Q. My two 1/2 year old nephew has just been diagnosed with ADD. When he was just a couple of days old he contracted meningitis. The doctors/specialists have said that he has ADD because of the meningitis. Is this possible? How does that work?

A. It's certainly possible that your nephew has Attention Deficit Hyperactivity Disorder (ADHD), though I have two concerns about that diagnosis. First, as the DSM-IV (Diagnostic and Statistical Manual) notes, "..it is especially difficult to establish this diagnosis in children younger than age 4 or 5 years, because their characteristic behavior is much more variable than that of older children and may include features that are similar to symptoms of ADHD."

Second, the diagnosis of ADHD is not made when the child's symptoms are due to another mental disorder, or to some substance or medication. Although strictly speaking, the diagnosis might be valid if the symptoms of hyperactivity/inattention follow meningitis, I have doubts as to whether this is true ADHD. I suspect that problems with hyperactivity/inattention that follow close on the heels of a brain infection (within a year or two) are of a different nature than those appearing at age 5 or 6 in a child with no history of brain infection. (Technically, meningitis is an inflammation of the membranes covering the brain, the meninges. The brain itself is affected in cases of meningoencephalitis).

This may seem to be just a matter of semantics, but I don't think we yet know the treatment implications--for example, is ADHD due to meningitis responsive to the same medications as regular ADHD? I doubt there is enough controlled evidence to answer that question. Nevertheless, it is plausible that your nephew developed problems with attention/hyperactivity as a complication of meningitis, depending on the type of infection (e.g., viral vs. bacterial). One study of complications following bacterial meningitis (DG Thomas, Med J Aust 1992 Oct 19;157(8):519-20) found sensorineural hearing loss in six of 71 children (8.5%); as well as learning difficulties (12.7%), motor problems (7%), speech delay (7%), hyperactivity (4.2%), blindness (2.8%), obstructive hydrocephalus (2.8%) and recurrent seizures (2.8%).

I don't know the precise mechanism by which these complications occur--I'm not sure anybody does--but presumably, the infection damages those brain structures normally involved in maintaining an appropriate level of attention and motor activity. I think there are two pressing questions regarding your nephew: 1. Would a second opinion from a pediatric neurologist or neuropsychiatrist be helpful? (I would consider getting one); and 2. What are the proposed treatments for this condition? Here, too, a second opinion may be useful.

January 2003

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