Has your child's behavior suddenly changed in a strange way? Let's learn about (PANDAS/PANS)!

Has your child suddenly started behaving in an unexpected way? Does it seem to you that your previously well-behaved child has "changed overnight" ? Or has your child suddenly developed new fears and strange habits? As a parent, it's only natural for you to be very concerned when you see things like this. Sometimes the cause of these sudden changes can be conditions called PANDAS or PANS. Let's talk about this in a little more detail and simply.

What are these PANDAS and PANS? A sudden big change!

Simply put, PANDAS and PANS are two conditions in which a child suddenly develops symptoms of Obsessive Compulsive Disorder (OCD) . OCD is characterized by persistent thoughts about something (obsessions) and repeated urges to do certain things (compulsions). In PANDAS/PANS, these OCD symptoms come on very quickly and are severe. Not only that, but you may also notice many other sudden changes in your child’s behavior. Some parents say that their child “changed completely overnight.” But there is good news. There are medications and therapies for both PANDAS and PANS. Doctors and mental health professionals can provide you and your family with the guidance and support you need to get through this challenging time.

What are the symptoms of PANDAS and PANS?

A child with PANDAS or PANS may suddenly and very severely experience one or both of the following:

Obsessions

This can cause the child to develop new, very strong fears. Or, they may worry about things like everything having to be neat, clean, and dirty. Disturbing thoughts and images can keep coming to mind. These fears, thoughts, and worries can be so intense that it can be very difficult to comfort the child. Imagine, a child who previously had no problems suddenly begins to be extremely afraid of germs and getting sick. Or, they may worry that everything has to be "just right" and become very anxious about even the smallest thing.

Things you can't stop doing (Compulsions - Rituals)

In this case, the child may be tempted to wash, touch, do, or say certain things over and over again. They may also become unable to stop doing them and become addicted to them. For example, the child may go in and out of a door several times, thinking that they have to do it "right." Or, they may ask their parents repeatedly for reassurance about the same thing, "Is that right? Is that right?" Another example is hand washing. They wash their hands every five minutes, but they still feel like their hands are dirty. In addition to these OCD symptoms, children with PANDAS and PANS may develop other new symptoms. Some of these are:

• Tics, or jerky, jerky movements (such as blinking an eye or shrugging a shoulder).
• Anxiety , depression , or mood swings - feeling happy one moment, then sad the next , or getting angry quickly.
• Behaving aggressively or being "hyper," showing an inability to stay in one place .
• Talking like a little child (baby talk), being clingy to parents, or having a new fear of going to sleep at night .
• Sudden difficulty with handwriting or other fine motor skills . For example, a child who used to write beautifully may suddenly have a messy handwriting.
• New difficulties with remembering, reading, or doing math .
• New onset of bedwetting at night, not sleeping properly.
• A new fear of food and drink, of being stuck; not eating.
• New sensitivity to sounds, touch, clothes, and the outdoors . For example, a previously insignificant label on a piece of clothing may now be a major nuisance to the child.

Imagine, if these symptoms appear not just one or two, but several at once, within a few days, that is what is special about PANDAS/PANS.

What causes PANDAS and PANS?

It's a bit complicated, but here's the simple explanation: Experts believe that PANDAS and PANS are caused by a malfunction in our immune system's response to an infection . Normally, when a germ enters our body, our immune system fights off and destroys it. But in PANDAS/PANS, instead of attacking the germs, the immune system mistakenly attacks a specific part of the brain . This part is called the basal ganglia . This part of the brain helps control our thoughts, feelings, movements, and other behaviors. So, experts think that this "irritation" in this part of the brain is what causes the symptoms mentioned above.

What is the difference between PANDAS and PANS?

The main cause of sudden, severe flare-ups of OCD symptoms and tics is a bacterial infection called Group A Streptococcus (or "strep") . This is the bacteria that causes what we commonly call "strep throat." So, if a child's symptoms are clearly linked to a strep infection, that's a condition called PANDAS.PANDAS stands for Pediatric Acute -onset Neuropsychiatric Disorders Associated with Streptococcus . It is a sudden onset of neuropsychiatric disorders in children associated with streptococcus infection. PANS is a sudden onset of OCD symptoms associated with another infection . This means that it can be caused not only by strep, but also by other infections such as influenza (flu), chickenpox, mycoplasma infections, and Lyme disease . PANS stands for Pediatric Acute -onset Neuropsychiatric Syndrome . It is a sudden onset of neuropsychiatric syndrome in children. Simply put, PANDAS is caused by a strep infection. PANS is caused by a non-strep infection. The symptoms are very similar in both cases.

How do doctors diagnose and treat PANDAS and PANS?

This is very important. Not all children with OCD have PANDAS or PANS. OCD can also be caused by other conditions. To diagnose PANDAS or PANS, your doctor will spend a lot of time talking to you and asking you a lot of questions about your child's symptoms. They will examine your child and may also do some tests to check for infections. For example, they may take a swab to check for strep throat. Treatment starts with treating the infection . This means that if it is a bacterial infection, antibiotics may be given. Cognitive Behavioral Therapy (CBT) is also an important treatment for OCD. This is done by a trained mental health provider . Your child's doctor can refer you to someone who is qualified. CBT for OCD has a special component called Exposure and Response Prevention (ERP) . This treatment helps the child reduce the rituals that they are used to. Simply put, the child is gradually exposed to the feared object in a controlled manner, and is taught not to engage in the compulsions. Therapy can also address other behavioral and mood symptoms that may be part of PANDAS or PANS. For example, if the child has tics, Habit Reversal TherapyTreatments such as: can help. Therapists work closely with parents. They provide coaching to parents on how to help their child's symptoms improve. They also provide guidance on how to manage their child's distressing symptoms until they go away.

Are PANDAS and PANS contagious diseases?

No. PANDAS and PANS are not contagious. A child cannot catch these conditions from another person. Both PANDAS and PANS are relatively rare conditions . However, the underlying infection (such as strep throat) can be contagious. However, PANDAS/PANS is not contagious.

How can I help my child?

If you think your child may have PANDAS or PANS, see your child's doctor as soon as possible. It's best to start therapy as soon as possible. Your doctor can help you find a good mental health therapist. Or, you can use resources like the International OCD Foundation website to find a specialist who is trained to provide cognitive behavioral therapy (CBT) for OCD in children. Here are some things you can do to help your child recover:

• Start working with a therapist as soon as possible. The sooner therapy begins, the better the results.
• Make sure you don't miss any of your child's therapy sessions. Every session is important.
• Ask your therapist about the best ways to comfort and soothe your child, because sometimes comforting them the way we think can actually make their OCD symptoms worse.
• Give your child all the medications your doctor prescribes. It is very important to give the medication correctly and on time.
• If this is caused by an infection, give your child a new toothbrush to make sure all the germs are gone.

Watching a child suffer from symptoms of PANDAS or PANS can be very stressful and challenging for parents. Understandably so. Your care team is there to support and guide you. Never hesitate to seek their help and advice.

Finally, things to remember (Take-Home Message)

• PANDAS and PANS are conditions that cause sudden, severe changes in children's behavior and mood.
• These are mainly affected by things like OCD symptoms and tics .
• The cause is an incorrect immune system response to an infection.This is because a certain part of the brain (Basal Ganglia) is affected.
• If it is associated with a strep infection , it is called PANDAS, and if it is associated with other infections, it is called PANS.
• These are not contagious diseases.
• Early detection, treatment of the infection, and provision of therapeutic treatment (especially CBT for OCD) can help the child recover.
• As parents, you are not alone. Get help from doctors and therapists.

If you have any concerns about your child, please seek medical advice. Early intervention can help your child recover quickly.

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