By Kelley Herring
Do you have a child or grandchild with behavioral and / or learning difficulties?
If so, you are certainly not alone…
According to the CDC and other health organizations, millions of children are diagnosed each year with anxiety disorders, tics, OCD, depression, extreme oppositional defiance and other neuro-psychiatric conditions…. while millions more suffer from disorders related to reading (dyslexia), writing (dysgraphia) and other learning disabilities.
These conditions are becoming increasingly more common in child populations. And if a child you know or love is experiencing any of these conditions, you know how difficult and heartbreaking it can be.
You might believe it is simply due to genetics – an unlucky role of the dice. Or that the cause may be poor nutrition. Or perhaps you’ve accepted a “syndrome” diagnosis, like ADHD, ADD or OCD, that labels the condition… but does not identify a causative biological basis for the diagnosis.
However, new research shows there may be a specific underlying cause for the symptoms experienced by children with learning and behavioral issues. And that cause may be…
PANS & PANDAS: The Missing Piece in Behavioral & Learning Disabilities
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) was first reported by a team at the National Institute of Mental Health in 1998. This disease is associated with a strep infection, specifically Group A Strep (GAS).
Later, researchers broadened the condition to include PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). As opposed to PANDAS, which is associated with a strep infection, PANS can be caused by a variety of infectious agents, including influenza, varicella, and mycoplasma pneumoniae. Lyme disease may also trigger the neuropsychiatric symptoms, including those meeting criteria for PANS.
The onset of these conditions is usually in the range of four to nine years old. It happens when the child’s developing immune system does not properly recognize and respond to a newly-encountered pathogen.
Rather than mounting a proper defense, the offending microbe triggers the body’s own immune system to attack the brain. In other words, it causes a pediatric autoimmune condition, primarily affecting the brain. And it can lead to a wide variety of seemingly unrelated symptoms, including:
Obsessions and compulsions (OCD)
Increased urinary urgency and frequency
Deteriorating school performance
Dyslexia and other learning difficulties
It is an important clue if these symptoms seem to begin out of nowhere. For example, a child who is doing well in school suddenly develops learning difficulties. Or a child with normal behavior suddenly develops tics and separation anxiety. It is especially noteworthy if these symptoms appear following an illness.
Just last year, researchers at Yale made the connection between OCD and PANS/PANDAS by identifying specific antibodies that bind to brain cells called interneurons causing the classic symptoms of OCD.1
Associate professor of psychiatry and a researcher in the Yale Child Study Center, Dr. Christopher Pittinger says:
“It is really OCD plus. These children have OCD, but they can also have severe separation anxiety, subtle motor symptoms, and show frequent need to urinate. Many refuse to eat.”
Common Symptoms of PANS/PANDAS
It’s easy to dismiss a mild case of PANS/PANDAS as a child who is just “going through a phase”. These kids may count items obsessively, establish specific “rules” for themselves, or develop funny movements. Otherwise, however, they seem to be in good health and spirits. These children often fall through the cracks until their disease progresses.
PANDAS has five distinct criteria for diagnosis, including:
Abrupt “overnight” OCD or dramatic, disabling tics
A relapsing-remitting, episodic symptom course
Young age at onset (average of 6–7 years)
Presence of neurologic abnormalities and
Symptom onset following Group A Strep (GAS) infection.
For a child to be diagnosed with PANS, she or he must have the following:
Abrupt, acute, dramatic onset of OCD symptoms or severely restricted food intake
Concurrent presence of additional neuro-psychiatric symptoms with similarly severe and acute onset from at least two of the following categories:
|Anxiety||Rapid, exaggerated changes in mood and/or Depression|
|Irritability, Aggression and/or Severe Oppositional Behaviors||Behavioral (Developmental) Regression|
|Sudden Deterioration in School Performance||Motor or Sensory Abnormalities|
|Sleep Disturbances, Bedwetting or Urinary Frequency|
- Symptoms not explained by a known neurologic or medical disorder
Are Antibiotics the Answer?
Given that this condition is often caused by bacterial infection, it stands to reason that antibiotics can be an effective method of treatment. And while antibiotics do help some children where a specific bacteria – such as Group A Strep – is identified as the causative agent, these drugs often do more harm than good.
In fact, the use of antibiotics is associated with an increased risk of juvenile idiopathic arthritis (JIA) – an autoimmune rheumatic disease involving chronic joint inflammation.2 Daniel Horton, lead researcher of the study states:
“This study adds to a growing literature on the potential harms of antibiotic use in children. While antibiotics are certainly essential to treating some infections, these drugs are also overprescribed for other infections (frequently respiratory) that will usually resolve without treatment”
So, the answer is NOT to indiscriminately continue to prescribe antibiotics, which further contributes to the global issue of antibiotic resistance, and has long-term implications for health. But rather to pinpoint and target the offending microbe.
A number of tests are available to help diagnose PANS/PANDAS, with the Cunningham Panel being “the gold standard”. The Cunningham panel measures the level of circulating antibodies directed against antigens concentrated in the brain, and measures the ability of these and other autoantibodies to increase the activity of an enzyme (CaMKII) that upregulates neurotransmitters in the brain.
In many cases, herbal antibiotics, antifungals, and anti-histamines can be helpful. For more challenging cases, low dose naltrexone (LDN), plasmapheresis and intravenous immunoglobulin therapy (IVIG) can be life-changing for these children. Cognitive behavioral therapy (CBT) and counseling can also help manage the emotional effects of the disease, while they are being treated for the underlying cause.3
Nutrition for PANS/PANDAS
Like all autoimmune diseases, PANS/PANDAS requires a comprehensive approach that also focuses on nutrition, gut healing and microbiome optimization.
Many children with this illness find great relief in removing the worst dietary offenders – including gluten, sugar and soy – which can promote growth of the harmful pathogen and further impair gut integrity.
If a child you love exhibits any of the symptoms mentioned in this article, consider PANS/PANDAS and get help from a knowledgeable physician in the PANDAS Physician’s Network.
You just might change the trajectory of a little one’s life!
Read more of Kelley Herring’s Health & Wellness articles on our Discover Blog.
Ed Note: Need some kitchen inspiration? Grab Kelley’s free guide – Instant Pot Keto Dinners – made exclusively with Paleo-and-Keto ingredients, for quick and delicious meals that taste just as good – of not better – than your restaurant favorites. Get your free guide here.
Jian Xu, Rong-Jian Liu, Shaylyn Fahey, Luciana Frick, James Leckman, Flora Vaccarino, Ronald S. Duman, Kyle Williams, Susan Swedo, Christopher Pittenger. Antibodies From Children With PANDAS Bind Specifically to Striatal Cholinergic Interneurons and Alter Their Activity. American Journal of Psychiatry, 2020; appi.ajp.2020.1 DOI
Horton DB, Scott FI, Haynes K, Putt ME, Rose CD, Lewis JD, Strom BL. Antibiotic Exposure and Juvenile Idiopathic Arthritis: A Case-Control Study. Pediatrics. 2015 Aug;136(2):e333-43. doi: 10.1542/peds.2015-0036. Epub 2015 Jul 20. PMID: 26195533; PMCID: PMC4516942.
PANDAS Physicians Network: https://www.pandasppn.org/other-treatment-options/#5