth are at risk of high mercury levels. American dental associations are defensive on the subject of mercury fillings but many European countries have discontinued the use of them because of side effects.



16.(*10.) High manganese levels


17.(*11.) Iron deficiency: Iron is an essential component of hemoglobin, the oxygen carrying pigment in the blood. Iron is normally obtained through the food in the diet and by the recycling of iron from old red blood cells. The causes of iron deficiency are too little iron in the diet, poor absorption of iron by the body, and loss of blood. It is also caused by lead poisoning in children.


18.(*12.) B vitamin deficiencies: Many experts believe that one of the main causes for inattention, hyperactivity, impulsivity, temper tantrums, sleep disorders, forgetfulness, and aggression are caused by faulty neurotransmissions a problem with the neurotransmitters in the brain. Vitamin B-6 is a necessary vitamin used in the making of neurotransmitters that affect behavior.


19.(*13.) Excessive amounts of Vitamins: Excessive amounts of vitamins can be toxic to the body and may cause the same ADHD like symptoms. It is possible to overdose when taking vitamins so make sure you contact a physician and check for vitamin deficiencies before taking extra vitamins.


20.(*14.) Tourette's syndrome: Tourette's syndrome is a rare but disruptive condition. It involves multiple tics (small, repetitive muscle movements), usually facial tics with grimacing and blinking. Tics may also occur in the shoulders and arms. This is usually accompanied by loud vocalizations, which may include grunts or noises, or uncontrollable (compulsive) use of obscenities or short phrases. The tics are worse during emotional stress and are absent during sleep. The cause is unknown. It occurs most often in boys, and may begin around age 7 or 8 or not until the child is in his or her late teens or early twenties. It may, at times, run in families. This disorder can be mistaken for not being able to sit still or impulsive behavior.


21.(*15.) Sensory Integration Dysfunction: Sensory Integration Dysfunction is the inefficient neurological processing of information received through the senses, causing problems with learning, development, and behavior. These children are over-sensitive or under-sensitive dealing in touch, taste, smell, sound, or sight. For example, some of these children crave fast and spinning movement, such as swinging, rocking, twirling, and riding the merry-go-round- without getting dizzy. These children may move constantly, fidget, enjoy getting into upside down positions and be a daredevil. These children may become overexcited when there is too much to look at words, toys, or other children. They may cover their eyes, have poor eye contact, be inattentive when drawing or doing desk work, or overreact to bright light. These children often act out in an attempt to cope with their inability to process sensory information such as acting out in crowded or loud places.



22.(**1.) Early-onset diabetes: Symptoms include aggression, depression, and anxiety. If you have a family history of diabetes checking for this is a must.


23.(**2.) Heart disease: It affects blood and oxygen flow to the brain affecting brain function that in-turn affects behavior.


24.(**3.) Cardiac conditions: It can reduce the supply of blood, oxygen and nutrients to the brain.


25.(**4.) Early-Onset Bi-Polar disorder: Also know as child-like Bi-polar. The experts state that 85% of children with child-like Bi-polar also meet the criteria for ADHD. The symptoms are extremely close. Most people when they think of Bi-polar disorder, think of Adult like Bipolar which mood swings happen over a somewhat long period of time. In child-like Bipolar, the mood swings can happen many times within a twenty-four hour day, known as rapid cycling. At one moment they're calm and the next minute they could be in a full fledge temper tantrum. Some of the symptoms are Distractibility, Hyperactivity, impulsivity, separation anxiety, restlessness, depressed mood, low self-esteem, and many more. Early-Onset Bi-polar should be ruled out before ADHD is considered mainly because they are treated with different medications if you choose medications that is. ADHD is treated with stimulant medications which will make a Bipolar child worse possibly psychotic.




26.(***1.) CAPD (Central Auditory processing Disorder) will sometimes occur in children who have had a history of ear infections and/or PE tubes. Symptoms include distractibility, inability to follow a set of verbal instructions, "space out", etc.


27.(***2.) Worms: Such as Pinworms lay their eggs in the anal area, causing tickling and itching, which are most bothersome at night. The lack of sleep from this type of infestation can cause crankiness or bad behavior during the day. When asleep, nightmares may be present. This problem is mostly found in very young children preschool to kindergarten because of primitive toileting skills, they tend to put their fingers in their mouths, and they participate in a lot of hands-on activities with other kids and with pets. Roundworms, hookworms, and tapeworms are other examples that can make a child display ADHD like symptoms. Worms cause hyperactive behavior, learning problems, depression, or attention deficits by making children miserable on the inside.


28.(***3.) Viral or bacterial infections: When a child is affected by an infection that might cause problem behavior.


29.(***4.) Malnutrition or improper diet: Many children in the United States do not eat a well balanced diet. A proper diet is necessary to growing children. An improper diet can affect a child's behavior in an ill way.

30.(***5.) Head injuries: Such as the postconcussion syndrome. Some of the symptoms include Irritability, emotionality, memory problems, depression, and sleep disturbances. A concussion can disrupt brain functioning causing ADHD like symptoms.


31.(***6.) Dietary Factors: (For example to much caffeine and sugar) At doses as low as 250 milligrams a day, a level many American children exceed- caffeine can cause rambling speech, attention and concentration problems, agitation, heart palpitations, insomnia, and hyperactive behavior. In a way, it is true we are what we eat.


32.(***7.) Some disorders such as anemias reduce oxygen to the brain causing disturbance in the brains chemistry causing ADHD like symptoms.




33.(***8.) Fetal alcohol syndrome (FAS) or Fetal alcohol effects (FAE): FAS is a name that doctors use to describe the damage done to children's brains and bodies when their mother drink heavily during pregnancy. It is the leading form of mental retardation today. Prenatal alcohol impairment, however, also comes in a milder form called fetal alcohol effects (FAE). Children with FAE often don't look disabled, and they tend to score in the low-normal or even normal range of intelligence. But these kids arent normal. Their mal-developed brains cause them to exhibit a wide range of behavior problems, including hyperactivity, attention problems, learning disorders, and ethical problems such as stealing, lying, and cheating.


34.(***9.) Intentionally or unintentionally sniffing materials such as modeling glue or other house hold products.

35.(***10.) Some drugs:, (both prescription and illegal) can cause the brain to atrophy, leading to disturbed cognition and behavior. If your child routinely takes prescription or over-the-counter medications for asthma, hay fever, allergies, headaches, or any other condition, consider the possibility that the drugs are causing or contributing to behavior problems.

36.(***11.) :A beta-hemolytic streptococcus:(better known as "strep.") Although these bacteria are most commonly thought of as the cause of strep throat. Left untreated, strep can cause rheumatic fever and a movement disorder called Sydenham's chorea. Moreover, recurrent infections can lead, in susceptible children, to a group of symptoms collectively known as PANDAS (Pediatric autoimmune neuropsychiatric disorders) Some symptoms of PANDAS include obsessive-compulsive behavior, Tourette's syndrome, hyperactivity, cognitive problems, and fidgeting.



37.(***12.) Lack of exercise: "Hyper Couch Potatoes" are children who aren't moving enough. Some children because of lack of exercise may seem as though they are always in motion, but often that motion is in fits and spurts: leaping up from a chair, spinning around in the lunch line, bouncing in a chair while watching TV. Quite a few hyperactive children actually do not get enough sustained, strenuous exercise to stay healthy mentally and physically. Exercise can make people happier, less anxious, less hyperactive, and less depressed. One reason is that exercise increases serotonin levels in the brain exactly what Prozac, Elavil, and similar drugs do.


38.(***13.) Gifted Children: Gifted children often display ADHD like symptoms because most of the time they are bored with what other kids their age are doing. Behaviors associated with Giftedness are poor attention, boredom, daydreaming, low tolerance for persistence on tasks that seem irrelevant, their judgment often lags behind their development of intellect, their intensity may lead to power struggles with authorities, and they may have a high activity level. They may need less sleep compared to other children, and they may question rules, customs, and traditions. If your child scores above average on IQ tests, aces exams, has no trouble with homework, has no apparent learning disabilities, and primarily exhibits his or her problems mostly at school, maybe seeking a more challenging class or school would help.


39.(***14.) Emotional problems: Kids who are experiencing emotional problems most often display ADHD like symptoms. For example, kids who are constantly subjected to bullying at school can display ADHD like symptoms. These are normal kids that act out because they are scared. They experience sleeping problems, sadness, and they develop physical symptoms, especially if they think those symptoms will keep them home from school. Often they can't concentrate in class, partly because they are worried and partly because they are suffering from sleep deprivation. Really any emotional problem at school or home in which a child is having trouble coping with can result in ADHD like symptoms.


40.(***15.) Some kids are spoiled and undisciplined: A number of children labeled hyperactive are merely under-disciplined children. They tend to run their household and get away with anything. Dr Syndey Walker stated this problem best of why parents under-discipline their children. He stated that he blamed not the parents but on the psychological experts who have counseled parents for several decades that children are fragile, easily traumatized little flowers who could be ruined for life by a cross look or a scolding which is very untrue. Children need firm discipline and strict rules not abuse but setting rules and standards and demanding those standards be met, and giving consequences when your rules are broken. Labeling undisciplined kids as ADHD who are not gives them an excuse for their misbehavior, which will often make it worse.

41.(***16.) Spirited children: When dealing with spirited children the problem usually does not lie with the child but with society's perception of what normal childhood behavior is. Many normal children, according to some people, display ADHD like symptoms not because they are hyperactive or lack sufficient attention spans but because the person forming the opinion has unrealistic standards of how a child should behave.


42.(***17.) Lack of understanding and communication skills: One of the main reasons why a child acts out and throws temper tantrums when they have a problem is because of their lack of understanding of a problem and lack of expressing how they feel. Children do not have the vocabulary or know how to express their emotions like adults do, that's why many act out when they are in a difficult situation. They are not able tell you something is wrong so they show you instead. This is one reason why any emotional or medical problem can cause acting out behavior in children.






43.(Rare 1.) Early stage brain tumors: Found rarely in children but should still be considered. Statistically, this diagnosis may not be important but to individual families, they assuredly are.


44. (Rare 2.) Brain cysts: Another rare cause of hyperactivity but should still be considered when searching for the reasons behind displayed ADHD like behavior.



45. (Rare 3.) Temporal lobe seizures: The Temporal lobe is a part of the brain. Any brain malfunction can cause inappropriate behavior. That's why conducting brain scans is a must when trying to figure out behavior problems.



46. (Rare 4.) Klinefelter syndrom: A Genetic disorder in which a male has an extra X chromosome (XXY). Many individuals experience learning, behavior, and social problems. A degree of subnormal intelligence appears in some affected individuals. Many affected individuals are skinny and taller than most of their peers. A simple blood test can rule this disorder out.


47.(Rare 5.) Genetic Disorder XYY: The extra Y chromosome has been associated with antisocial behavior.



48. (Rare 6.) Porphyria: A hereditary enzyme-deficiency disease. Enzymes are very important to our body's chemical reactions. Really nothing occurs in our body without enzymes. A lack of enzymes causes body malfunctioning which can cause ill behavior.


49. (Rare 7.) Candida Albicans infestation (Yeast Infection) : Candida infestations cause hyperactivity in children. Most children who do suffer from Candida infestations have some underlying problem frequently an immune disorder, or a disorder affecting carbohydrate metabolism and thus altering blood sugar levels. So immune disorders can cause other problems that also have the same symptoms of ADHD.


50. (Rare 8.) Intestinal parasites: Parasites rob the body of needed nutrients which in-turn affects behavior.

Ever think that your adhd could have a cause that is curable ??

ME :D

Hi Speedo;

Thanks for the thread.

I'm surprised that they didn't list atypical depression (particularly for inattentive ADHD), although 'atypical' depression is apparently not all that atypical at all.

Symptoms can include (sometimes in addition to symptoms of 'typical' depression): fatigue (low energy/leaden paralysis), emotional blunting, problems with concentration, problems with motivation, emotional reactivity/sensitivity to rejection, hypersomnia, and increased appetite (and/or weight gain).

is that the same as unipolar depression ?

ME :D

Yes - it is unipolar depression...

But the symptoms are considered 'atypical' (e.g.; instead of the loss of appetite as with typical depression, 'atypical' depression presents with increased appetite; same with sleep).

here is an article: http://pn.psychiatryonline.org/cgi/content/full/38/20/20

This is a very useful list, and I am glad you posted it Speedo. But I do feel the need to interject some caveats.

It is my personal sense that, yes, conditions such as these are often seen, in people who have the traits and symptoms of ADD. Right off the top, there more than a couple I know to apply to me. That said, having those things treated had little impact on my cognitive functioning or my chronic lack of sufficient dopamine. I may have just become more energetic about finding my lost keys {grin] once my thyroid was treated, but I still lose the keys as often.

So do I think it is useful to "warn" people about the other conditions they may experience? Yes. Do I think that having those things diagnosed and treated will improve overall wellbeing? You bet. Will an improvement in overall wellbeing assist with the symptoms of ADD? No doubt. But I fear it is misleading to suggest that resolving these other things will "cure" the ADD. If misapplied, that view could lead to more blaming and shaming of a child for distressing obstacles that are still brain and biology driven.

The real rub is that while an adult can have some perspective and insight on how long and chronic a problem has been and what other conditions appear to go along with it, it is very difficult to have the same perspective or insight about a child. Every responsible expert I've seen make recommendations about ADD in kids suggests a comprehensive pediatric history and physical, but I suspect that advice is not always followed.

Thus the benefit of a list like this, to me, is to (a) alert people to insist on that comprehensive physical and (b) to make them aware of things a person with ADD may also experience. But both (a) and (b) seem more useful to me than leading with a suggestion that the symptoms of ADD may "really" be this or that thing instead of the ADD.

In addition to Carla's caveats, I'd like to add my own in response to some of these "conditions". Most of the conditions listed here are either bogus or do not in any way resemble ADHD.


! 1.)Hypoglycemia (Low Blood sugar)Low blood sugar can stem from thyroid disorders, liver or pancreatic problems, or adrenal gland abnormalities, or even an insufficient diet. Hypoglycemia can display the same ADHD like sypmtoms.Thyroid problems don't necessarily exclude the possibility of ADHD. In fact, a large percentage of children with bipolar disorder also have thyroid problems and ADHD.


2.(! 2.)Allergies: 15 to 20 percent of the world has some type of allergy. A person can be allergic to nearly anything so check for all forms. Food is one of the primary causes of allergic reactions. Now, that's just not true.

The prevalence of true food allergies is about 3% in children and less than 1% of adults.
The most common cause of allergic reactions is pollen.




7.(*1.)Spinal Problems: Some spinal problems can cause ADHD like symptoms because if the spine is not connected to the brain properly nerves from the spinal cord can give the brain all of signals at once making a child rambunctious and always on the go.
Silly! There's absolutely nothing to this. There aren't any "spinal problems" that can make children rambunctious!





8.(*2.) Toxin exposures: Children are more vulnerable to toxins than adults. Such as pesticide-poisoning (Eating vegetables and fruit not washed thoroughly, they can be exposed to them by playing outside on the ground), also by gasoline fumes, and herbicides.


True. But toxicity from these kinds of things is EXTREMELY rare.



9.(*3.)Carbon Monoxide poisoning: Thousands of children each year are exposed to toxic levels of this gas each year. Sources include gas heaters, and other gas appliances such as fireplaces, dryers, and water heaters.
Also true. But it doesn't cause ADHD symptoms! Children die from carbon monoxide poisoning. They don't develop hyperactivity or innattention.





15.(*9.)High mercury levels:One of the most interesting things regarding high mercury levels is that it can relate to dental fillings.

This is pure myth and it has been debunked many times over.




16.(*10.)High manganese levels
:confused:





17.(*11.)Iron deficiency:Iron is an essential component of hemoglobin, the oxygen

Symptoms don't look anything like ADHD.



18.(*12.) B vitamin deficiencies:Many experts believe that one of the main causes for inattention, hyperactivity, impulsivity, temper tantrums, sleep disorders, forgetfulness, and aggression are caused by faulty neurotransmissions a problem with the neurotransmitters in the brain.NONE of those problems are related to Vitamin B deficiencies. The only symptoms of Vitamin B deficiencies that come close are confusion & disorientation.

Vitamin B deficiency is extremely rare in the U.S., and the more common symptoms are things like mouth ulcers.



23.(**2.)Heart disease: It affects blood and oxygen flow to the brain affecting brain function that in-turn affects behavior.



24.(**3.)Cardiac conditions: It can reduce the supply of blood, oxygen and nutrients to the brain. :confused:




29.(***4.)Malnutrition or improper diet: Many children in the United States do not eat a well balanced diet. A proper diet is necessary to growing children. An improper diet can affect a child's behavior in an ill way.

Perhaps, but not likely ADHD symptoms.


32.(***7.) Some disorders such as anemias reduce oxygen to the brain causing disturbance in the brains chemistry causing ADHD like symptoms.Wasn't that #17? Isn't it also covered in #23 & #24? This is also just silly.





37.(***12.)Lack of exercise:"Hyper Couch Potatoes" are children who aren't moving enough. Some children because of lack of exercise may seem as though they are always in motion, but often that motion is in fits and spurts: Exercise is good. Exercise can reduce symptoms. But lack of exercise does NOT cause ADHD symptoms. It's probably mostly responsible for the rise in obesity, though.




38.(***13.) Gifted Children: Gifted children often display ADHD like symptoms because most of the time they are bored with what other kids their age are doing.
Now, this is probably true. But then kids like mine get delays in diagnosis because we just think he's bored.....


I won't even go there with the "rare" ones.

I do agree that amalgam fillings can't possibly lead to high mercury levels in the body.
Amalgam has a really low solubility and basically can't be absorbed into the blood in amonts that are detectable. Amazingly though, I've rad that the europeans have banned the use of amalgam dental fillings because of their mercury content.

However; Mercury poisioning DOES mimmic the symptoms of ADHD, as will other metals, particularly lead and to a lesser extent, silver. The key here is that metal poisioning comes with additional symptoms besides confusion and hyperactivity.

Also, certain spinal problems CAN cause excitability and distractedness that could be mistaken for ADHD. Lyme disease can lead to a degenerative disk condition that does exactly that... along with neuropathic pain, of course... Again, the key is that there will also be other symptoms present besides hyperactivity and distractedness.

I agree with the rest of your comments, as the article is poorly worded.

Me :D


In addition to Carla's caveats, I'd like to add my own in response to some of these "conditions". Most of the conditions listed here are either bogus or do not in any way resemble ADHD.

Thyroid problems don't necessarily exclude the possibility of ADHD. In fact, a large percentage of children with bipolar disorder also have thyroid problems and ADHD.

Now, that's just not true.

The prevalence of true food allergies is about 3% in children and less than 1% of adults.
The most common cause of allergic reactions is pollen.

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Silly! There's absolutely nothing to this. There aren't any "spinal problems" that can make children rambunctious!

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True. But toxicity from these kinds of things is EXTREMELY rare.



Also true. But it doesn't cause ADHD symptoms! Children die from carbon monoxide poisoning. They don't develop hyperactivity or innattention.




This is pure myth and it has been debunked many times over.



:confused:


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Symptoms don't look anything like ADHD.


NONE of those problems are related to Vitamin B deficiencies. The only symptoms of Vitamin B deficiencies that come close are confusion & disorientation.

Vitamin B deficiency is extremely rare in the U.S., and the more common symptoms are things like mouth ulcers.


:confused:


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Perhaps, but not likely ADHD symptoms.

Wasn't that #17? Isn't it also covered in #23 & #24? This is also just silly.
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Exercise is good. Exercise can reduce symptoms. But lack of exercise does NOT cause ADHD symptoms. It's probably mostly responsible for the rise in obesity, though.


Now, this is probably true. But then kids like mine get delays in diagnosis because we just think he's bored.....


I won't even go there with the "rare" ones.

However; Mercury poisioning DOES mimmic the symptoms of ADHD, as will other metals, particularly lead and to a lesser extent, silver. Well, I suppose that would depend on how similar something has to be for you to consider it similar. Here's a post I made on the topic in another thread:

http://www.addforums.com/forums/showpost.php?p=273269&postcount=53

I don't agree that these symptoms are similar to ADHD.



Also, certain spinal problems CAN cause excitability and distractedness that could be mistaken for ADHD. Lyme disease can lead to a degenerative disk condition that does exactly that... along with neuropathic pain, of course... Again, the key is that there will also be other symptoms present besides hyperactivity and distractedness.Any sources for this?

The comment on the list you posted, particularly in context with many of the other comments, sounds like a chiropractic quack statement, but if we're talking about specific things like your example, I'd be interested in looking at it. My mother-in-law and a close friend have both disk problems and depression, and I'd like to see how they might be related.

Thanks for the posting Speedo. Looking over the list, my first response was, hummm, that's interesting.

Then I found myself refuting or limiting each condition, line by line. Then I tried to identify the underlying flaw in the list.

Carla is spot on.


Thus the benefit of a list like this, to me, is to (a) alert people to insist on that comprehensive physical and (b) to make them aware of things a person with ADD may also experience. But both (a) and (b) seem more useful to me than leading with a suggestion that the symptoms of ADD may "really" be this or that thing instead of the ADD.
The list presents a non-sequester, that these numerous conditions may mimic ADHD (certainly debatable), therefore you or your kid may have one of these, implying that they don't have ADHD.

This is a logical flaw that defeats any benefits of the list, as written.
If a, then not b, when a and b are unrelated, not mutually exclusive.


Of course, folks ought to be concerned about physical conditions like heavy metal poisoning, or lead exposure, or untreated Lymes disease (which can cause a dementia -rare- that looks like senile dementia, not ADHD), if there's good reason to suspect exposure or if characteristic symptoms of illness are evident.

But how often do these conditions even present themselves to potentially interfere with a diagnosis of ADHD (assuming that they could)?

Not very often.



:eek: - I take that back. Adults and kids can carry high mercury loads, from eating seafood too often.

I think the important thing to know is that there are a lot of things that can mimmic ADHD.
They ought to be ruled out early in the diagnostic process in order to avoid getting treated for the wrong illness.



The first thing I was tested for was metal poisioning. Along with that test the doc ordered blood sugar and thyroid... also with the usual blood tests in case I had allergies of some kind. They took 5 tubes of blood that day.

From there I followed up and discovered a hearing problem that was adding to my sensory troubles.

I was later diagnosed with ADHD combined type and anxiety disorder NOS. Now, I've been diagnosed with insomnia and sleep aphnia....and there is lots more to come.

ME :D

I agree with you here, speedo. A targetted clinical work-up is a good idea.

Trouble is, if you search too far afield you're likely to obtain a positive finding to something that isn't clinically relevent.

That's what we need, a more confused ADD diagnosis.


Oh, and amalgams can certainly cause mercury poisoning. (http://www.cdc.gov/mmwr/preview/mmwrhtml/00014464.htm)
Episode 1. On August 7, 1989, four adult occupants (two men and two women ranging in age from 40 to 88 years) of a private home were hospitalized for evaluation of nausea, diarrhea, shortness of breath, and nonspecific chest pain. During hospitalization, the patients experienced progressive dyspnea and pulmonary insufficiency.

On August 11, investigators learned that one of the patients had been smelting dental amalgam in a casting furnace in the basement of the home in an attempt to recover silver from the amalgam. Mercury fumes released during the operation apparently had entered air ducts in the basement and had circulated throughout the house.
These folks all died. :(

Lesson: If your concerned about mercury exposure and yank your amalgam fillings. Don't be a cheapskate and attempt to recover the silver. Dispose of them, instead -- in an environmentally friendly manner, of course. ;)

Mercury poisioning is a nasty way to die. I have read of a researcher who was exposed to methyl mercury and died in 6 months. There was not a lot doctors could do. It was absorbed through her skin and was spread throughout her body very quickly.

ME :D


I agree with you here, speedo. A targetted clinical work-up is a good idea.

Trouble is, if you search too far afield you're likely to obtain a positive finding to something that isn't clinically relevent.

That's what we need, a more confused ADD diagnosis.


Oh, and amalgams can certainly cause mercury poisoning. (http://www.cdc.gov/mmwr/preview/mmwrhtml/00014464.htm) Episode 1. On August 7, 1989, four adult occupants (two men and two women ranging in age from 40 to 88 years) of a private home were hospitalized for evaluation of nausea, diarrhea, shortness of breath, and nonspecific chest pain. During hospitalization, the patients experienced progressive dyspnea and pulmonary insufficiency.

On August 11, investigators learned that one of the patients had been smelting dental amalgam in a casting furnace in the basement of the home in an attempt to recover silver from the amalgam. Mercury fumes released during the operation apparently had entered air ducts in the basement and had circulated throughout the house.
These folks all died. :(

Lesson: If your concerned about mercury exposure and yank your amalgam fillings. Don't be a cheapskate and attempt to recover the silver. Dispose of them, instead -- in an environmentally friendly manner, of course. ;)

I'm thinking you might have missed one. Bipolar Disorder. When I was little I was diagnosed as ADHD, but never medicated. As a teen I then diagnosed with Bipolar Disorder. It goes back and forth. Currently I take lamictal, adderall, and klonopin. I don't know what I have, but I know my doctor treats the symptoms.

Both Bipolar disorder and ADHD share many characteristics: impulsivity, inattention, hyperactivity, physical energy, behavioral and emotional lability (behavior and emotions change frequently), frequent coexistence of conduct disorder and oppositional-defiant disorder, and learning problems. Motor restlessness during sleep may be seen in both (children who are bipolar are physically restless at night when "high or manic",though they may have little physical motion during sleep when "low or depressed"). Family histories in both conditions often include mood disorder. Psychostimulants or antidepressants can help in both disorders (that is, depending on the phase of the bipolar disorder). In view of the similarities, it is not surprising that the disorders are hard to tell apart.

Yes. Bipolar disorder can sometimes be hard to distinguish from ADHD.

Another one is Pervasive developmental disorder (including asperger's syndrome).
People who have a PDD sometimes are mistakenly diagnosed with ADHD.

Me :D

I'm thinking you might have missed one. Bipolar Disorder. When I was little I was diagnosed as ADHD, but never medicated. As a teen I then diagnosed with Bipolar Disorder. It goes back and forth. Currently I take lamictal, adderall, and klonopin. I don't know what I have, but I know my doctor treats the symptoms.

Both Bipolar disorder and ADHD share many characteristics: impulsivity, inattention, hyperactivity, physical energy, behavioral and emotional lability (behavior and emotions change frequently), frequent coexistence of conduct disorder and oppositional-defiant disorder, and learning problems. Motor restlessness during sleep may be seen in both (children who are bipolar are physically restless at night when "high or manic",though they may have little physical motion during sleep when "low or depressed"). Family histories in both conditions often include mood disorder. Psychostimulants or antidepressants can help in both disorders (that is, depending on the phase of the bipolar disorder). In view of the similarities, it is not surprising that the disorders are hard to tell apart.

I'm thinking you might have missed one. Bipolar Disorder. When I was little I was diagnosed as ADHD, but never medicated. As a teen I then diagnosed with Bipolar Disorder. It goes back and forth. Currently I take lamictal, adderall, and klonopin. I don't know what I have, but I know my doctor treats the symptoms.

Both Bipolar disorder and ADHD share many characteristics....And let's not forget it's not an either/or issue!

Co-morbidities are common with ADHD. I have seen people treated for many combos at the same time, e.g. ADD + depression or bipolar or OCD or Tourette's. That's why, as you note, many physicians these days treat more on the symptoms than on the diagnosis codes.

For me, all of it confirms a "spectrum" sense of things. I see ADD (and its own spectrum of intensity) as the first layer of an onion that can circle out to connect with more aggravated diagnoses, each of which can occur alone or in combination. Thus lots of folks are "only" ADD and remain so, with or without subclinical threads of some other issues, while others may find over time that some other untreated aspects are worsening, or that treating the ADD brings the rest of what still remained to see.

Whether meds for ADD are helpful, alone or in combo, is a highly individual thing to be explored with a skillful MD who refines the aim over time. But behavioral strategies will be useful for anyone with focusing issues and that part could get short shrift if "ADD" was crossed off the menu.

In short, I'd love to see us start framing the mind as a complex ecosystem of linking, evolving interdependencies instead of reducing it to an either/or checklist that never quite fits.

I would add other hormonal disorders or blood disorders and various imbalances, too. Anything threatening homeostasis of the body/brain.


The Parathyroid:

One that comes to mind is Parathyroid Problems: "hyperparathyroidism" or "hypoparathyroidism"!

These diseases often look "mental" (fatigue, inattention, learning problems, behavioural issues) and is often missed. (I once knew a Pediatrician's daughter who has this. She was written off as a "crazy" or "depressed female" for a long time. She has school problems like LD/ADD inattention, too.)

MS & other myelination or muscle degenerative diseases:

Early stage MS also has "mental" symptoms of inattention, learning issues, behavioural problems, etc.

Delirium States:
e.g. infections (incl pneumonia, etc), toxicities, organ failure problems, shock, blood loss, injuries, endocrine hormones, imbalances, hypoxia, anemia, etc. (can create all varying levels of delirium, which could have 'inattention' or 'restlessness' as a feature)

Airway Issues:
Also, TONSILS and ADENOIDS can obstruct an airway so much (in daytime and nighttime) that a child's growing brain does not get the air (O2) that it needs.

I read about a case of a girl with "retardation" and "learning problems" who, in fact, had this problem (Dr. Meier Kryga's book?). Sadly, her brain had developed in an Oxygen-Starved environment, so her problems were lifelong.

---

These lists are quite endless!

All of these things underscore the need to SEE A DOCTOR if you think you have ADHD.

ME :D

I'm glad to have read this. I'm already seeing a naturopath, and it seems I do have a food allergy. My pdoc thinks it's odd I am doing this. funny, it seems to me that my diet has ALOT to do with everything.

My pdoc is trying to get me on lithium. And I won't because something isn't right. I'm amazed being the amount of research my doctor has done, that she isn't supportive enough.

This is a good list Speedo - it's good to see it here, (and become sticky).

I think one of the important points for people who are unsure of what they have, (or whether they think they have been diagnosed incorrectly), is that a lot of these conditions that mimmic ADHD/ADD are short lived. So, the question you should ask yourself is: "Has this been happening all my life?". If 'yes', then you can wipe off nearly all these conditions apart from a couple - basically genetic disorders, and lead/mercury poisoning, (which accrues in the body and never releases).

I find it pretty surprising the some people are so quick to dismiss all of those conditions and being completely bogus.

To the person ruling out all those conditions -- are you even qualified to be doing that? Doing some quick google searching that explain the symptoms briefly are not enough to determine if something is bogus or not.

Most of these conditions can have a variety of symptoms that show up in a variety of ways. Many times they can indeed be mistaken for AD/HD.

A lot of people medicated for AD/HD right now could have other underlying conditions that could *actually* be causing it.

My two cents

Might post various thoughts on these 50 things(In my own random order):

1. Hypothyroidism. Personally my mother, brother and myself have it. The symptoms I noted were cold intolerance and fatigue. Which improved with
thyroxine but it did not correct any of my core ADHD related deficits[inattention, impulsivity].

http://en.wikipedia.org/wiki/Hypothyroidism#Adults symptoms

http://thyroid.about.com/od/thyroidbasicsthyroid101/a/5lies_2.htm

That mentions the Barnes temperature method (and its limitations)of determining if you might have low thyroid. In my case my body temperture was quite low upon waking (96-97). Oh your body temperture gets lower in the night anyway so this test depends on a normal night of sleep and waking at the normal time.

2. Lead , Pb I had a hair analysis test in 2001 that said I had 40 ppm.
(0-1.4 consider normal) I had the test because I suspected high levels of lead. Hair analysis of Lead is not consider legit by the FDA I should warn.

http://en.wikipedia.org/wiki/Lead_poisoning

The symptoms of chronic lead poisoning include neurological problems, such as reduced cognitive abilities, or nausea, abdominal pain, irritability, insomnia, metal taste in oral cavity, excess lethargy or hyperactivity, headache and, in extreme cases, seizure and coma. There are also associated gastrointestinal problems, such as constipation, diarrhea, vomiting, poor appetite, weight loss, which are common in acute poisoning. Other associated effects are anemia, kidney problems, and reproductive problems.

I would say I had: reduced cognitive abilities,irritability, insomnia, metal taste in oral cavity, excess lethargy ,gastrointestinal problems, kidney pain, poor appetite.

I took DMSA and in just a few days I had an extreme increase in energy levels. Though the perception of increased energy faded quickly. I took it in the normal treatment protocol. Over the years I studied up on Lead .Some of
the effects of lead are permanent particularly to those 6 and under. Also most
your bodies lead burden will be in hard tissue like bones. So even if you completely eliminate your environmental exposure and under go treatment you can anticipate your blood levels will rebound. R-alpha-lipoic acid has been shown in studies in combination with DMSA to reduce lead burden from the brain. (http://www.ncbi.nlm.nih.gov/pubmed/12135622?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

Oxidative stress similar to methamphetamine neurotoxicity is part of how lead damages the brain. And a number of similar antioxidants used to prevent methamphetamine neurotoxicity have been used to prevent the damages from lead. Though if their much good after exposure is not clear, but since it will be nearly impossible to get blood lead levels to zero you might could mitigate future toxicity.

Its impossible to say how much lead has played a role in my inattention and impulsivity but unfortunately treatment did not reduce the deficits.

2. Lead , Pb I had a hair analysis test in 2001 that said I had 40 ppm.
(0-1.4 consider normal) I had the test because I suspected high levels of lead. Hair analysis of Lead is not consider legit by the FDA I should warn.

http://en.wikipedia.org/wiki/Lead_poisoning



I would say I had: reduced cognitive abilities,irritability, insomnia, metal taste in oral cavity, excess lethargy ,gastrointestinal problems, kidney pain, poor appetite.

I took DMSA and in just a few days I had an extreme increase in energy levels. Though the perception of increased energy faded quickly. I took it in the normal treatment protocol. Over the years I studied up on Lead .Some of
the effects of lead are permanent particularly to those 6 and under. Also most
your bodies lead burden will be in hard tissue like bones. So even if you completely eliminate your environmental exposure and under go treatment you can anticipate your blood levels will rebound. R-alpha-lipoic acid has been shown in studies in combination with DMSA to reduce lead burden from the brain. (http://www.ncbi.nlm.nih.gov/pubmed/12135622?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

Oxidative stress similar to methamphetamine neurotoxicity is part of how lead damages the brain. And a number of similar antioxidants used to prevent methamphetamine neurotoxicity have been used to prevent the damages from lead. Though if their much good after exposure is not clear, but since it will be nearly impossible to get blood lead levels to zero you might could mitigate future toxicity.

Its impossible to say how much lead has played a role in my inattention and impulsivity but unfortunately treatment did not reduce the deficits.

theta, if I was you I would also do blood and urine tests to monitor Lead levels rather than just relying on one hair analysis result and your symptoms being consistent with Lead toxicity. You could see what

I know in my own case, while my hair Lead levels weren't abnormally high, the hair mineral analysis showed that my Lead to Iron ratio was abnormally high - which was bad in their report. Anyway I had my blood levels of Iron and Lead tested, and everything came out normal. My urine Lead levels were normal as well.

I know you are male and males aren't advised to take Iron supplements unless there is something wrong with their Iron levels, but have a look at some papers (see below) of the relationship between Iron and Lead and ADHD...

Like you mention, the neurotoxicity damage of Lead in your 'developing brain' may have already been done but still it might be worthwhile to make sure your Iron levels are sufficient. Serum Ferritin is the test that is needed.

Be very careful if you do try to supplement with something like Iron of course- excessive iron levels are said to commonly contribute to health problem in males. Still, if I had ADHD and excessive Lead levels (shown by Blood, Hair, and/or Urine), I would want to make sure I carefully tried increasing my Iron levels and seeing if there was any kind of improvement in my symptoms.


The short article written below by Konofal and Cortese focus on the potential neuroprotective role of iron against the deleterious effect of lead on the development of ADHD symptoms...

http://www.pubmedcentral.nih.gov/articlere...i?artid=1940080 (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1940080)

Journal List > Environ Health Perspect > v.115(8); Aug 2007

PubMed articles by:
Konofal, E.
Cortese, S. Environ Health Perspect. 2007 August; 115(8): A398–A399.
doi: 10.1289/ehp.10304.
Copyright This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original DOI
Perspectives
Correspondence
Lead and Neuroprotection by Iron in ADHD
Eric Konofal and Samuele Cortese
Child Psychopathology Unit, University Hospital Robert Debré, Paris, France, E-mail: eric.konofal@rdb.aphp.fr
The authors declare they have no competing financial interests.

We read with special interest the article by Braun et al. (2006). In this large survey, the authors concluded that prenatal exposure to tobacco and environmental lead are risk factors for attention deficit hyperactivity disorder (ADHD).
We would like to focus on the potential neuroprotective role of iron against the deleterious effect of lead on the development of ADHD symptoms.

Although the mechanisms underlying ADHD remain unclear, both genetic and environmental factors have been implicated. In a recent review on the implication of the dopaminergic system in the etiology of ADHD, Swanson et al. (2007) highlighted the importance of environmental risk factors as possible etiologies of dopamine deficit. Among these environmental factors, Swanson et al. (2007) cited the effects of lead exposure (at levels < 10 μg/dL) on ADHD-related behaviors and ADHD diagnosis.

Lead in the central nervous system may contribute to dopaminergic dysfunction inducing alteration of dopamine release and dopamine receptor density (Gedeon et al. 2001; Lidsky et al. 2003). Moreover, lead may disrupt the structure of the blood–brain barrier function essential for brain integrity (Dyatlov et al. 1998). Interestingly, Wang et al. (2007) recently reported that iron supplementation protects the integrity of the blood–brain barrier against lead insults. On the other hand, iron deficiency could increase the toxic effect of lead, suggesting a potent neuroprotective effect of iron supplementation on dopaminergic dysfunction due to lead exposure (Wright 1999; Wright et al. 2003)

In a controlled comparison group study, we (Konofal et al. 2004) showed that iron deficiency was correlated to ADHD symptoms severity, hypothesizing that iron supplementation may improve symptoms of ADHD in those subjects with low ferritin levels.

Given that lead exposure may contribute to ADHD and iron deficiency may exacerbate deleterious effects caused by lead, we recommend systematically seeking for iron deficiency in children with ADHD. We also think that controlled studies assessing the potential effectiveness of iron supplementation on ADHD symptoms should be encouraged. Such studies could aid the understanding of the complex pathophysiology underlying ADHD and provide effective therapeutic strategies for this disorder.

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Below is some more correspondence regarding the article, "Exposures to Environmental Toxicants and Attention Deficit Hyperactivity Disorder [ADHD] in U.S. Children," by Braun et al. from Brondum and the reply from Braun et al. to the comments of both Brondum, and Konofal and Cortese...


Letter: Brondum J
Response: Braun JM, Lanphear BP, Kahn RS, Froehlich T, Auinger P

Environmental Exposures and ADHD

Environ Health Perspect 115:395-399 (2007). doi:10.1289/ehp.10274 available via http://dx.doi.org (http://dx.doi.org/) [Online 24 June 2007]

Referencing: Exposures to Environmental Toxicants and Attention Deficit Hyperactivity Disorder in U.S. Children

In their article, "Exposures to Environmental Toxicants and Attention Deficit Hyperactivity Disorder [ADHD] in U.S. Children," Braun et al. (2006) advanced our knowledge of the effects of environmental tobacco smoke (ETS) and lead on the central nervous system of children. With respect to lead exposure, the study, importantly, focused on an older age group (4–15 years) than is generally studied (< 6 years) because of the greater sensitivity of the developing central nervous system to environmental insult early in life [Centers for Disease Control and Prevention (CDC) 1997].

In the logistic model used by Braun et al. (2006), the association of ADHD with lead exposure was statistically significant in the highest exposure quintile; however, it was also tenuous. Although not unheard of, the cutoff (p < 0.2) for inclusion of factors and variables associated with ADHD on univariate analysis was generous compared with the commonly used 0.1 or 0.05, and very close to the p-value of the lead–ADHD association of 0.19. The lead–ADHD relationship also exhibited a significant monotonic dose response, so it would have been helpful to know how the authors developed their exposure metric. Why, for example, were quintiles selected rather than another interval scheme, and why were they not of uniform size? Was the reported dose response the only model considered, or did the authors investigate other models, as some have done in studying the relationship of lead exposure and cognition (Canfield et al. 2003)?

Braun et al. (2006) noted that their analyses were limited by the cross-sectional nature of the National Health and Nutrition Examination Survey data they used, precluding adjustment of their model for certain covariates and potential confounders (e.g., parental psychopathology). Based on data from multiple studies, ADHD heritability has been estimated to be about 75% (Biederman and Faraone 2005). Inability to adjust for parental psychopathology is therefore an important limitation, because adjustment would likely reduce—and might eliminate—the associations of ADHD with ETS and lead. In studies of lead exposure and cognition, some of which Braun et al. (2006) cited as being consistent with their findings, the strength of the IQ–lead relationship can be dwarfed by the relationship of IQ to other factors such as parenting and socioeconomic status (Koller et al. 2004). When reporting associations of environmental contaminants and pathology, it seems prudent to maintain a broader perspective, as well as an environmental health perspective.

The authors declare they have no competing financial interests.

Jack Brondum
Hennepin County Department of
Human Services and Public Health
Environmental Health and Epidemiology
Hopkins, Minnesota
E-mail: jack.brondum@co.hennepin.mn.us
References

Biederman J, Faraone SV. 2005. Attention-deficit hyperactivity disorder. Lancet 366: 237–248.

Braun JM, Kahn RS, Froehlich T, Auinger P, Lanphear BP. 2006. Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. children. Environ Health Perspect 114:1904–1909.

Canfield RL, Henderson CR Jr, Cory-Schlechta DA, Cox C, Jusko TA, Lanphear BP. 2003. Intellectual impairment in children with blood lead concentrations below 10 µg per deciliter. N Engl J Med 348:1517–1526.

CDC. 1997. Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials. Atlanta, GA:Centers for Disease Control and Prevention.

Koller K, Brown T, Spurgeon, Levy L. 2004. Recent developments in low-level lead exposure and intellectual impairment in children. Environ Health Perspect 112: 987–994.

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ADHD: Braun et al. Respond

Environ Health Perspect 115:395-399 (2007). doi:10.1289/ehp.10274R available via http://dx.doi.org (http://dx.doi.org/) [Online 24 June 2007]

We appreciate the comments of Brondum, and Konofal and Cortese, and the opportunity to clarify our results (Braun et al. 2006). It is common practice to select variables with a p-value of 0.2 for inclusion in multivariable models (Katz 1999). Although the association of blood lead levels and ADHD appeared "tenuous" in bivariate analysis (i.e., p = 0.19), this was largely an artifact of our decision to categorize blood lead levels. When we entered lead into our multivariable analysis as a continuous variable, we found a 1.2-fold increased odds [95% confidence interval (CI), 1.0–1.4; p = 0.02] of ADHD for each 1.0-µg/dL increase in blood lead levels. The blood lead quintiles were not divided into exactly equal sample sizes because we used weighted percentages to categorize the data. We decided a priori to present the analysis in quintiles to make the results easier to interpret and also to illustrate any dose–response relationships for blood lead levels and ADHD.

As we noted in the "Discussion" of our article (Braun et al. 2006), a limitation of our study was the inability to adjust for parental psychopathology. This is an unfortunate trade-off when using a large nationally representative survey. In other studies, prenatal tobacco exposure has been shown to be a risk factor for the development of ADHD after controlling for parental psychopathology (Mick et al. 2002; Weissman et al. 1999). Although there is considerable experimental and epidemiologic evidence linking lead exposure with behaviors consistent with ADHD, future studies of childhood lead exposure will need to confirm our results by accounting for parental psychopathology and other potential confounders.

The hypothesis proposed by Konofal and Cortese—that iron deficiency may play a role in symptom severity among children with ADHD—is intriguing. Indeed, it was their original research that prompted us to incorporate ferritin as a measure of iron status (Konofal et al. 2004). It is certainly plausible that iron deficiency may confound or modify the effects of environmental lead exposure on ADHD in children. Alternatively, lead exposure may act as a confounder or modifier for the observed effects of iron deficiency with ADHD. Unfortunately, we were not able to examine whether ferritin (or other indicators of iron status) was associated with ADHD symptom severity using the National Health and Nutrition Examination Survey. Nor did we specifically test for an association between iron deficiency and ADHD. Although iron or other micronutrient supplementation may protect children from lead toxicity, recent evidence from a double-blind randomized trial (Kordas et al. 2005) suggests that iron and zinc supplementation did not appreciably lower blood lead levels or improve child behavior, as measured by the Conners Rating Scales. However, Kordas et al. included only children without anemia in their trial.

The authors declare they have no competing financial interests.

Joe M. Braun
Department of Epidemiology
University of North Carolina-Chapel Hill
Chapel Hill, North Carolina
E-mail: jmbraun@unc.edu


Bruce P. Lanphear
Robert S. Kahn
Tanya Froehlich
Department of Pediatrics
Cincinnati Children's Hospital
Medical Center
Cincinnati, Ohio
E-mail: bruce.lanphear@chmcc.org


Peggy Auinger
Department of Pediatrics
University of Rochester School of Medicine
Rochester, New York
References

Braun JM, Froehlich TF, Kahn RS, Auinger P, Lanphear BP. 2006. Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. children. Environ Health Perspect 114:1904–1909.

Katz M. 1999. Multivariable Analysis: A Practical Guide for Clinicians. New York:Cambridge University Press.

Konofal E, Lecendreux M, Arnulf I, Mouren M. 2004. Iron deficiency in children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med 158:1113–1115.

Kordas K, Stoltzfus RJ, Lopez P, Rico JA, Rosado JL. 2005. Iron and zinc supplementation does not improve parent or teacher ratings of behavior in first grade Mexican children exposed to lead. J Pediatr 147:632–639.

Mick E, Biederman J, Faraone SV, Sayer J, Kleinman S. 2002. Case-control study of attention-deficit hyperactivity disorder and maternal smoking, alcohol use, and drug use during pregnancy. J Am Acad Child Adolesc Psychiatry 41:378–385.

Weissman MM, Warner V, Wickramaratne PJ, Kandel DB. 1999. Maternal smoking during pregnancy and psychopathology in offspring followed to adulthood. J Am Acad Child Adolesc Psychiatry 38:892–899. <!--IBF.ATTACHMENT_220856--><!--QuoteEnd-->