PANS PANDAS

....it is worth considering Pans Pandas.  If your child is showing signs of Pans Pandas, then Primitive Reflex Integration may help with the symptoms.

PANS and PANDAS are a set of conditions which result in an inflammation of the brain causing a variety of neuro-psychiatric conditions such as OCD, tics and eating restrictions.  These conditions are often misdiagnosed or blamed simply on bad behaviour and poor parenting. 

An abrupt, acute, dramatic onset (usually within 24-48 hours) of obsessive compulsive disorder (OCD)* or severely restricted food intake** along with two or more of the following symptoms which are not better explained by a known neurologic or medical disorder.

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• Anxiety (heightened anxiety, separation anxiety, irrational fears, panic episodes)
• Tics
• Emotional lability and/or Depression
• Irritability, Aggression, and/or Severely Oppositional Behaviours
• Behavioural (Developmental) Regression (increase in temper tantrums, loss of age-appropriate language, clingy behaviour not related to anxiety).
• Sudden Deterioration in School Performance (due to difficulties with memory, concentration, hyperactivity, impulsivity, new deficits of visuospatial skills)
• Motor or Sensory Abnormalities (dysgraphia, clumsiness, tics, new sensory sensitivities to light, noise, smell, taste or texture).
• Insomnia and/or Sleep disturbances
• Enuresis and/or Urinary frequency​
• Whilst not part of the diagnostic criteria, in approximately 25% of cases there have been reports of Psychosis and/or Hallucinations

PANDAS is a subset of PANS.  Similarly, it is a neuropsychiatric condition which is triggered by a misdirected immune response to a Streptococcal infection which results in an inflammation of a child's brain.

Usually starting with an acute onset of obsessive compulsive disorder and/or tics, particularly multiple, complex or unusual tics.  PANDAS symptoms can then appear to wax and wane with the child experiencing flares periodically, following illness or periods of stress.  The child is usually between the ages of 3 and puberty when first symptoms occur and usually appear following a streptococcal infection such as Sinusitus, Ear infections or Scarlet Fever.  In some cases children can carry the streptococcus bacteria without showing signs of illness.

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Whilst it is not necessary for diagnosis, in addition to OCD* and/or tics, children can also experience a range of symptoms from the following list:

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• Enuresis and/or Urinary frequency
• Insomnia and/or Sleep disturbances
• Food restrictions**
• Anxiety (heightened anxiety, separation anxiety, irrational fears, panic episodes)
• Emotional lability and/or Depression
• Irritability, Aggression, and/or Severely Oppositional Behaviours
• Behavioural (Developmental) Regression (increase in temper tantrums, loss of age-appropriate language, clingy behaviour not related to anxiety).
• Sudden Deterioration in School Performance (due to difficulties with memory, concentration, hyperactivity, impulsivity, new deficits of visuospatial skills)
• Motor or Sensory Abnormalities (dysgraphia, clumsiness, tics, new sensory sensitivities to light, noise, smell, taste or texture).

Anxiety and anger are probably the most talked about emotions when it comes to emotional regulation and they can be so very difficult to manage, particularly for children.

When we are triggered by something in our environment that our bodies perceive to be dangerous or a threat to us, we produce hormones which are capable of changing our physiological state into fight or flight.  This is so that we can fight the threat or run away from the threat, but problems arise when our our fight/flight response is activated when there is no real danger to us.  And the more we are in fight or flight, the quicker we are to be triggered, so the triggers can become less and less obvious to others.

The fight part of fight or flight is where the anger and frustration shows, whereas flight is more about anxiety.  It is important to try to remember is that the fight or flight response is completely outside of our control - it happens instantaneously and it is far away from our consciousness.  So, it is important to try to remain as calm as possible when your child has been triggered, and any removal of things that are important to them will only fuel the fire.  

Sound is very much capable of triggering us into fight or flight, but there can be many other triggers and they can be different for everyone.  What's particularly difficult is the person may not realise something is triggering them, and all of a sudden they find themselves becoming dysregulated* and losing control.  *Dysregulation is the poor ability to manage emotional responses or to keep them within an acceptable range of typical emotional reactions.

If dysregulation without an obvious trigger appears to be happening in your home, keep a diary of the dysregulation and what was going on in the environment before the dysregulation.  Triggers are different for everyone - for one person it might be a constant background noise, for another it might be a sudden loud noise, and for another it might be something that is not even sound related.  You then may be able to identify a pattern and identify the trigger which then can hopefully can be avoided.

Fight or flight can also lead to OCD behaviours, because we are trying to control our world in order to keep us safe.  

Some children can find themselves going into a freeze state, which is where we feel depressed and isolated and we are unable get on with daily life.

There are many therapies that can help such as CBT or NLP, however to my mind how can these work if the physiological response has not been addressed?  

This is where Primitive Reflex Integration comes in....if we have a retained Fear Paralysis reflex we could be anxious, have low self-esteem, be insecure and/or shy along with being oversensitive to smells (particularly coffee and perfume).  A retained Fear Paralysis often goes hand in hand with a retained Moro reflex which can lead us to be oversensitive to sound, light, taste and touch, have emotional outbursts, more likely to get into conflicts and have problems playing with other children.  With these reflexes retained we are constantly on the look out for danger and can be hypervigilant and can easily be triggered into fight or flight.

Sound is also so very important when it comes to our physiological state: if we are sensitive to sound - and that can be a sudden loud sound, a constant background sound, or problems with hearing because of background noise - then this can be enough to trigger us into fight or flight.  This is where the Safe & Sound Protocol comes in....it trains the muscles of the middle ear so that we are no longer oversensitive to sound, which calms our physiological state and helps us to become more open to social engagement (because we feel safe).

These two therapies are key in helping children (and adults) with problems with emotional regulation.  If possible, investigate Primitive Reflex Integration and also the Safe & Sound Protocol for your child to help make life easier for them (and you!) whilst waiting for CAHMS.