“PANDAS” is an acronym for “Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.” Although the relationship between infection and movement disorders was noted hundreds of years ago, scientists began studying it in the early 1990’s. The findings have been contentious, with some researchers arguing that PANDAS is not really a unique disorder, while others arguing that it is. PANDAS is not listed in the current or proposed diagnostic manual for mental health disorders.
The term PANDAS is generally used to describe a subgroup of children who have either a tic disorder (such as Tourette’s Syndrome) or Obsessive-Compulsive Disorder and whose tics, obsessions, and/or compulsions typically worsen dramatically following streptococcal infections or children who have no prior history or tics, obsessions, and compulsions but who suddenly “explode” in symptoms following a Group A ß-hemolytic streptococcal infection. It is important to keep in mind that the symptoms of Tourette’s Syndrome and OCD do tend to go through periods of exacerbation (“waxing cycles”) and that most waxing cycles are not due to infection. PANDAS is thought to affect perhaps 10-15% of children with Tourette’s and/or OCD.
What parents refer to as “strep throat” is one form of streptococcal infection. In some cases, parents may be aware that their child had a strep throat in the recent past, but in other cases, the child may have (or have had) a strep infection without it being detected.
While research has focused on bacterial infections, there are clinical reports of viral infections also being associated with acute onset or dramatic exacerbation of OCD or Tourette’s Syndrome. There are also clinical reports that suggest that it may not just be tics and obsessive-compulsive symptoms that are acutely worsened. Some reports also suggest that children or teens who have this PANDAS problem may also experience acute-onset or worsening of separation anxiety and mood problems, and that PANDAS may also be linked to ADHD.
PANDAS is thought to represent a type of auto-immune problem: instead of the body’s antibodies fighting an infection, they attack the healthy cells in the basal ganglia of the brain, causing the acute worsening of symptoms.
There is not much for educators to know other than on a practical level, if the student does have PANDAS, expect that their symptoms will be significantly worse following an infection and that more accommodations may need to be provided.