PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Assosciated with Streptoccocal Infections) **Similar condition is called PANS, but I will use the term PANDAS throughout By Michelle Wright

What is PANDAS? A sudden appearance of symptoms that are associated with a Group A streptococcoal infection (often presents as strep throat) There are 5 main criteria: OCD and/or dramatic tics that seem to appear overnight Symptoms that seem to come and go Young age of onset (usually around ages 6-7) Neurological abnormalities Association with streptococcal infection This is still a relatively new disorder, as it was first identified in 1998 This 6 min video gives you an overview (visual/audio learners!) https://www.youtube.com/watch?v=yIQEMcHoXlM

Other Symptoms Moodiness Irritability Anxiety Separation anxiety ADHD symptoms Difficulties sleeping Bed wetting or frequent urination Changes in muscle movements (ex. Changes in hardwriting or walking) Joint pains

What Causes PANDAS? Strep bacteria stays in the human body for long periods of time It does this by hiding from the immune system as long as possible, by mimicking cells that are found in the child’s heart, brain, skin and joint tissues Eventually the body recognizes the infection and develops antibodies to fight off the infection The body attacks the strep molecules, but also attacks molecules that the strep created to mimic the child’s cells The body then starts to attack the child’s own tissues (the ones that had been mimicked) If the body attacks brain cells, then PANDAS can develop

How common is PANDAS? Only occurs in around 1 in 2000 children Strep throat is a very common childhood illness, and most children recover normally The concern about PANDAS occurs when tics and/or OCD like behaviours occur rapidly and intensely after a strep infection

How is PANDAS treated? The first goal is to treat the strep infection with antibiotics Symptoms often subside or lessen if the infection is no longer present in the body OCD symptoms can be treated with Behaviour Cognitive Therapy (BCT) Anxiety and depression can be treated with SSRI medication (Selective Serotonin Reuptake Inhibitors) - commonly referred to as anti- depressants

Impact at School In addition to the symptoms previously mentioned, children with PANDAS may experience these difficulties at school: Exposure to another strep infection (can worsen symptoms) Math difficulties Slow processing Fatigue Handwriting difficulties Absences from school

Info for Teachers The student has an illness, and is not just behaving poorly The student may require constant supervision The student may have days when they have trouble functioning in class Symptoms flare up and worsen at times During a flare up the student may: Be violent Ignore all instructions Be extremely emotional Be unable to focus Have a low tolerance for frustration Have difficulty problem solving

Info for Teachers on Aggression Some students with PANDAS exhibit aggression (especially during a flare up of symptoms) They may bite, kick, hit, act aggressively or threaten others For some students with PANDAS, this is a result of psychotic thinking Punishment doesn’t work to lessen the aggression Distracting the student can work in many cases Minimizing triggers during a flare up (ex. Hunger, sensory overload, change in routine, frustration, pain) can help First and foremost - keep other students safe

How can we help students with PANDAS in the classroom? Provide a space to rest, with few distractions Allow student frequent bathrooms breaks Have a ‘safe person’ that they can go to when feeling anxious (ex. Admin, LST, EA) Support handwriting difficulties More space to write, scribing, SEA equipment, speech to text software Support math difficulties (usually with calculations) Allow calculator, tape times table sheet to desk Support processing difficulties Fewer questions, extra time, oral and written directions

It Takes a Village Many people and resources come together to support a child with PANDAS, including: Parents Family Members Teachers / EAs / School Admin Family Doctor Psychologist Psychiatrist Occupational Therapist Specialized Doctors Parent Support Groups

How can teachers ensure that a child with PANDAS reaches their full potential? Most importantly - recognize that the student has an illness and cannot control their symptoms There are so many possible symptoms associated with PANDAS, so figure out what the struggles are for your student, and work on supporting each concern (ex. Identify the specific OCD challenges that this student faces. Identify ways to support the child with their handwriting difficulties.) Communicate frequently with parents!!! They know their child best! An open line of communication about how things are going at home and school will help both parties effectively support the child. Provide a safe, supportive environment for the student

Discussion Time! If you had a child with PANDAS in your class... What are the first steps that you would take to support the student? What accommodations and/or modifications would you put in place? What questions would you still like answered?

References https://www.nimh.nih.gov/health/publications/pandas/index.shtml http://www.pandasnetwork.org/research-resources/school/ http://www.moleculeralabs.com/pandas-pans-patient-education/