Long term antibiotic therapy may be an effective treatment for children co-morbid with Lyme disease and Autism Spectrum Disorder

Abstract

Patients diagnosed with Lyme disease share many of the same physical manifestations as those diagnosed with an Autism Spectrum Disorder (ASD). In this study four male children (ages 26–55 months) who have an ASD diagnosis and one male child (age 18 months) who displayed behaviors consistent with an ASD, were assessed using the SCERTS Assessment Process Observation (SAP-O) form. The SAP-O meets state and federal requirements for providing a comprehensive, ongoing assessment of a child with an ASD [33]. The SAP-O form measures children’s abilities using observational, authentic assessment procedures in the domains of joint attention, symbol use, mutual regulation, and self regulation via observations of specific behaviors in familiar settings [33]. The five children tested positive for Lyme disease and their SAP-O score was evaluated before and after 6 months of antibiotic therapy. Each child was prescribed 200 mg of amoxicillin three times per day and three of the five children were prescribed an additional 50 mg of Azithromycin once per day. All of the children’s scores on the SAP-O assessment improved after 6 months of antibiotic therapy. The assessors also reported anecdotal data of improved speech, eye contact, sleep behaviors, and a reduction of repetitive behaviors.

Introduction

Autism is a developmental disorder that appears in the first 3 years of life; a physical condition linked to abnormal biology and chemistry that affects the brain’s normal development of social and communication skills [30]. Over the last 20 years the prevalence of Autism has increased by over 600% [6]. Because of current prevalence rates, the term Autism Spectrum Disorders (ASD) is commonly used. This classification (ASD) is inclusive of diagnoses under the Pervasive Developmental Disorders in the Diagnostic and Statistical Manual IV-TR: including Autistic Disorder, Aspergers Disorder, and Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS) [12]. Many hypotheses for increased prevalence rates have been proposed, this study investigates the correlation between ASD and Lyme disease and the use of long term antibiotics as a possible treatment.

Lyme disease is a multisystemic illness caused by the spirochete bacteria Borrelia burgdorferi (Bb); it is the most common vector born disease in the United States [13]. Lyme disease has been called “The Great Imitator” because infected individuals often present neurological and physical symptoms that are similar to other disorders [8]. Late stage Lyme disease is commonly misdiagnosed because it mimics many better known disorders [32].

Misdiagnosis of initial symptoms of Lyme disease and delayed treatment can lead to debilitating chronic illnesses with musculoskeletal, cognitive, and neuropsychiatric impairments [10]. Children who have gone undiagnosed and later been found to have Lyme disease have displayed one or more of the following symptoms: decreased reading comprehension and handwriting skills, impaired speech fluency, attention deficit behavior, hyperactivity, withdrawal from activities with peers, inability to perform at grade level, obsessive compulsive behavior, anxiety, mood swings, dyslexic-like behaviors, sensitivity to light and sound, and inability to manage frustration [2], [21]. All of these symptoms would be considered criteria for Autism Disorder [4].

A review of case studies and literature has shown that between 3% and 25% of children reportedly lose their ASD diagnosis and enter the normal range of cognitive, adaptive and social skills [23]. The question should be raised, why do a small percentage of children diagnosed with an ASD lose their diagnosis and what caused them to present behaviors similar to an ASD? Or were these children misdiagnosed with an ASD and do the behaviors they present have a physiological, pathogen induced cause?

Published studies in peer reviewed literature have shown that a number of individuals who are diagnosed with an ASD test positive for Lyme disease. A study of was conducted by Dr. Garth Nicolson in 2003 where 20% of the children diagnosed with an ASD came back positive for Lyme disease [9]. A similar study was conducted by Dr. Aristo Vojdani [38] and 22% of the ASD patients he tested came back positive. Also, in a personal interview with an assistant of Dr. Charles Ray Jones, the only pediatric physician in the world who exclusively treats Lyme disease, he estimated that 50% of his patients who have been diagnosed with an ASD have come back positive for Lyme disease (Personal Interview April 8, 2011).