8 year old OCD/PPANDAS

[pam106]

First, we are scheduled to see a pediatric specialist in a few weeks. I am writing for your opinion-- not for a solution or diagnosis. I have been trying to figure my son out, it seems, since he was born-- he is now almost eight. As a baby he was rigid with needing routine/structure. He did have some social issues along the way and a clear problem with impulse control. These issues, however have resolved for the most part-- or should I say he has improved-- without medication or "official" therapy.  We do have one issue, however that is worsening.

At age 5, fairly actutely he began to touch every object to his nose. He developed a blister because every thing he touched, went to his nose-- not to smell-- just to make contact-- even tiny lego pieces. His pediatrician at the time thought it might just be one of those phases that kids go through. Sure enough-- it went away.

Now at almost 8, and for the last few months he has developed "compulsions." He must touch people or objects a certain number of times; first it was 4 and now it is 12. If he brushes against a wall by accident he will need to go back and touch it again. He also needs to step on all the cracks in the sidewalk-- just a certain way. He says often that he "needs to be even." It is getting worse, he did a deep knee bend the other day, touching his knee a certain number of times. He is aware of them and wants to stop which is why we are now scheduled to see a specialist.

My brother had a facial tic as an adolescent. My sister in law is teased about being OCD (which I think is more of a personality description than a disorder). Other than these things we have no family history.

I have been reading about PANDAS and realize it is very rare. But my son has had strep throat at least 5 times; the first was when he was 5 (the same age that the nose touching started).

In your opinion is PANDAS even a possibility? And if not, what is the long term prognosis for an 8 year old boy with OCD?

[Kevin Kennedy, Ph.D.]

In addition to the psychiatric symptoms (e.g., OCD symptoms), children with PANDAS also display some neurologic symptoms. As I understand the situation with your son, no neurologic symptoms are present. In any case, treatment of any PANDAS-related OCD relapse is treated just like non-PANDAS OCD, with a serotonergic agent.

[pam106]

Thank you very much!

[pam106]

Thank you for responding so promptly. Could you explain rationale for saying "likely not an example of PANDAS?" I am just trying to understand the disorder (s) and have trouble understanding PANDAS versus true OCD. My gut feeling is as you have said, more classic OCD, but I would like to make sure I understand the distinguishing factors. Thank you!

[Kevin Kennedy, Ph.D.]

This is likely not an example of PANDAS. The first example may have been, but it resolved spontaneouslyThe current situation is far more likely to be due to a legitimate OCD. With treatment, the prognoisis is good. But absolutely treatment, consisting of both therapy and medication, will be required if OCD is ultimately diagnosed. The most effective form of therapy for OCD is cognitive-behavioral treatment, and the medication is usually one of the serotonergic medications, such as Prozac (fluoxetine) or Zoloft (sertraline).