By Alex Laoch
Lyme disease is one of the fastest growing vector-borne illnesses in the United States; in fact, the CDC (Centers for Disease Control and Prevention) reports over 300,000 people contract Lyme disease annually. 1 Lyme disease and other tick borne illnesses can become chronic and affect any part of the body. This includes, but is not limited to, the heart, bones, muscles, and brain. When Lyme disease infects the brain, it is referred to as neurological Lyme disease. It can both mimic and cause cognitive damage and present as learning disabilities. 2,3 Learning disabilities and disorders often overlap, and people can have more than one learning disability (this is called comorbidity). Learning disabilities and physical symptoms can appear gradually or suddenly.
Children are at higher risk of infection because they spend a lot of time outdoors; therefore, it is important to be aware of signs and symptoms associated with learning disabilities. The more knowledge you have, the better equipped you are to help a child. 4
Although many learning disabilities and disorders are covered in this article, not all of them are listed. For more information regarding learning disabilities, go to https://ldaamerica.org or https://www.understood.org/en. These are also good resources to use when looking at what “age appropriate” standards apply to learning disabilities.
Following are only some of the many learning disabilities, along with some signs and symptoms that may accompany them:
ADHD (Attention-Deficit/Hyperactivity Disorder)
ADHD can affect children in any environment, including at home, school and while playing with friends. Children with ADHD display a regular pattern of inattention and/or hyperactivity-impulsivity. There are three presentations of ADHD: Predominantly Inattentive ADHD, Predominantly Hyperactive-Impulsive ADHD, and a Combined Presentation of ADHD.
Predominantly Inattentive ADHD
A child with Predominantly Inattentive ADHD may have difficulty focusing (“paying attention”) and appear as though he/she is not listening. Staying organized, keeping track of items, becoming easily distracted and making careless mistakes on schoolwork are also symptoms of Predominantly Inattentive ADHD. 5
What does Predominantly Inattentive ADHD “look” like at school and outside a school setting?
At school, a teacher may say things like, “Jonny just doesn’t seem to pay attention and daydreams often. Jonny rushes through his work and makes silly mistakes on things I KNOW he knows. His binder is very unorganized, and he has difficulty finding supplies he needs for class. Jonny often forgets to turn in his homework even though he says he did it. When Jonny does seem to pay attention he is easily distracted.”
At home, Jonny may have difficulty doing homework, completing tasks and chores and staying organized. He may lose things often and doesn’t seem to be listening sometimes when people talk to him.
Predominantly Hyperactive-Impulsive ADHD
Children with Predominantly Hyperactive-Impulsive ADHD may often fidget, seem as though they are “driven by a motor,” interrupt others and blurt out in class. They may be excessively talkative and can have difficulty with social situations, such as sharing and waiting for his/her turn while playing games. 6 Difficulty controlling impulses, such as refraining from talking to a classmate during a lesson, along with behavioral difficulties, are sometimes displayed by children with ADHD. 5
What does Predominantly Hyperactive-Impulsive ADHD “look” like at school and outside of a school setting?
At school, a teacher may say things like, “Sally talks out-of-turn, interrupts others and blurts out often; this behavior is disruptive and interferes with her peers’ learning during classes. It is challenging for Sally to wait her turn and share items appropriately with others. She has difficulty cooperating with classmates during small group assignments. Sally makes impulsive decisions, such as poking a friend as a joke, and she doesn’t take time to think about her actions and their consequences. She squirms in her seat, fiddles with items, always seems to be on the go and is overly energetic and talkative.
Sally may have tons of energy at home, be overly talkative and interrupt others frequently. Sally doesn’t like to sit still, and it can be difficult for her to take turns and/or share with playmates or siblings. Sally may behave inappropriately during social situations, such as running around in a grocery store or jumping on the bed when she knows it is not allowed.
Combined Presentation of ADHD
Children may exhibit symptoms associated with both Predominantly Inattentive ADHD and Predominantly Hyperactive-Impulsive ADHD, as described in the above paragraphs. 56
Auditory Processing Disorder (also known as Central Auditory Processing Disorder or CAPD)
People with Auditory Processing Disorder usually have normal hearing. However, discriminating between sounds can be difficult, especially in noisy environments. Processing verbal information is disrupted due to a neurological breakdown that occurs when someone processes language. This results in difficulty listening and comprehending what is said. 6
What does Auditory Processing Disorder “look” like at school and outside of a school setting?
Teachers may say, “Sally is having difficulty distinguishing different sounds. This affects spelling and reading. For example, last week she thought I said ‘catnip’ when I actually said ‘catnap’ and ‘planting’ when I said ‘panting.’ Both words were used in context that gave clues as to what words would make sense. Sally especially struggles when there is more noise. Recalling what has been said poses a challenge for her and she has difficulty expressing her thoughts in a cohesive manner. Sally asks me to repeat what is said quite often and has difficulty understanding lessons and casual conversations. She needs me to break down directions in a step-by-step manner, says, ‘what?’ on a regular basis, and needs me to rephrase and repeat what I’ve said quite frequently”. 78
Outside of school, Sally would exhibit very similar and/or the same symptoms as described in a school setting.
Autism/Autism Spectrum Disorder (ASD)
There is great variability with regards to the severity of people with Autism/Autism Spectrum Disorder (ASD), which is one reason the word “spectrum” is used. Children may fall on the more severe end of the spectrum, the less severe side of the spectrum and anywhere in between. Difficulty with social interactions and understanding verbal and nonverbal communication are common amongst people with ASD. Children often misinterpret nonverbal communication and are sometimes unaware of others’ feelings due to difficulty interpreting facial expressions and body language. Repetitive behaviors are common among people with ASD. Often, but not always, people with ASD do not like to be touched and have difficulty tolerating noise; one theory is this is due to sensory issues and is part of the biology of the condition. 9 10
On the more severe end of the spectrum, kids have exacerbated difficulty communicating and may say one word, a few words or speak in phrases. They can have difficulty putting together sentences in a coherent manner and often repeat what they say or what is said by other people. They may display repetitive behaviors such as flapping their hands, moving objects, rocking back and forth and playing with their fingers.
On the less severe end of the spectrum, children can present with mild language difficulties that may not be noticeable to people who are not trained in the field of learning disabilities. They may also have an extensive vocabulary, which is well beyond their years. People with ASD can be extremely knowledgeable about topics of interest and are often infatuated with them. Changes in routine and in general are often very distressing for a child with ASD. 11
What does Autism/Autism Spectrum Disorder (ASD) “look” like at school and outside of a school setting?
Due to the wide range of variability regarding Autism/Autism Spectrum Disorder, what teachers could say would depend on the severity of the disorder.
On the less severe end of the spectrum, a teacher may say, “Jonny displays repetitive motions. He constantly plays with his hands in the exact same manner; for example, he seems to enjoy watching his hands make the same wiggling motions. Jonny doesn’t seem interested in interacting with his peers. He likes to spend time by himself at recess. When Jonny does interact with classmates, he has difficulty interpreting their verbal and nonverbal language. For example, he thought a fellow student said something mean to him yesterday, but she actually gave him a compliment.
Jonny has a lot of difficulty understanding sarcasm and jokes, and this leads to misunderstandings. Sometimes I forget that he doesn’t like a pat on the back when he’s doing a good job, and he freezes up and squirms away. If there is a change in the daily schedule, it really throws Jonny off. Last week we had a guest speaker during PE time. He asked me about the changes in schedule over and over again and seemed very anxious. He has a voracious vocabulary and seems to know everything in the world about the solar system; in fact, he knows so much about the solar system, he could teach a class about it!
On the more severe end of the spectrum, a teacher may say, “I’m very concerned about Jonny. He isn’t speaking in an age-appropriate manner. Jonny says a word or two or short phrases rather than sentences. He repeats what he says often and “parrots” what others say. He rocks back and forth and sometimes has difficulty controlling his emotions. Jonny seems to become angry and have outbursts for what seems like no apparent reason or very minor things.
Outside of the school setting, children may experience the same type of difficulties, such as difficulty with social interactions, verbal and non-verbal communication, and repetitive behaviors. Any change in schedule or routine can be very upsetting to a child with ASD. Children with ASD may not have many friends or may have difficulty interacting with playmates and siblings.
Cognitive Impairment Cognitive
Impairment encompasses a wide variety of intellectual or cognitive deficits that can range from mild to severe. 12 Clinical diagnoses may be too mild to fit a specific learning disability diagnosis but can also include many learning differences, such as those discussed in this article. Cognitive Impairment can also include Down Syndrome, Dementia, Alzheimer’s, Traumatic Brain Injury, along with Intellectual Disabilities, otherwise known as Developmental Delays or Mental Retardation.
In general, someone with Cognitive Impairment may have difficulty with memory, “brain fog,” acquiring new information, planning, organizing, and thought processes; again, Cognitive Impairment can range from mild to severe. Many people with Lyme disease and tick borne illnesses suffer from some form of Cognitive Impairment.
What does Cognitive Impairment “look” like at school and outside of a school setting?
Since Cognitive Impairment is a broad term and encapsulates a variety of disabilities and diseases, it is difficult to describe what it “looks” like at school and outside of a school setting without having more details regarding the specific nature and severity of Cognitive Impairment.
Dyslexia is a learning disability wherein students often have difficulty with reading fluency (reading accurately, with expression and at an appropriate pace). Challenges with word recognition, sound-symbol correspondence (a letter or group of letters make a sound), spelling, writing and reading comprehension may also be noticed. 13 Although some people with dyslexia may write some letters or numbers backwards, it is a misnomer that this alone is a defining characteristic of dyslexia.
What does Dyslexia “look” like at school and outside of a school setting?
A teacher may say, “Sally is having difficulty with words that require memorization (these are called sight words because they must be memorized and can’t be sounded out) and words that need to be decoded (breaking up a letter or group of letters into sounds to form words). This affects her spelling, reading and writing. Even when she does read words, she is unable to tell me about what she read. She makes frequent spelling errors and needs extra support when she tries to read words that can be sounded out. Because spelling and reading are so laborious for Sally, this also has a negative impact when she writes in her class journal or about an assigned topic. Most tasks are far more laborious for her, and she needs extra time on assignments and projects.”
Outside of school (and at school), Sally may think she is “stupid” because she knows she is having trouble reading, writing and spelling words. She may struggle to do homework or put up a fight when it is time to do homework. Sally may act out due to her frustration, such as throwing mild to severe temper tantrums. She may be resistant to reading and even having books read aloud to her. Sally’s entire demeanor changes when school or homework is brought up. She may become depressed or cry often.
Dyscalculia is a math-based learning disability wherein someone has difficulty with number sense as well as memorizing and recalling math facts. According to the Learning Disabilities Association of America, “Dyscalculia affects a person’s ability to understand numbers and learn math facts. Individuals with this type of Learning Disability may also have poor comprehension of math symbols, may struggle with memorizing and organizing numbers, have difficulty telling time, or have trouble with counting.” 14
What does Dyscalculia “look” like at school and outside of a school setting?
A teacher may say, “Jonny struggles to comprehend basic number sense, such as one-to-one correspondence (an object or objects represent(s) a number or numbers), place value and where numbers fall on a number line. Regarding where numbers fall on a number line, it is difficult for him to tell what comes before or after a specific number. As far as difficulty with place value, he doesn’t understand that a number, such as 136, represents 100 + 30 + 6. He has a really tough time understanding and recalling vocabulary associated with math, such as the definition of fractions or what the word ‘addition’ really means. Word problems really trip him up. I have to remind him quite often to look at the math operation used in a problem; for example, sometimes he may add when there is a subtraction symbol, and vice versa. Jonny finds it extremely challenging to solve multi-step problems, such as when he solves two-digit plus two-digit addition problems that involve carrying.
Outside of the school setting (and in a school setting), Jonny may have difficulty understanding concepts such as days of the week and months of the year. Jonny may find it difficult to count money, make change or tell time. He may put up a struggle when it is time to do math homework. 14
Executive Functioning Deficits
According to understood.org, “Executive function is like the CEO of the brain. It’s in charge of making sure things get done from the planning stages of the job to the final deadline.” 13 Executive Functioning describes processes that help us plan, organize, and remember details. People with Executive Functioning deficits often have difficulty with organization, prioritizing and time-management. 15 16 They may lose things, have difficulty making decisions and prioritizing what to do. Children may have difficulty starting and completing tasks and need to be told directions many times. It is difficult for a child with Executive Functioning Deficits to think about or process more than one thing at a time. 17
A teacher may say, “Sally really struggles to remember daily routines that other students learned how to master months ago. I have to take her through our morning routine step-by-step every day. I remind her take out her lunch from her backpack and put it in the lunch bin. Then, she will just stand at her desk and is unsure of her next step. I remind her the next step is to turn in her homework. Then, I ask her to put her backpack inside the cabinet. It takes Sally a lot longer than other students to complete these tasks and daily schoolwork. I have to provide her with extra support with almost all tasks. For example, I have to help her organize her binder frequently. She forgets where she puts items, becomes overwhelmed easily with tasks, and needs help from the beginning to the end of most tasks.”
At home, parents may have to prompt Sally to do her basic morning routine, such as brush her teeth, take a bath, and put on her clothes. She knows what to do, but just has trouble remembering the sequence and/or following through with tasks. Homework can become quite a struggle and can be very overwhelming in every aspect, from getting her to begin homework, to staying focused on it, to completing it. 18 19 According to Understood.org, “Kids with weak planning and prioritizing skills may not know how to start planning a project. They may be easily overwhelmed trying to break tasks into smaller, more manageable chunks. They may have trouble seeing the main idea.” 20
Language Disorders: Receptive Language Disorder, Expressive Language Disorder, Mixed Expressive-Receptive Language Disorder
People with Receptive Language Disorder have difficulty making sense of what is said or written. There is a breakdown in processing and information becomes “jumbled.” They are easily confused and misunderstand things frequently.
Expressive Language Disorder involves difficulty expressing thoughts both verbally and in written form. People with Expressive Language Disorder typically have difficulty forming simple and/or complex sentences, recalling words, and have limited vocabulary on a consistent basis.
Mixed Expressive-Receptive Language Disorder involves challenges associated with Receptive Language Disorder and Expressive Language Disorder. They have difficulty expressing their thoughts and accurately understanding what it being said.
What does Receptive Language Disorder, Expressive Language Disorder, and Mixed Expressive-Receptive Language Disorder “look” like at school and outside of a school setting?
If a child has Receptive Language Disorder, a teacher may say, “Jonny has trouble understanding what is said or written in an accurate manner. I may say something simple, such as, ‘Jonny, write three complete sentences about rain forest animals we have been studying.’ I ask him to rephrase what I’ve said to check for understanding, and it turns out he didn’t get the gist of what I was saying, gets parts of it or completely misinterprets what I said. He seems to struggle keeping up with and carrying on conversations with his peers. It’s as though he gets behind and lost in the conversations.”
If a child has Expressive Language Disorder, a teacher may say, “Jonny tries to tell me what he is thinking, but it is apparent he has difficulty getting his thoughts out. It takes him longer than average to express himself. He doesn’t speak in complete sentences, and sometimes what he says doesn’t end up making sense. I have to ask him a lot of questions to get to the bottom of what he is trying to say. He becomes frustrated because he knows in his head what he wants to say, but it just doesn’t come out the way he wants it to. He has difficulty communicating both socially and academically with his peers. They get frustrated with the time and effort it takes to get to the bottom of what he is trying to express.”
Someone with Mixed Expressive-Receptive Language Disorder has signs and symptoms of both Receptive and Expressive Language Disorder, so a teacher could say something along the lines of what was described in the aforementioned paragraphs.
Outside of a school setting, one would see very similar signs and symptoms.
Processing Speed Deficits
Someone with Processing Speed Deficits processes, or makes sense of things, in a slower manner than “normal”. They may have difficulty taking in information, processing it, and deciphering how to respond to the input. 21
What does Processing Speed Deficits “look” like at school and outside of a school setting?
A teacher may say, “It takes Sally extra time to figure out what is said. She often needs things clarified in a very simple manner along with information being repeated. It takes her time to figure out what to do and how to respond, both verbally and on assignments. She requires prompting with regards to figuring out answers to questions and on assignments. She needs extended time to finish assignments and tests and has difficulty making decisions.”
Outside of the school setting, the signs and symptoms are very similar, most notably in conversation, completing tasks, and making decisions. It may take your child significantly longer than the average child to do homework. Giving too much information at once can be overwhelming, and breaking down information into a step-by-step manner is helpful. Children need more time to answer questions and respond during conversations.
Visual Perceptual/Visual Motor Deficits
Children with Visual Perceptual/Visual Motor Deficits find it challenging to discriminate differences in shapes and letters. They may have difficulty tracking, or following along, when reading and lose their place often. 22 Environments that are visually rich can be quite distracting and overwhelming. For example, bright colors and lots of posters in a classroom may be very distracting.
Their eyes become tired more easily, and they sometimes complain of their head hurting. Children also become tired when reading, writing and copying information because it is so taxing on them. When copying information, they can look at the original words, shapes, etc., but may quickly forget what they needed to copy. This results in the child looking at the original material several times throughout the process.
Eye/hand coordination can be challenging and can manifest in poor handwriting and difficulty cutting out objects. Often, students may have “sloppy” handwriting, difficulty staying in the lines on paper and their words may run together. Their writing may be slanted, and they may turn written materials at odd angles to “see” them better. This can also affect reading comprehension and writing skills. Unfortunately, teachers who are not trained in this area may think the child is being “lazy” and not putting in effort when in reality, it takes extreme effort for a child with Visual Perceptual/Visual Motor Deficits to complete tasks. 22
What does Visual Perceptual/Visual Motor Deficits “look” like at school and outside of a school setting?
Jonny’s teacher may say, “Jonny turns in very sloppy work. His handwriting is very large and his spacing is a problem because his words run together when he writes sentences. If you look at his spelling tests, number one starts at the left end of the paper and subsequent spelling words move more and more to the right of the paper. Writing is particularly taxing for Jonny. I often have to have him verbally express what he wants to say, and he is able to express himself quite well orally. However, when it comes to writing it down, he freezes. It takes immense effort on his part. He reverses b, d, p, and q often. He has difficulty discriminating subtle differences in very basic shapes and patterns. Jonny becomes very frustrated when he has to cut items even though he tries hard. The end product is sloppy, out of line, and has rough edges. He hates coloring and cannot stay in the lines. He has difficulty understanding what he is reading.
Outside of the school setting, Jonny is probably very resistant to doing homework and often puts up a fight about it. He may become very frustrated when doing homework, get into arguments with his parent(s) or guardian(s) and cry. Jonny may not like doing any sort of crafts and becomes easily distracted by environments that are rich in color and decoration. Children with Visual Perceptual/Visual Motor Deficits may have difficulty with what seem like very simple life skills, such as “matching socks [and] learning phone numbers.”
There are a plethora of learning disabilities and other impairments that people with Lyme disease and tick borne illnesses can suffer from. This article is certainly not all inclusive and serves as a starting point to gain information and have a better understanding of some of the numerous manifestations Lyme disease and tick borne illnesses can mimic and cause.
What can you do if you suspect your child may have Lyme disease?
It is imperative that children receive a proper diagnosis and medical treatment whether or not the diagnosis is or is not Lyme disease. Qualified Lyme treating physicians have expertise and experience treating patients with Lyme disease and other tick borne illnesses. A competent healthcare professional will make a differential diagnosis in effort to ensure the correct diagnosis is made.
For help finding an experienced Lyme disease treating physician, contact www.LymeDoc.org
It can be helpful to take your child to be evaluated using the parameters presented in Dr. Robert Bransfield’s Neuropsychiatric Assessment of Lyme Disease.
If your child has Lyme disease and/or tick borne co-infections:
A child with Lyme disease may be afforded rights under the Individuals with Disabilities Act (IDEA). Options may include either an Individualized Education Plan (IEP) or services under Section 504
*This article is for informational purposes only and does not serve as medical or legal advice.
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