early identification and intervention for ADHD symptoms and emotional/behavior problems in children with a history of enterovirus 71 CNS infection. Increased risk of ADHD following CNS infection is not specific to enterovirus 71, but occurs with a variety of microorganisms. A recent review of etiologic factors, especially environmental causes, found an increased prevalence of ADHD in children born to women with a viral exanthematous rash of measles, varicella, or rubella during pregnancy. Other

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... viral infections invoked include HIV, varicella zoster encephalitis, and influenza. (Millichap JG. Pediatrics 2008;121:e358-e365). A possible relation between ADHD and streptococcal infection, Borrelia burgdorferi and Lyme disease, or otitis media requires confirmation. Clinical manifestations of enterovirus 71 infection are protean and include hand-footand mouth disease, brainstem encephalitis and polio-like paralysis. Isolation of the virus in cell culture is the standard diagnostic method, and stool and throat specimens produce the highest yield (AAP Redbook, 27th ed, 2006). In a previous report of a long-term study of