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Lyme Disease Misdiagnosed as ADHD in Children

Lyme disease can affect attention, behavior, and school performance
Some symptoms may resemble ADHD in children and adolescents
A broader evaluation may be needed when physical symptoms are present

Over the years in clinical practice, I have evaluated a number of adolescents and children with suspected Lyme disease. In some cases, parents or schools were initially concerned about attention problems, behavioral changes, or declining academic performance.

These situations sometimes lead clinicians to consider attention deficit hyperactivity disorder (ADHD). While ADHD is common and often appropriately diagnosed, Lyme disease misdiagnosed as ADHD can occur when infection-related symptoms affect concentration, mood, behavior, and school performance. Fallon and colleagues described Lyme disease as the “new great imitator” and reviewed cases in which neuropsychiatric Lyme disease mimicked ADHD, depression, and other neurologic disorders.¹

Recognizing this overlap is important because Lyme disease can affect the nervous system in ways that influence cognition, behavior, and emotional regulation.

Some of these patterns overlap with issues I have discussed in other pediatric Lyme disease cases. In Behavioral Changes in Children With Lyme Disease, I describe how Lyme disease may be associated with changes in mood, irritability, and attention. In Early Signs of Lyme Disease in Children, I review how cognitive changes and school difficulties may appear before more recognizable symptoms such as rash or joint pain.

Can Lyme Disease Be Misdiagnosed as ADHD?

Children with Lyme disease may develop symptoms that resemble ADHD. These may include:

Difficulty concentrating
Forgetfulness
Declining school performance
Irritability or mood swings
Sleep disturbances
Fatigue that interferes with learning

These symptoms can resemble ADHD, particularly when concentration difficulties and behavioral changes develop before more recognizable signs of Lyme disease appear.

In some children, these symptoms appear gradually. Teachers may notice changes in attention or academic performance before physical symptoms become obvious.

Because ADHD is relatively common, the possibility of infection may not initially be considered.

Why Lyme Disease Can Affect Attention and Behavior

Lyme disease is a multisystem infection caused by Borrelia burgdorferi. When the nervous system is involved, some patients may develop cognitive, behavioral, or neurologic symptoms.

Some children develop neurologic or cognitive symptoms such as headaches, memory problems, slowed processing, or sensitivity to light and sound. These symptoms may interfere with classroom learning and concentration.

In an analysis of 100 patients with late-stage neuropsychiatric Lyme borreliosis, Bransfield and colleagues reported frequent impairments in attention span, working memory, concentration, executive functioning, and school or job performance.² Although this was not specifically a pediatric study, the reported cognitive difficulties overlap with symptoms commonly associated with ADHD.

Learn more about neurologic Lyme disease.

In my experience evaluating adolescents with suspected Lyme disease, families sometimes report that a child who previously functioned well in school begins struggling with focus, organization, or emotional regulation.

When these changes occur alongside physical symptoms—such as fatigue, headaches, joint pain, dizziness, or sleep disruption—Lyme disease deserves consideration.

Patterns That Raise Clinical Suspicion

Lyme disease misdiagnosed as ADHD is more likely when attention difficulties occur alongside other unexplained symptoms.

Fallon and colleagues emphasized that Lyme disease can present with psychiatric and cognitive symptoms that complicate diagnosis, particularly when physical symptoms are subtle or not immediately recognized.¹

Clinical patterns that may raise suspicion include:

Sudden change in school performance
New headaches or fatigue
Joint or muscle pain
Dizziness or autonomic symptoms
Sleep disruption
Fluctuating symptoms

Exposure history can also be important. Children living in or visiting tick-endemic regions may be at higher risk for Lyme disease.

In these situations, a broader clinical evaluation may be appropriate.

Why Misdiagnosis Can Occur

Lyme disease misdiagnosed as ADHD does not necessarily occur because clinicians overlook obvious signs. Instead, it reflects the complexity of Lyme disease presentations.

Several factors contribute:

Children often do not recall a tick bite.
The classic erythema migrans rash is not always recognized.
Symptoms may appear gradually.
Attention problems may appear before other physical symptoms are recognized.

When symptoms involve multiple organ systems, diagnosis can be challenging.

A Balanced Clinical Perspective

Most children with attention problems do not have Lyme disease. ADHD remains a common and important diagnosis.

However, Lyme disease misdiagnosed as ADHD can occur when infection-related symptoms affect attention, cognition, mood, behavior, and physical functioning. Recognizing the broader symptom pattern remains important when evaluating children whose difficulties extend beyond attention alone.

For clinicians, parents, and educators, the key is to remain open to reconsideration when symptoms evolve or when additional physical findings appear.

Careful clinical evaluation remains the most reliable way to distinguish between primary ADHD and medical conditions that may affect attention and behavior.

Frequently Asked Questions

Can Lyme disease be misdiagnosed as ADHD?

Yes. Some children with Lyme disease develop concentration problems, memory difficulties, fatigue, headaches, and behavioral changes that may resemble ADHD. A comprehensive evaluation can help distinguish between the two conditions.

What symptoms of Lyme disease can resemble ADHD?

Difficulty concentrating, forgetfulness, declining school performance, irritability, fatigue, sleep disturbances, and behavioral changes may resemble ADHD in some children with Lyme disease.

Why can Lyme disease affect attention and behavior?

When Lyme disease involves the nervous system, some patients may experience cognitive, behavioral, or emotional changes that interfere with attention and daily functioning.

Do most children with ADHD have Lyme disease?

No. ADHD is a common condition, and most children with ADHD do not have Lyme disease. Lyme disease should be considered when attention problems occur alongside other unexplained physical symptoms.

Clinical Takeaway

Lyme disease can sometimes present with concentration problems, behavioral changes, fatigue, and declining school performance that resemble ADHD. Although ADHD remains the most common explanation for attention difficulties, clinicians should consider Lyme disease when symptoms are accompanied by headaches, pain, sleep disruption, dizziness, or other physical complaints.

A careful clinical evaluation can help distinguish primary ADHD from infection-related symptoms that may affect attention, behavior, and learning.

Behavioral Changes in Children With Lyme Disease

Early Signs of Lyme Disease in Children

Lyme Disease Rash in Children

Pediatric Lyme Disease