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Many patients get well only when multiple factors are addressed: Co-infections (often coming from the same tick as the Lyme spirochete) most commonly Babesia , Anaplasma , Ehrlichia , and Bartonella Immune dysfunction Inflammation Environmental toxins and detoxification problems Vitamin, mineral, and/or nutritional deficiencies Mitochondrial dysfunction Hormonal abnormalities Neurodegenerative disorders, possibly precipitated by infection Neuropsychiatric disorders in the aftermath of infection Sleep disorders Autoimmune disease and postural orthostatic tachycardia syndrome (POTS), a condition that affects the autonomic nervous system and causes such symptoms as low blood pressure, fatigue, palpitations, and dizziness Allergies Gastrointestinal disorders Liver dysfunction Pain disorders Deconditioning and lack of exercise

Participants were evaluated using the CGI-I, ABC, Behaviour Assessment Scale for Children (BASC) and the Children Development Inventory (CDI)