Unit 7: PANDAS/Mental Health Recovery Flashcards
PANDAS
The rapid onset of OCD or tic symptoms in a previously healthy child, temporally associated with a recent Group A streptococcus (strep) infection
Specific diagnostic criteria for PANDAS
Include the presence of OCD and/or a tic disorder; pre-pubertal onset of symptoms; abrupt onset or exacerbation of symptoms with a relapsing and remitting course; associated neurological abnormalities; and a correlation between the development of symptoms with Group A strep, with symptoms often occurring within 2 weeks of a strep infection.
–Associated symptoms may include emotional lability; separation anxiety; enuresis (bedwetting); and academic difficulties, including deterioration in handwriting, poor attention, attention deficit hyperactivity disorder–like impulsivity, decreased visual–spatial abilities, and math and reading deficits in school-age children, Fatigue has also been reporte
When was the existence of PANDAS was first advanced by scientists?
At the National Institutes of Mental Health in the late 1990s
Classification of PANDAS
Although PANDAS is currently classified as a rare disease, some experts suggest that PANDAS occurs more frequently than people realize, with some proposing that as many as 25% of children with OCD have PANDAS
- Current figures estimate a prevalence rate of 1 case for every 200 individuals
- Diagnosis has historically been controversial, despite research evidence confirming its existence which may be part of the reason that there is often a lag of 2 to 3 years between emergence of symptoms and diagnosis
Occupational Therapy and PANDA
Among school professionals, OT’s have the most knowledge of medical conditions, and they therefore can be leaders in understanding and sharing information about children with PANDAS.
- Their ability to identify daily occupations in which children and families engage both inside and outside of school, and to address the body functions and performance skills required for engagement in those occupations, also makes OT’s well suited to address issues associated with PANDAS
- They can help educational and health professionals recognize and understand signs of PANDAS to make appropriate referrals to physicians and to develop appropriate interventions to address occupational performance difficulties, especially during exacerbation
Identification and Treatment of PANDAS
- When identified and treated promptly, PANDAS often goes into remission.
- Sometimes, in more complex cases, symptoms take years to fully resolve, or may even worsen with subsequent stress to the immune system in the form of repeated infections or inflammation that can lead to Pediatric Autoimmune Neuropsychiatric Disorder (PANS), which is characterized by a clinical presentation comparable to that of PANDAS
- After exacerbation, children with PANDAS usually show a pattern of a gradual return to function, but a few may not return completely to baseline and are left with continued impairment after exacerbation
Children with PANDAS usually gradually return to function but not to baseline and are left with continues impairment after exacerbation in these cases…
Practitioners also may notice new or recently intensified symptoms of OCD; tics; or unusual movements, rage, mood swings, or anxiety
-They may also notice sudden or unusual changes in student academic functioning.
Mistaken Diagnosis of PANDAS Symptoms
Just as symptoms of PANDAS/PANS may be mistakenly attributed to behavioral disorders, sensory symptoms arising from the condition might be wrongly attributed to sensory processing disorder, which would entail a different type of intervention and prevent the child from receiving appropriate services quickly. For example, a school professional reported Ethan’s tics as sensory-seeking behavior, which resulted in a program that had no effect on reducing them and could have contributed to a delay in receiving needed intervention.
Period of Exacerbation (PANDAS)
Accommodations and adaptations should be the focus of occupational therapy interventions during this period with occupational therapy practitioners and other professionals, such as speech-language pathologists, special educators, school psychologists, social workers, and nurses, sharing a common understanding of the many ways that motor and vocal tics can present, to avoid confusing these with voluntary behaviors
-ollaboration with the family is also essential in designing and delivering successful services.
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PANDAS School-Based Practice
When participating in an individualized education program (IEP) meeting for a child with PANDAS or PANS, remember that these are medical conditions.
-Therefore, the other health impairments category is likely the most appropriate way to qualify a student for needed special education and related services
Determining Eligibility for PANDAS in School-Based Practice
- The course of symptoms for children with PANDAS/PANS can be challenging because a student’s present level of functioning may not be related to future performance.
- Teams need to carefully examine recent changes and potential for future symptom exacerbations, guided by input from health care providers as appropriate in planning for accommodations and services
- Teams must recognize that the child’s symptoms may change dramatically in the course of the school year, either for the better—with a medication change, for example—or for worse, with an exacerbation secondary to another infection.
- Service delivery must be flexible and should include plans to respond rapidly to changes in student behaviors and needs
Additional Intervention for Children with PANDAS/PANS
- Stress-relieving activities, use of routines to reduce anxiety, and explicitly teaching problem-solving and conflict-management strategies.
- Academic supports, such as extended time for tasks, graphic and visual organizers, modifications for academic and math difficulties, smartpens, and word processors, have also been recommended.
- Other approaches include frequent breaks and positive behavior supports, and interventions for issues such as fatigue
- OT’s can also work with children and families to develop positive mental health and coping strategies
Childrens Response to PANDAS Treatment
Children with PANDAS/PANS often do respond positively to treatment, but the process of identification and intervention may be difficult for them, their families, and even the professionals who work with them, especially in an educational setting.
Occupational therapy practitioners must carefully observe children demonstrating what symptoms?
- Sudden onset of sensory sensitivities, OCD, tics, and related symptoms, and they must be responsive to the changing needs of children.
- Communication with families and other professionals is crucial to successful intervention.
- OT’s, with their holistic backgrounds, have much to contribute to developing effective interventions for children with PANDAS and PANS.
According to the Substance Abuse and Mental Health Administration (SAMHSA), recovery is defined as…
“A process of change through which indi- viduals improve their health and wellness, live a self-directed life, and strive to reach their full potential”
