y to do schoolwork and to concentrate before the illness began. It's not clear to them how competent they would have been had they not gotten Lyme disease. It's a very puzzling picture for these children, and hard for them to be self-confident, in the face of this illness.
Now, let's look at some of the FUNCTIONAL IMPAIRMENTS in children and
adolescents who have chronic Lyme disease?
One can see functional impairments at home, in school, and among the peer group. The child's
physical problems, unpredictability of symptoms, and feelings of helplessness can lead, IN SOME
KIDS, to a self-focused view of life, understandable given what these kids are trying to cope with.
I'd like to show you a slide that I used in a presentation at a Lyme Disease Association medical
conference. It highlights what some of the functional impairments are, and points to how the
school can help.
In this chart (See Slide #1)
I give an example of some of the common impairments we see:
• Fatigue • Problems Sleeping • Lethargy • Attentional problems, such as distractibility, impulsivity, problems focusing
• Depression or anxiety, including obsessional thinking
or racing thoughts, "brain never stopping" (thinking constantly)
• Problems with eating (due to gastrointestinal symptoms, either from
the Lyme itself, or secondary to the antibiotics.)
• Behavioral problems, severe at times • In adolescent girls, by the way, PMS symtoms can be QUITE severe, as well.
Let's look at some of what the functional impairments might LEAD TO.
We can see the process here. The functional impairments that are the original
produced by Lyme (and when I say Lyme, I include, of course, the co-infections) result in further
problems for the child. (see the second column)
• Poor school attendance
• Chronic lateness
• Behavioral problems at school • Withdrawal from peers (particularly when peers fail to understand how sick
• Situation-induced mood problems (aside from the mood problems coming
• Weight gain or loss, at times, dramatic
• Mood swings, inappropriate verbal outbursts,
(In general, kids and adolescents do not have a high degree of frustration tolerance. We all know that. Lyme disease severely challenges the child's already-limited resources)
What, then, might the child do to COMPENSATE for what is going on?
(these are what I call the "self-selected solutions")
All that I have discussed so far is distressful
for the child. She may try to cope with all of this by
doing any of the following:
• As school performance falls, and they're less involved with activities,
Lyme patients might shift to a lower-functioning peer group, cut classes, and, in the extreme, they might drop out of school (if over 16), to avoid the frustration of dealing with academic demands
• For the kids with GI problems, they might severely limit
their food intake, or begin gorging and purging
• For energy, or to self-treat the attentional problems,
• To calm them down, or to keep them from thinking about all that
is going on, alcohol, marijuana or other drugs might be chosen
I have seen all of the above in adolescents with chronic Lyme in my practice.
Any of the functional impairments can lead to any of the results, and to any or all of the self-selected solutions.
Functional impairments in school are often very significant, and call on the educators to develop
creative plans to help the student with Lyme succeed. Without the support of the school, the best
efforts of the parents might not be enough to keep a kid on track, in school, and successful!!
What THERAPEUTIC SOLUTIONS might we offer, to help deal with the FUNCTIONAL
Please note that these solutions do NOT directly connect with any particular item in the previous
There are different categories of therapeutic solutions, but for now, I'd like to focus on what the
school can do. They can make the difference between success and failure for a child with
We see several listed on this slide. I'll mention others later. They DO WORK, and most of them
are not very costly for the district or the state:
I'll just mention briefly another important area wher