In this study, zinc levels were significantly lower in children with attention deficit hyperactivity disorder than controls. This was combined with significant lower levels of ferritin in in-attentive type, significantly lower levels of ferritin and magnesium in hyperactive type and significantly lower levels of magnesium in combined type.
Melatonin regulates dopamine function, which is widely believed to be a key factor in the pathogenesis of attention-deficit/hyperactivity disorder [16, 17]. Higher Magnetic Resonance Imaging (MRI) of glutamate neurons observed in children with attention deficit hyperactivity disorder combined with a chelatable zinc pool in the synapses of these neurons may suggest higher zinc turnover in this disorder and possibly a higher zinc requirement in children with attention deficit hyperactivity disorder [18–22].
Oner et al, 2010  reported that low zinc and ferritin levels were associated with higher hyperactivity symptoms in children. This is in accordance with our results which also in accordance with other studies reported that serum zinc levels correlate with parent and teacher rated inattention in children with attention deficit hyperactivity disorder [22–24].
Iron serves as a cofactor in the synthesis of important neurotransmitters such as dopamine, nor-epinephrine and serotonin  and deficiency in early years of life can negatively affect neural and behavioral development [25, 26].
In this study, ferritin was significantly lower in children with in-attentive and hyperactive types than in controls; this is consistent with other studies [27, 28]. No significant difference in ferritin levels was found between children with combined type and controls, and this is not in accordance with the previous studies. This may be due to relatively higher level of hemoglobin in children with combined type in our study with no significant difference as regards hemoglobin level between children with combined type and controls.
In agreement with other studies [29, 30], magnesium levels were significantly lower in both children with hyperactive and combined types than in controls and this may be due to the role of magnesium in protecting cell membranes from excitatory neurotransmitters such as glutamate.
Riley et al, 2008  reported that preschool children with hyperactive and combined types of attention deficit hyperactivity disorder demonstrated similar levels of functioning and they suggested that hyperactive type may represent an earlier form of combined type. This supports our results as both children with hyperactive and combined types were lower in zinc and magnesium levels than controls.
Bosc et al, 2004 and Mousain et al, 2006  reported that magnesium/vit.B6 intake reduces central nervous system hyper-excitability in children with attention deficit hyperactivity disorder and this supports our results as magnesium levels were significantly lower in both hyperactive and combined types but not in in-attentive type.
Copper is an essential factor for both the development and function of the central nervous system. It acts as a cofactor for several key enzyme systems, most notably dopamine hydroxylase . In this study, there was no significant difference between children with attention deficit hyperactivity disorder and controls as regards copper levels and this is not in accordance with other studies which had reported lower levels of copper in those children , nor in accordance with other studies reported that excess copper may cause hyperactivity, mood swings, anxiety and anti-social behavior .
A history of smoking, either paternal or maternal, was significantly higher in children with attention deficit hyperactivity disorder than in controls. This is in accordance with many studies reported that maternal smoking during pregnancy is a risk factor for many cognitive and behavioral disorders [35, 36].
A positive family history of attention deficit hyperactivity disorder was also significantly higher in patients than controls and this is in accordance with other studies which had reported that attention deficit hyperactivity disorder shares familial and genetic factors [37, 38]. Smidts et al, 2007  reported more prevalence of attention deficit hyperactivity disorder in boys than girls while Dong et al, 2008  reported the reverse. This study showed no significant difference between girls and boys or between rural and urban children. This may be attributed to the selection of our controls whose age, sex and socioeconomic state were matched with patients. Limitations of this study included the small sample of patients - only 58 children - but this may be attributed to Egyptian culture which consider regular visits of neuropsychiatry unit is shameful as well as low incidence of attention deficit hyperactivity disorder in general.