Child and adolescent psychiatrists need to be aware of “red flags” that may indicate a child’s psychiatric symptoms are attributable to an undiagnosed neurologic disorder. What should lead a child and adolescent psychiatrist to question whether symptoms are purely psychiatric in nature; and what should they do if they suspect an alternative diagnosis? This Clinical Case Conference acquaints the child and adolescent psychiatrist with the kinds of medical and neurological conditions that are often initially misdiagnosed as psychiatric and the psychiatric conditions that are commonly comorbid with neurological disease. Suggestions for working with and referring such cases are discussed.