After a bout with a sore throat, nine-year old Jason started to cling to his parents and obsess over noises outside his bedroom window. He was sure that there were robbers outside that would break through and harm him and his family.  Jason said he knew his fears weren’t “real,” but still refused to sleep in his own room unless his parents helped him perform an elaborate ritual – checking under the bed, in the closet and other places to make sure he was safe.  The symptoms started suddenly and then subsided gradually over the ensuing weeks.  Jason seemed to be over the problem, but he developed the same symptoms again several months later, following a bout of the flu.  

Eight-year-old Jessica thought monsters would emerge from the bathroom pipes to take her away from her parents. She resisted taking baths and complained about going to school. Abruptly, she began to twirl and pull at her hair, and display facial tics, so much so that her teachers recommended a psychologist. These behaviors emerged suddenly after a course of strep throat.  

Given these symptoms, many parents would consider counseling for their children. Such obsessions and/or compulsions are observed in about 1% of children of elementary school age and often bring kids into the counselor’s office.  However, in some cases, physicians determine that the symptoms stem from an unlikely source – the aftermath of an untreated strep throat infection.  Doctors are tipped off by how suddenly the behaviors came about, and by how closely they show up in connection with a strep infection. These children may be suffering from a little-known disorder called PANDAS or Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococci.

Dr. Susan Swedo is the National Institute of Mental Health physician and researcher who is credited with the discovery of PANDAS. She says, “These children explode with symptoms before they come into the physician’s office. Typically, the OCD symptoms and movement disorder symptoms don’t come by themselves.” In addition to obsessions, compulsions and tics, children affected by this autoimmune disorder also display attachment fears, deficits of attention and a host of other behavioral symptoms, including irritability and excessive mood swings.

Dr. Swedo, who is also Chief of the Pediatrics and Developmental Neuropsychiatry Branch noted, “We get reports of children who had no problems separating from parents who now need to follow them everywhere they go. For example, one 11-year-old boy begged to sleep with his parents because he feared something might happen to him.” 

What is PANDAS?

The course of PANDAS is often confusing since there is little warning or predictability to the behaviors. No one knows the prevalence of PANDAS but for families affected by it, the disorder can become all consuming. What separates PANDAS from non-strep related psychiatric symptoms is the sudden and abrupt emergence of the symptoms. Without warning or prior history of psychiatric illness, children become fearful, obsessed with danger, develop compulsions or other movement disorders. A typical pattern is for a pre-pubertal child to experience strep throat and then within several days of the occurrence of the bacterial illness, the child changes dramatically. Normally happy, sunny children often develop worries, obsessions and/or extreme mood swings. They may refuse to leave the room where a parent is. Children who previously had no problems going to bed will throw tantrums to get a parent to stay in the room or will repeatedly crawl into bed with parents.

The behavioral symptoms usually persist for several days to weeks. The tics or OCD then seem to go away, and the children often enjoy a few weeks or several months without problems. However, for reasons described below, these children remain vulnerable to relapses.  

How Does Strep Lead to Psychiatric Symptoms?