Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep
This article is adapted with permission from the Children’s and Adult Center for OCD and Anxiety. Founded and directed by Tamar Chansky, PhD, a leading expert on anxiety and OCD, the Center publishes worrywisekids.org. Dr. Chanksy is shown in the photo, left.
For approximately 25% of children who have OCD, the sudden onset of the OCD is exacerbated or trigged by strep throat, in which the body’s own immune cells attack a part of the brain, the basal ganglia, rather than the strep. This does not occur in all children, but only those who have a genetic predisposition to OCD or tics. The difficulty in diagnosing may occur because the OCD can develop shortly after the strep infection but many times months after, and the strep infection could have been so minor that it was not treated. It is most common in children who have not yet reached puberty, though it is not limited to this age group.
The biggest difference between regular OCD and PANDAS OCD is the sudden onset. OCD usually develops slowly over weeks, months or even years; however, PANDAS OCD seems to come out of the blue with parents saying one day their child woke up a different kid. There are also other symptoms that help differentiate the 2 types of OCD. PANDAS OCD is also characterized by:
- Choreiform movements: involuntary or irregular writhing movements of the legs, arm or face
- Presence of tics and/or hyperactivity
- Irritability, temper tantrums, or mood lability
- Nighttime difficulties
- Severe nightmares and new bedtime rituals or fears
- Separation anxiety
- Age regression: going back to younger developmental stage
- New handwriting problems, loss of math skills, sensory sensitivities
What to Do if You Suspect Your Child Has PANDAS
- Contact your pediatrician. Advocate for your child by being clear about what you want your doctor to do. In some cases, you may have to find a sympathetic doctor who is willing to learn about PANDAS. The PANDAS Clinic at NIMH may be willing to consult with doctors.
- Have your pediatrician do a throat culture of group A B-hemolytic strep. Ask that the specimen be cultured, not just the rapid test.
- Your doctor may also do a blood test to assess elevated streptococcal antibodies (Anti-DNAse B and Antistreptolysin titers (ASO)).
- You and/or your doctor can get information and treatment guidelines from the National Institute of Mental Health (www.nih.gov); type in PANDAS to access the appropriate link.
- Contact the OC Foundation to help locate an expert in OCD in your area.
- Have your child retested if there is a resurgence in OCD symptoms.
The first line of treatment for PANDAS is antibiotics to cure the strep infection. Sometimes repeated antibiotics may be necessary. Occasionally more invasive procedures are needed to remove the antibodies from the blood stream, these are described in detail at the NIMH PANDAS page. Though a child’s OCD symptoms will reduce dramatically within a few weeks of completing antibiotic treatment, the residual symptoms are typically amenable to exposure and ritual prevention techniques that are used for non-PANDAS OCD.