After 37 years treating Lyme disease, I’ve seen this pattern repeatedly: children diagnosed with ADHD whose symptoms resolve completely with antibiotic treatment. A 7-year-old girl presented with declining school performance and difficulty focusing. This case demonstrates why attention problems in children warrant evaluation for tick-borne infections.

When School Struggles Signal Infection

A 7-year-old girl who had difficulty focusing in school was initially diagnosed by a neurologist with probable attention deficit disorder. But she exhibited numerous other symptoms consistent with Lyme disease, as described by Fallon from the Department of Psychiatry, Columbia University Medical Center and the Lyme Disease Research Program, New York.

Her symptoms extended beyond attention problems:

• Lethargy
• Irritability
• Forgetfulness
• Headaches
• Poor coordination
• Joint pain
• Word-finding difficulties
• Light and sound sensitivity

Initial Response to Treatment

The young girl’s medical workup revealed a positive Lyme ELISA. I started antibiotic treatment. Her attention deficit disorder resolved and her school grades returned to normal.

Her course over the subsequent 2 years appeared to be antibiotic-dependent. She would do well as long as she stayed on antibiotics and relapse when taken off. From age 9 to 12, she remained symptom-free without the need for antibiotics and maintained A to A+ grades.

Relapse at Age 12

At age 12, symptoms returned. She developed knee pain, frequent headaches, and poor concentration.

Serologic tests were again positive by ELISA, IgG and IgM western blots. She rapidly improved with a two-month course of oral cefuroxime. Her symptoms recurred two months after the end of treatment.

Her teacher reported numerous problems:

• Trouble with consistency in day-to-day work; careless; head in the clouds; scattered and sloppy work
• Assignments late, forgotten, or lost; difficult time following directions
• More forgetful and disorganized
• Emotionally frustrated, overwhelmed, tearful, aggressive, and fearful with new onset phobias and nightmares
• Physically: knee pain with mild swelling, paresthesias, headaches, moderate fatigue, insomnia, and trouble focusing

Her parents noted that she would go to school with homework in her bag but once there have no idea where it was or whether she had done it.

Neurocognitive Testing and Final Diagnosis

Her neurocognitive testing revealed 6 of 9 inattention areas consistent with attention deficit hyperactivity disorder (ADHD). No depression or suicidal ideation. Verbal IQ was 132.

But significant deficits appeared in visual motor planning, speed of processing, visual scanning, attention, visual memory, and learning.

I diagnosed her with persistent encephalopathy secondary to Lyme disease. After several months of oral antibiotics, she returned to normal without ADHD.

Frequently Asked Questions

Can Lyme disease cause ADHD-like symptoms in children?
Yes. Lyme disease can cause attention problems, poor concentration, and organizational difficulties that closely resemble ADHD.

How can doctors tell the difference between ADHD and Lyme disease?
Key signs include physical symptoms (headaches, joint pain), sudden onset, and improvement with antibiotics rather than ADHD medications.

Should children with ADHD be tested for Lyme disease?
Testing should be considered when symptoms appear suddenly, include physical complaints, or occur after outdoor exposure in endemic areas.

Related Reading

Lyme Disease Misdiagnosis: Why It Happens and What Patients Need to Know
Pediatric Lyme Disease
Lyme Red Flag: “You Need to See a Psychiatrist”
Autism Symptoms Improve Following Treatment for Lyme Disease
Neuropsychiatric Lyme Disease

References

1. Fallon BA, Kochevar JM, Gaito A, Nields JA. The underdiagnosis of neuropsychiatric Lyme disease in children and adults. Psychiatr Clin North Am. 1998;21(3):693-703.