Lyme Disease Misdiagnosed as ADHD in a 7-Year-Old Girl
Attention problems may not always be ADHD
Neuropsychiatric Lyme disease can affect focus, mood, and learning
Recognition and treatment may improve cognitive symptoms
Can Lyme disease look like ADHD? A case reported by Fallon and colleagues suggests that pediatric Lyme disease may sometimes present with symptoms that resemble attention deficit hyperactivity disorder (ADHD). In this case, a 7-year-old girl with difficulty focusing in school was initially diagnosed by a neurologist with probable attention deficit disorder before additional symptoms raised concern for Lyme disease.
Children with pediatric Lyme disease may present differently than adults. Cognitive symptoms, fatigue, behavioral changes, headaches, and school difficulties may sometimes dominate the clinical picture.
These symptoms included:
- Lethargy
- Irritability
- Forgetfulness
- Headaches
- Poor coordination
- Joint pain
- Word-finding difficulties
- Light and sound sensitivity
The young girl’s medical workup revealed a positive Lyme ELISA. After starting antibiotic treatment, her attention deficit disorder resolved and her school grades returned to normal.
Fallon and colleagues reported that her course appeared closely linked to treatment response, with improvement during treatment periods and recurrence of symptoms after antibiotics were stopped. The authors described this pattern in “The underdiagnosis of neuropsychiatric Lyme disease in children and adults.”
From age 9 to 12, she remained symptom-free without the need for antibiotics and maintained A to A+ grades. Unfortunately, at age 12 symptoms appeared to return. She developed knee pain, frequent headaches, and poor concentration.
Again, serologic tests were 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.
Teachers and family members observed increasing academic and behavioral difficulties. Concerns included inconsistent school performance, forgetfulness, difficulty staying organized, emotional distress, new fears, headaches, fatigue, trouble concentrating, insomnia, paresthesias, and worsening knee pain.
Her neurocognitive testing revealed 6 of 9 inattention areas consistent with attention deficit hyperactivity disorder (ADHD), no depression or suicidal feeling, a verbal IQ of 132, “but significant deficits in visual motor planning, speed of processing, visual scanning, attention, visual memory, and learning,” according to Fallon.
These findings overlap with symptoms commonly described in neuropsychiatric Lyme disease, where inflammation and neurologic dysfunction may contribute to cognitive and behavioral symptoms.
Subsequently, Susan was diagnosed with a persistent encephalopathy secondary to Lyme disease and, after several months of oral antibiotics, returned to normal without ADHD.
Frequently Asked Questions
Can Lyme disease be mistaken for ADHD?
Yes. Problems with concentration, memory, processing speed, irritability, and school performance may sometimes resemble ADHD symptoms.
Can pediatric Lyme disease affect school performance?
Fatigue, headaches, attention problems, and neurocognitive symptoms may interfere with academic performance and classroom behavior.
What symptoms besides inattention suggested Lyme disease in this case?
Joint pain, headaches, poor coordination, fatigue, sensory sensitivity, cognitive changes, and positive Lyme testing supported a broader diagnosis.
Can Lyme disease cause behavioral changes in children?
Some children with Lyme disease may develop irritability, emotional changes, anxiety, sleep disruption, or difficulty regulating emotions alongside physical symptoms.
When should ADHD symptoms prompt evaluation for other causes?
Additional evaluation may be reasonable when attention problems occur alongside headaches, pain, fatigue, neurologic symptoms, sensory changes, or fluctuating symptoms.
Clinical Takeaway
Attention problems in children do not automatically mean ADHD. Lyme disease and other medical conditions may occasionally contribute to cognitive, behavioral, and academic symptoms.
This case highlights the importance of considering broader diagnostic possibilities when attention problems occur alongside neurologic, physical, or systemic symptoms.
Related Articles
Learn more about related pediatric and neurologic presentations of Lyme disease:
Lyme disease misdiagnosis
Neurologic Lyme disease
Brain fog in Lyme disease
Delayed Lyme disease diagnosis
Persistent Lyme disease symptoms
References
- 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, viii.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
Hope this informaiton gets to Special Education Departments in local school systems.
Which antibiotic ultimately worked for Susan and how long did she have to take the antibiotics.
Same questions. We are in the same exact situation. I am inquiring about retesting this summer and going back on abx instead of the adhd medications that made Lyme rage way worse! We need major help. My son has had Lyme for 4 years now.
I have children with Lyme disease and rage in my practice.
She’s “lucky” that her Lyme tests showed positive and that she received treatment. So many do not.