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Ferris M, A-086 When to Consider Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) in Ambiguous Obsessive–Compulsive Disorder (OCD) Presentation, Archives of Clinical Neuropsychology, Volume 35, Issue 6, September 2020, Page 879, https://doi.org/10.1093/arclin/acaa068.086
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Abstract
Recent literature has illustrated a need for a neuropsychological “endophenotype” in children with OCD. Further, the diagnostic issue of PANDAS appears to be one of the most controversial in the OCD literature. The following case illustrates the lack of diagnostic clarity in a comorbid presentation with ambiguous etiology.
A 9-year-old male presented for neuropsychological testing due to difficulty controlling his anger, becoming physically aggressive, sleep disturbances, and a recent decline in academic performance. The patients biological parents noted recent instances of PICA and ritualistic behavior. No clear onset was disclosed. The examiners noticed hyperactivity, poor self-control, sensory seeking behaviors, vocal tics, and the inability to emotionally regulate in intake. Family history was negative for learning, social, or emotional disorders. Medical history was positive for numerous bouts of streptococcal pharyngitis. Results (included but not limited to): T.O.V.A (Attention Performance Index = −3.23). WISC-V: Working Memory Index = 72; 3rd percentile. Wisconsin Card Sorting Task: Unable to Complete. DKEFS: Trail Making Test: Condition 4 Number-Letter Switching: Profound Deficit. WISC-V: Visual Spatial Index = 67, 1st percentile. RCFT: Copy = < 1st percentile. CVLT-C: Correct Recognition Hits = 1/15, < 0.1 percentile. Symptoms of OCD are frequently hidden or poorly articulated, especially in younger children. Further, according to the OCD literature, fewer diagnostic issues appear to be as controversial as that of PANDAS. This case illustrates the importance of increasing our diagnostic understanding of PANDAS and the need for diagnostic clarity in co-morbid, severe psychopathology pediatric patients.
