Can you spot the difference between PANS/PANDAS and Autism?

by Robyn Cogger
5 minutes
Can you spot the difference between PANS/PANDAS and Autism?

Recently in a parent’s conversation someone asked, trying to understand autism, what does autistic behaviour look like.   Here were some of the behaviours that parents noted:

  • Extreme behaviour of hitting, damage to rooms, slamming doors, ripping drawers from cabinets, pulling curtains down, throwing books, smashing and breaking toys. Repetitive behaviours like flicking light switches on and off.  All done with no regard for safety;
  • Behavioural issues like throwing items out windows - to the point where windows need to be locked;
  • Not wanting to be alone - to the point the child will sit next to parent in the bathroom because of separation anxiety;
  • Compulsive behaviours like slamming things, licking things, touching and tapping everything…
  • Obsessive collecting or hoarding of a particular interest or object;
  • Extreme meltdowns over the smallest things and set off  by the smallest upsets.
  • Episodes of rage, only to calm down a few hours later, oblivious to the chaos caused and wondering why everyone is upset an on edge;

And then someone makes an unusual comment. Yep sounds like our son.. he has PANS/PANDAS though…

Autism is a life long condition defined by 2 criteria:

  1. social communication disability and:
  2. restricted repetitive behaviours, interests and routines (stereotypy).

According to the raising children’s network, around 75% of autistic children have at least one other co-morbidity. That is a disability or psychiatric condition additional to it. The most common are ADHD, intellectual disability, bipolar disorder, epilepsy and tics. OCD is considered prevalent in autistic populations, but currently there is no tool to assess it in autistic children, due to overlapping symptoms of stereotypy.

PANS & PANDAS is a neuro-immune mediated psychiatric condition that, currently in Australia, is not formally recognised by the DSM-5 (diagnostic manual of mental disorders). The condition is, however in the ICD (international classification of diseases).  It is also described on to the American NIHM (National Institute for Mental Health) website. It’s not life long. But it is degenerative if not detected early. It’s treatable. Symptoms can be eradicated. And its criteria has a much bigger scope  than autism. According to NIHM, a PANS child only may have 2 criteria in the  list, or all of them:

  • Obsessive compulsive thinking and behaviour (OCD); 
  • Tics and involuntary movements;
  • Sleeping disorders showing REM motor disinhibition;
  • Episodic regression of behaviour;
  • Separation anxiety;
  • Emotional lability including extreme fits of rage;
  • Episodic ADHD behaviour;
  • Restricted food intake;
  • Episodic regression of cognitive ability (including academic ability);
  • Increased urination and episodes of bed wetting;
  • Hallucinations;
  • Short term memory lapses;
  • EEG test showing spikes or diffuse slow results consistent with autoimmune encephalitis.

So what is the difference between autism with co-morbidity and PANS/PANDAS? Spotting it in autistic child with co-morbidities is difficult, but their best trajectory in life depends on it.

Diagnostic overshadowing is a real and well-documented occurrence, where new and arising psychiatric and neurological symptoms are thrown under the autism diagnosis. An onset of a blinking tic, face grimacing, compulsive anxious behaviours, a return to nappies, extreme outbursts of rage and anxiety may actually be a developing new condition of PANS/PANDAS alongside autism.

If any of this information sparks a resonance with your situation, and you'd like to discuss with me, please make a booking and include potential PANS/PANDAS when completing your initial patient health and wellness form. 

https://raisingchildren.net.au/autism/learning-about-autism/about-autism/conditions-that-occur-with-asd

https://journals.sagepub.com/doi/abs/10.1177/0145445513509475?journalCode=bmoa&fbclid=IwAR1FFs9-fzU5BrN_kgqp2hxv9p97gEPMzoucpbfIQ9k_GpmRDduFkli8cZY

https://www.nimh.nih.gov/health/publications/pandas/index.shtml

https://www.sepans.org/diagnostic-criteria

https://www.mdpi.com/2077-0383/7/4/71/htm

Photo of Robyn Cogger from Arising Health


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