About three times per year a child is brought to my office for an assessment for ADHD who ends up having "Early Onset Bi-Polar Disorder." These children are typically displaying very extreme behaviors, such as throwing their bicycle -- off of the roof -- at the policemen who have been called, and so on. (When I received that call I wasn't sure what to ask first. "What was he doing on the roof with his bike?" was the best I could think of. "He was going to ride off of the roof, of course." was the answer from the child's mom.)

The behaviors may not be constant or consistently displayed as one might expect from an ADHD child, and may be more extreme than one would expect from ADHD.

The big clue is taking a family history and seeing if either of the parents, their brothers or sisters, or their parents, have/had a bi- polar disorder. If so, then this clue will be very helpful in making a proper diagnosis. I usually refer families to UCLA for a better evaluation, but in your community you may need to rely on an evaluation by a very good psychiatrist (never go to a bad or even average psychiatrist, only good ones!). Ask about experience with bi-polar disorder in children.

Telephone teaching hospitals in your area if there are any, or call your local private psychiatric hospital. Don't ask the switch board operator for a referral, instead ask for the children's unit or the adolescent unit. Once transferred there, ask the unit nurse who they would recommend ("If it were your child, who would you take your child to see?") The nurses know.

To learn more about ADHD visit us at the ADHD Information Library http://www.ADD101.com.

Consider these things:

1. How old is your child? If you child is 4 or 5 years old (especially with males) and is struggling in Kindergarten, he may simply be too young for structured learning. Not a big deal. Bring him home and work with him for another year. I usually recommend that parents start their sons in Kindergarten at age 6 anyway. And many kids with ADHD are just so neurologically immature that they are not going to really be "ready" for a classroom setting until they are 8 or 9 or 10. So consider homeschooling the young ADHD kids.

2. If the child is older, and the reason cited is "immaturity," then ask yourself these questions: When did the "immaturity" become apparent? Did it just begin this year? Are there emotional issues, or learning disabilities, that need to be addressed? Or is it really "immaturity?" How long has the teacher felt that this was a problem? What other options exist to deal with the situation? Would your child benefit from being with students who were a year younger than himself if the problem is immaturity?

3. If the reason given for retaining the child is lack of academic progress, then ask yourself these questions: Why didn't my child learn more? Were there problems in school behavior? Poor attention span? Poor work ethic? Poor work skills? Too much TV watching? Too little parental supervision? Too much parent supervision?

Would any of these problems be fixed by holding him back, or would you just repeat the same situation over again?

Are there other options, such as tutoring, home schooling, summer school, school interventions and accommodations?

Look at all of your options first. There are dozens of things that can be done besides holding a student back a grade in school. Just some simple thoughts. Hope they help. You can learn a lot more about Attention Deficit Disorder in children and teens at the ADHD Information Library at http://www.ADD101.com.

With a Doctorate in Psychology, and a Master of Science degree in Marriage and Family Therapy, doctor Cowan has worked with over 1,000 children and their families with ADHD or related conditions as a licensed Marriage and Family Therapist, researcher, and author.