Increasing Numbers of Parents of Autistic Children are Concerned About P.A.N.D.A.S/P.A.N.S; but What is it?

Brook and his Autistic Son

Autism spectrum disorders (ASD) are part of a broad spectrum of neurodevelopmental disorders known as Pervasive Developmental Disorders, with Classic Autism being the hallmark of the conditions. These occur in childhood and carry on through adulthood. ASD’s are widely characterized by a range of impairments in social interaction, verbal and nonverbal communication and the presence of restricted and repetitive stereotyped behaviors.

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As of now, the etiology of ASD is largely unknown; however, genetic, environmental, immunological, and neurological factors are believed to play a major role in the development of ASD. Per an article published by Paul Ashwood, Sharifia Wills, and Judy Van de Water an increasing serge of research has recently been focused on the connections between the immune system and the nervous system and its possible role in the development of ASD. This is where a condition called P.A.N.D.A.S or P.A.N.S comes in.

What is P.A.N.D.A.S though?

P.A.N.D.A.S. wasn’t recognized as a syndrome until 1998. This is when researchers at the National Institute of Mental Health, Neuroscience Division, began to recognize and name this previously unrecognized psychiatric syndrome. It is also known as: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep. Then in 2010, experts broadened the term to include other pathogens that can cause psychiatric flares in young children, and P.A.N.S. was named. This is also known as: Pediatric Acute –Onset Neuropsychiatric Syndrome.

P.A.N.S and P.A.N.D.A.S are “clinical diagnoses given to children who have a dramatic – almost overnight – onset of neuropsychiatric symptoms including Obsessive Compulsive Disorder (OCD) and/or eating disorder.” Per Stanford Children’s Health, “children with P.A.N.S, or P.A.N.D.A.S, may become moody, irritable and anxious and have difficulty with schoolwork.” The changes that take place in the child are much like those of a child diagnosed with Autism.

What to look for

It is reported that the change in the child will be an “unmistakable and dramatic.” Often it is an overnight change in personality that sometimes continues to escalate over weeks. Parents find that their children are often desolate. Many of these children are no longer able to handle school. Though some can still go to school, over time they will “lose ground socially, psychologically and academically.”

P.A.N.S is described as the acute, dramatic regression of a child from toddler age to youth; where Autism is more often described as an acute, dramatic regressive change in a child from infancy to childhood that carries on to adulthood. There are many parallels though. Both Autism and P.A.N.D.A.S having Anxiety, Perseveration, and OCD like symptoms. They both often have low Vitamin D levels and TICS as well.

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What Causes it?

It is important to note that the exact cause of these syndromes, as with Autism, is unknown in most cases. It is thought to be “triggered by infections, metabolic disturbances, and other inflammatory reactions.” Children with P.A.N.D.A.S or P.A.N.S have an “acute onset – within 2 to 3 days – of neuropsychiatric symptoms, specifically OCD and/or tics (involuntary, purposeless movements).” However, P.A.N.D.A.S patients test positive for a known trigger, such as “strep throat, peri-anal strep or scarlet fever.” Like P.A.N.S patients, P.A.N.D.A.S patients also suffer from “uncontrollable emotions, irritability, anxiety and poor academic performance and deterioration in handwriting skills.” To date, P.A.N.D.A.S is the only known subset of P.A.N.S, but it is reported that we may discover more in the future.

Researchers now believe children who develop P.A.N.S or P.A.N.D.A.S have a genetic predisposition for these syndromes. Much like with Autism, they believe that these are triggered by an “environmental stressors.” With P.A.N.D.A.S. this is often an infection though; but with P.A.N.S, that trigger is unknown. P.A.N.D.A.S is thought to be “triggered by a Streptococcal infection.” What’s interesting though is that blood tests that were conducted on children with P.A.N.S sometimes show signs of inflammation. More research needs to be done in this area.

It is reported that the average age of onset is 4-12 years of age. Whereas, most parents believe their child was born with Autism, and they certainly show signs before the age of 4. It is estimated that 1 in 200 children have this P.A.N.D.A.S, or P.A.N.S. New research being published indicates that P.A.N.S involves a “misdirected autoimmune process that affects the protective blood brain barrier.” In other words, the ‘“switching station” of the brain, the basal ganglia, is affected causing dysregulation in multiple areas of the brain.’ Much like research is leaning towards Autism being caused by differences in the brains of those who have it.

It is important to note that “children without special needs often get this P.A.N.D.A.S or P.A.N.S, but it is known that children with autism suffer more acutely for reasons that are not clearly understood.” The symptoms of P.A.N.S will “wax and wane over weeks or years.” Parents will tell you that exacerbation tends to worsen over time if no treatment is received. What is the treatment for P.A.N.D.A.S or P.A.N.S though?

Treatment Options

The standard course of treatment for P.A.N.S or P.A.N.D.A.S is antibiotics or antivirals. These will cause an “immediate improvement if the child’s illness is caught early.” It is noted that if the symptoms return after the initial course, then a doctor should administer a longer course of antibiotics. In severe cases, doctors may consider “a short course of anti-inflammatories, intravenous immunoglobulins, plasmapheresis together with low dose SSRI’s.”

Who should I consult if I suspect my child has P.A.N.D.A.S or P.A.N.S?

Per Special Needs Parenting, talk to your trusted pediatrician first. Because this is a relatively new illness, a consortium of physicians and researchers have published a new P.A.N.D.A.S Physicians Network website where doctors can register and learn more about treatment options: www.PANDASppn.org. For a list of current doctors treating the illness, parents can go to www.PANDASnetwork.org

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