Oppositional behavior in children with Lyme disease
Several studies have found that children and adolescents infected with Borrelia burgdorferi, the causative agent of Lyme disease, can, in some instances, develop extreme neuropsychiatric symptoms, including sudden, abrupt mood swings, aggressiveness, explosive anger, depression, panic disorder, neuropathy and even homicidality. [1]
As Dr. Richard Bransfield explains in Neuropsychiatric Disease Treatment, “Lyme disease and the immune, biochemical, neurotransmitter, and the neural circuit reactions to [Lyme disease] can cause impairments associated with violence.” [1]
Children with serologic evidence of a tick-borne illness can also develop severe oppositional defiant behaviors, according to Dr. Rosalie Greenberg, a child and adolescent psychiatrist, who runs a private practice in New Jersey.
[bctt tweet=”Lyme disease can trigger extreme oppositional behavior in kids. ” username=”DrDanielCameron”]Out of 69 youths evaluated at Dr. Greenberg’s practice, 49 (or 2/3) were positive by blood tests for one or more tick-borne illnesses including Lyme disease, Bartonella, Babesia, Ehrlichia and Anaplasmosis.
“I have seen a number of children and adolescents who exhibit significant acute or gradual onset of highly oppositional behaviors often both at home and at school,” she says.
Several examples include:
- Refusal to do class work or homework
- Heightened paranoia or feeling rejected by others
- Increased irritability
- Extreme temper tantrums
- Problems concentrating
- Elevated impulsivity
- Sensory hypersensitivity (sound, touch, smell, taste and/or light)
- Intense emotional lability
Patients also exhibited bouts of rage. “During periods of intense anger over minimal issues, they can appear menacing and threaten to kill a sibling, parent or a friend or state that they want to die themselves,” Greenberg says.
The onset or presentation of the oppositional behavior varied. “Parents describe these behaviors as either a sudden change or a period of worsening of a previous condition, such as attention-deficit hyperactivity disorder or mood 
disorder,” she explains.
In some cases, infections including Borrelia burgdorferi, the bacterial pathogen causing Lyme disease, can induce an immune dysfunction and a condition known as Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). An abnormal immune response triggers various neuropsychiatric symptoms including OCD-like behaviors, tics, mood changes, bouts of rage and aggression.
Dr. Bransfield’s and Dr. Greenberg’s observations will need to be studied further to prove a direct correlation between tick-borne illnesses and aggression and oppositional behaviors. Until then, it would be reasonable to consider a tick-borne illness as a potential underlying cause of extreme oppositional behaviors.
Editor’s note: I have treated both middle and high school students with Lyme disease who exhibited severe oppositional behavior.
Related Articles:
Suicidal behaviors in patients with Lyme and associated diseases
16-year-old boy with Lyme disease presenting as depression
Video: Is Lyme disease an autoimmune disease?
References:
- Bransfield RC. Aggressiveness, violence, homicidality, homicide, and Lyme disease. Neuropsychiatr Dis Treat. 2018;14:693-713.
- Greenberg R. Aggressiveness, violence, homicidality, homicide, and Lyme disease. Neuropsychiatr Dis Treat. 2018;14:1253-1254.
Jamie Taylor
04/18/2024 (3:29 am)
Hello all sadly I hate to become part of this community but my 3 yr old grandson was found with a tick on him less then a month ago. I removed the tick myself and reported it to his mother immediately. About a week after finding the unwanted guest she took him to the doctor who prescribed antibiotics. When following up with my daughter she informed me that the doctor didn’t do any actual testing for the strain of the Lyme disease and really didn’t have a whole lot of feedback regarding what to do in the future and what sort of side effects that we should be on the look out for? Today was the first day he has been back in my care and “WOW” is all can say. I am having difficulty with getting him to follow simple commands, or to remember what I asked him to do to get what he was wanting? He was reported to have a physical outburst towards a close family friend and couldn’t explain why! Any suggestions that can be funneled my way, really want to assist my daughter who is losing her patience with a plan to deal with such a huge burden, that started with such a small interaction. Is the antibiotic something he will have to take for years?? What test should she request to know the strain of Lyme he is being affected by? If you know what strain that you are affected by does that assist in treatment efforts?
Dr. Daniel Cameron
04/18/2024 (6:48 am)
I am sorry to hear your grandson is having problems. The tests for Lyme and co-infections are not as reliable as I would like. I have to rely on clinical judgement to determine the best tests and treatment strategies. I also have to rule out other illnesses. I don’t treat younger children. All the best.
Candice Webster
02/04/2023 (12:09 pm)
Hello. My daughter (5 years old) was diagnosed with Lyme disease over the summer. The pediatrician treated it with a month long antiobitic but this winter she’s been exhibiting a lot of behavioral problems at school. How do I know if she’s still suffering effects of the lyme? What steps should I take to look into this further?
Dr. Daniel Cameron
02/06/2023 (2:07 pm)
I advise my patients to include a doctor experienced in treating Lyme disease to their team of doctors.
Crystal
10/12/2022 (1:22 am)
This sounds just like what we are dealing with! My son 15 months ago got LD. And he changed. He is/was so smart. But now he struggles daily. School has become hell for him. He won’t listen, he gets angry over the simplest tasks, he isn’t violent towards others but in class he will throw desks and chairs away from others. He’s now recently starting to run out of the school. He’s only 8. He sometimes almost seems like he blacks out in his fits of rage like he don’t know what’s going on. He struggles to do his school work, when he used to do it no problem. He’s always been advanced academically until he got LD now he can’t barely think enough to put it on paper. He don’t sleep well. He does this weird thing with his neck since the LD, almost like a tick habit. The Dr just wants to say he has ODD. He cries to me that he don’t understand why he’s so angry and he feels broken, that he wishes he could kill himself some way, unless he can hurry up and feel better. My heart breaks for him, I’m on wait lists to get him evaluated but I’m sure they won’t diagnose him right. I’m trying everything no one just believes me it’s from LD. I wish there was a medicine and test to help show and regulate what he’s feeling and going through. 😭
Dr. Daniel Cameron
10/12/2022 (9:00 am)
I have children in my practice with the same presentation. I advise those patients to include an evaluation with experience treating Lyme disease.
Crystal
10/12/2022 (2:54 pm)
We don’t have any lyme disease speacilist in our area. And unfortunately the closet one is 2hrs away from us and medical won’t cover it and it can get very costly I’m told. I’m just at loss. I am seeing his pediatrician again today begging her for help. But Dr’s just don’t want to even acknowledge it’s side affects from lymes. They don’t believe there are long term side effects like this, they act like I’m making it up and talking out my ass. But I’m still waiting on an evaluation with a psychiatrist to do an evaluation on him but I feel like that will also be missed diagnosed. Do you have any suggestions on which way I sure ask these people on how to evaluate and treat him?
Dr. Daniel Cameron
10/12/2022 (8:07 pm)
I have not been very successful in urging doctors to take chronic manifestations of Lyme disease seriously. You may have to pay out of pocket. You may save money by using local labs and using your prescription or GoodRx.
Debbie
07/05/2022 (5:39 pm)
My grandson got Lyme and was treated at once with antibiotics. I now wonder if it was erased few years later at 9 yrs exhibited violent outbursts and anxiety, could not go to school for few months and after overload of antibiotics seems better until another violent outburst, has been hospitalized couple of times but getting better, tested negative for Lyme and is now 12 and still struggling??
Dr. Daniel Cameron
07/05/2022 (10:40 pm)
I have seen patients of mine with tick borne illnesses with rage.
Jo
06/07/2022 (11:00 pm)
I have a 12 year old grandson who has been diagnosed with ADHD, ODD, Anxiety, and 2E. Behavioral problems began as early as 3 or 4 years and have gotten worse the older he gets. Is it possible that unknowingly he had lyme disease as a child that was never treated which could be causing the problems he is having? His parents have worked very hard at trying to find the right help for him, to no avail and especially because finding mental health treatment is beginning to feel like next to impossible.
Dr. Daniel Cameron
06/08/2022 (12:25 pm)
I have patients with ADHD, OCD and anxiety who have benefits from antibiotics. I have some patient with Lyme and ADHD, OCD and anxiety