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Parent and Child Psychological Services PLLC 
941.357.4090 (Office)/ 727.304.3619 (Fax)
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When Mental Health Challenges Come out of Nowhere- PANS/PANDAS Explained By Kate Gibson, Psy.d., ABPP

2/23/2020

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There are children for whom we see signs that they are anxious or unhappy or beginning to suffer emotionally or behaviorally. We try to get help for our children when these struggles become larger or begin to interfere more. Children affected by PANS/PANDAS, however, develop mental health symptoms literally overnight after being sick. These are not kids who were always a little timid then seemed to get more anxious once they started school; Not kids who latched onto routines that eventually evolved into more elaborate rituals that have to be done a precise way. These are kids who were anxiety, OCD and behavior problem free until getting sick one day, and then show full blown anxiety, OCD, or behavior problems that were not present prior to getting sick. Parents are often at a loss to explain what is happening and feel that all of a sudden they have a completely different child. 

Strep is the most common illness that those who have heard of PANS or PANDAS think of, but there are more illnesses besides strep that can trigger these reactions. PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections. This is the condition associated with strep. PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome. PANS can be caused by other forms of infection and metabolic issues. The common thread is that both are autoimmune and cause inflammation in the brain (encephalitis). This means that the antibodies that normally attack illnesses within our body attack our own body instead, and with PANS and PANDAS the area attacked is in the brain (basal ganglia). When the basal ganglia portion of the brain is impacted it affects a child’s thoughts, feelings and behavior.

Treatment for PANS/PANDAS generally involves blood tests (to diagnose the infection), antibiotics or other medicines for fighting infections (sometimes a long course), anti-inflammatory medicine (to reduce the swelling in the affected brain areas), and cognitive-behavioral or behavioral therapy (to address the emotional and behavioral symptoms as they do not tend to resolve with medical treatment alone). People are often understandably skeptical when they are told their child has a condition they have never heard of before. And can also be skeptical of the treatments that are recommended, that often require heavy rounds of medication. If we think about this as an attack on the brain, with our brain being the basis of our behavior, it helps us understand that to effectively treat it we need both medicine and behavioral treatment approaches.

For the medical treatment portion of your child’s care it is best to find a pediatric specialist who has extensive experience treating children with PANS and PANDAS. For the mental health portion many therapists who specialize in treating OCD also have experience working with children with PANS and PANDAS. Even if the child is presenting with symptoms that differ from OCD starting by talking to a therapist with extensive OCD experience can be a good first step if you are having trouble locating someone that treats PANS or PANDAS.

The sudden onset mental health symptoms are treated with cognitive-behavioral or behavioral therapies that target the specific symptoms with which that child is presenting. Behavioral and emotional symptoms triggered by PANS/PANDAS can include but are not limited to (taken from https://iocdf.org/pandas/):
  • Acute sudden onset of OCD
  • Challenges with eating, and at the extreme end, anorexia
  • Sensory issues such as sensitivity to clothes, sound, and light
  • Handwriting noticeably deteriorates
  • Urinary frequency or bedwetting
  • Small motor skills deteriorate – a craft project from yesterday is now impossible to complete (see images below)
  • Tics
  • Inattentive, distractible, unable to focus and has difficulties with memory
  • Overnight onset of anxiety or panic attacks over things that were no big deal a few days ago, such as thunderstorms or bugs
  • Suddenly unable to separate from their caregiver, or to sleep alone
  • Screaming for hours on end
  • Fear of germs and other more traditional-looking OCD symptoms

When the presentation involves Anxiety or OCD a form of CBT called exposure therapy is used to treat it. The form of exposure therapy used to treat OCD is called Exposure and Response Prevention (ERP). For tics and body-focused repetitive behaviors a form of behavioral treatment called Habit Reversal Training (HRT) is used. If problem behaviors are the main presentation behavioral treatments that heavily involve the caregivers such as Parent-Child Interaction Therapy (PCIT) or other forms of Parent Management Training (PMT) can be used.

Despite thorough treatment of symptoms children can have a recurrence of symptoms after getting sick again, which is called a flare (like a flare-up). Children often need another round of medical and sometimes a booster of behavioral treatment when they are having a flare.

You and your child are not alone. There is help out there for these sudden onset mental health struggles. Here are more resources.

Book For Parents:
Childhood Interrupted: The Complete Guide to PANDAS and PANS by Beth Alison Maloney

Web Resources:
PANDAS Network- http://pandasnetwork.org/medical-information/
PANSPANDAS-Hope- http://panspandas-hope.com/ 
International OCD Foundation (IOCDF)-
https://iocdf.org/pandas/

Referrals
for Medical and Behavioral specialists can be found at:
PANDAS Network: http://pandasnetwork.org/us-providers/
PANDAS Physicians Network: https://www.pandasppn.org/practitioners/

Children’s books
that can help parents and professionals talk about PANS and PANDAS with children who are affected by it:
  • In a Pickle Over PANDAS by Melanie S. Weiss, R.N.
  • My Story About PANS/PANDAS by Owen Ross
  • PANS/PANDAS: Strength-Hope-Understanding: A Picture Book for Children, Family, & Educators by Suzanne Gushansky

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Managing Stress: Tips for Teens and Parents By Kirsten Ellingsen, PhD

2/13/2020

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The second semester of school can involve heightened stress for many teenagers. Academic demands and social pressure are two primary causes, but stress can come from a variety of sources.  While some stress can be motivating and provide a higher level of focus and energy to perform a specific task, when it becomes overwhelming, too intense, or impairs functioning it is problematic. Too much stress for too long can be both physically and emotionally harmful.
 
Teenage behaviors and symptoms that might indicate high levels of stress include: increased or unusual irritability, sleep disturbance, over-eating or under-eating, pattern of reacting too intensely to apparent minor problems, increase in nervous habits (e.g., nail biting), headaches, more frequent crying, muscle tension, increased expressed frustration, social withdrawal, difficulty concentrating, and low motivation.  It can trigger anxiety and anger. Teens who have poor coping strategies might also turn to alcohol and drug use or self-harm.

TIPS FOR TEENS
  • Be careful not to overschedule. Cut out activities if necessary
  • Be realistic. Do not aim for perfection. Set small goals and break tasks into smaller, manageable chunks.
  • Get good sleep. Get enough and have a good sleep routine
  • Relax. Learn and Practice relaxation strategies (diaphragmatic breathing, progressive muscle relaxation)
  • Make time for fun. Schedule activities you enjoy. Take a break. Listen to music, talk with a supportive friend, draw, write, create
  • Prioritize Health and treat your body well. Get exercise and eat well
  • Avoid excess caffeine, illegal drugs, alcohol and tobacco.
  • Find the upside. Attitude can influence emotions
  • Solve the little problems. Address small problems. Break tasks into smaller steps so that they are not overwhelming
  • Know what you can control. Focus on what you can control (reactions, actions) and let go of what you cannot (other people’s opinions and expectations)
  • Build positive relationships. Ask for help and support when needed
  • Learn how to be assertive. Practice expressing your needs and setting boundaries in a polite and clear way
  • Decrease negative talk. Use more helpful and neutral thoughts and self-talk statements such as I can handle this.
 
(From TeensHealth, Nemours https://kidshealth.org/en/teens/stress.html and https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Helping-Teenagers-With-Stress-066.aspx)
 
TIPS FOR PARENTS
  • Watch for signs of high stress and help identify sources of stress in your teen
  • Provide practical support
  • Have open communication and listen to concerns from your teenager’s perspective. Be available to talk and provide opportunities to talk.
  • Challenge negative thoughts (gently): negative thinking can increase negative emotions
  • Encourage a healthy lifestyle-exercise, adequate sleep and good nutrition
  • Model healthy and effective stress management
  • Help problem solve how to address stressors (For a handout to help create a stress plan see https://www.healthychildren.org/English/Documents/BR3_My_Personal_Stress_Plan.pdf)
 
Stress is inevitable. Helping your teenager build skills that help reduce and cope with stress will have a lifelong benefit. Maintain a positive relationship with your teen. Observe, communicate, listen, accept, and model healthy coping strategies. Have realistic expectations for yourself and your teenager.  Practice self-care. If you or your child need support or assistance managing stress, please contact our office.
 
*(Researchers at Harvard Center for the Developing Child distinguish between positive, tolerable, and toxic stress. The recommendations here are related to tolerable stress. For more information about toxic stress see
https://developingchild.harvard.edu/guide/a-guide-to-toxic-stress/).

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How to Play with Your Child for Relationship Building and Behavioral Improvements By Tara Motzenbecker, MS, NCSP

2/6/2020

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Play is a child’s first language.  Play provides a context for self-expression, a medium to fulfill wishes, and allows children to work through problems. So when a parent can enter a child’s play world, the parent can truly become part of the child’s world.  Enhancing the parent-child relationship through play can lead to a reduction of behavioral issues, development of coping strategies and an increase in positive feelings or self-worth and confidence, for parent and child. Parents can also gain a greater understanding and acceptance of the child’s world and develop more effective parenting skills. Most importantly, play can help parents recapture the joy of parenting. 

By setting aside 30 minutes each week or 10 minutes each day devoted to special play time, the parent-child relationship can be greatly enhanced.  During this time, the child is the center of the universe and the parent is merely an observer that must be invited in. The child leads and the parent follows.  In this special playtime, there are no reprimands, questions, teaching, judgements, put-downs, requirements or reprimands. The parent follows the child’s lead by showing keen interest and carefully observing the child’s play, without making suggestions or asking questions, and by actively joining in the play when invited by the child. For 30/10 minutes, you (parent) are “dumb” and don’t have the answers; it is up to your child to make decisions and find solutions. If the child determines that the trains are best used upside-down, then that is how the trains will be used. 

During the play parents can verbally describe what the child is doing, verbally reflect what the child is saying and most importantly, reflect the feelings that the child is experiencing through play. 

While special play time is not an opportunity to teach, there may be times that limits need to be set.  Limits help a child feel safe and supported when used properly. Limits should be stated in a way that help foster self-control while also validating the child’s desires. Limits can be set around not breaking/damaging the toys, time and not physically hurting anyone in play. Consistency is key.  

Parents should prepare the play area ahead of time with boundaries and special toys that do not have specific rules such as board games or lego kits. Convey to the child that this is special playtime and they can play with the toys in lots of the ways they’d like. (This allows for freedom while also providing opportunity for limit setting as needed.) Anytime the child asks for permission or information, turn it back to the child by stating “You can decide” or “That can be whatever you want it to be”. 

After a few special play sessions, you will notice an enhancement in your relationship with your child and likely notice improvements in behaviors and self-control.

Tara Motzenbecker, Licensed School Psychologist, is available to speak more in-depth on this topic to groups at day cares, medical offices, schools and parent-groups.  Please call Parent and Child Psychological Services (941) 357-4090 to discuss a free seminar on this topic.

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    Parent and Child Psychological Services is a private practice serving children and families in the Sarasota, Florida area. The practice is owned and operated by Dr. Gibson, a Licensed Psychologist who is Board Certified in Clinical Child and Adolescent Psychology. ​

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Parent and Child Psychological Services PLLC 
info@childtherapysrq.com
941.357.4090 (Office)
727.304.3619 (Fax)                                                                                                                                                               
4071 Bee Ridge Road, Suite 204                                                                                                              
Sarasota, FL 34233                                                                                                                                   
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