Are frequent ear infections an early risk factor for later ADHD?

In a word, yes. Of course, we need decades more of studies to prove it with absolute certainty. Nonetheless, the connections are logical. ADHD is not so much a disease as a cluster of nonspecific symptoms lacking clear causation. The National Institute of Mental Health describes ADHD as “one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behaviour, and hyperactivity (over-activity).

The general nature of the condition does beg the question: What would make a child distracted? One likely suspect is poor auditory processing development. Studies following children with a history of frequent ear infections found they tended to be more distracted all the way through high school than children who didn’t have early ear troubles. Today distracted adolescents are apt to be diagnosed with ADHD, raising disturbing questions about the relationship of early ear infections to later attention issues.
People with a well-developed auditory processing system can prioritize information coming in through their ears. For example, they can decide to listen to the teacher giving out the homework assignment and not pay attention to Nicky tapping his pencil. When the processing is poor, all of that information has the same priority, so it sticks randomly. A child may not hear the homework assignment because he is distracted by his friend who is whacking his pencil against the desk. 
Auditory processing has a huge effect on executive functioning. If the science teacher says, “take out a piece of lined paper, fold it lengthwise, and put your name on the top right-hand corner,” you can do that after hearing it once. The child whose auditory development went astray takes out the lined paper and “forgets” what else he is supposed to do.
These are the symptoms of ADHD, but when the medical history includes long stretches of ear infections or fluid in the ear, I call it posttraumatic ear infection syndrome (PEIS) because I believe much of the distractibility comes from a poorly functioning auditory system. Not all ADHD is related to PEIS. But the specific distinction, when relevant, helps identify a treatable cause, whereas ADHD only describes the symptoms.
What to do?
  • Try an elimination diet. The following four foods are most associated with ear infections: dairy products, wheat, soy, and eggs. Before eliminating all of these foods from the diet, consider taking dairy products and soy out first. This change alone is often sufficient to reduce or stop infections.


  • Have your child take a probiotic. Found in the refrigerator section of health food stores, probiotics balance the digestive tract and reduce allergic tendencies. Ear infections are treated with antibiotics, which kill both good and bad bacteria, leaving many children short on the good guys. It may take some trial and error to find the right probiotic for your individual situation. Some are too strong and will increase gas and irritability; others are not potent enough. If the probiotic causes side effects and symptoms are not alleviated in a few days, reduce the dose, change brands, or consult with a health care professional familiar with using probiotics therapeutically.


  • Have your child’s auditory processing skills evaluated. If your distracted child has a history of ear infections, her auditory processing abilities may have been affected. Auditory processing abilities can be determined by educational assessment. Once the problem areas have been identified, a plan can be made to address them.
Ear infections and their nasty remnant, PEIS, are very common and mostly preventable. An ounce of prevention is worth years of distraction.


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