Join Me at an All-Day Workshop for Educators & Parents on December 5th

I’ll be conducting an all-day workshop for educators on Monday, December 5, 2011 at the Grappone Conference Center in Concord, New Hampshire. The event is sponsored by the University of New Hampshire Institute on Disability and is geared to regular and special education teachers, school psychologists and social workers, behavior specialists, occupational therapists, administrators, and parents.

Description:

Neurological disorders that emerge in childhood often have significant impact on students’ academic, behavioral, and social-emotional functioning. Participants will learn about the cardinal features of Tourette’s Syndrome, Obsessive-Compulsive Disorder, Attention Deficit Hyperactivity Disorder, Executive Dysfunction, Mood Disorders such as Depression and Bipolar Disorder, and the memory deficits, sensory issues and “storms” that sometimes accompany them. Strategies and assistive technology to accommodate symptom interference in activities such as handwriting, homework, math calculation, and written expression and big projects will be described. Pitfalls in behavioral interventions, and simple social skills and problem-solving interventions will also be identified.

For more information on the workshop and registration information, download the brochure or register online at www.iod.unh.edu.

Hope to see you there!

Obsessing Over Strep Throat in Kids

A site commenter kindly pointed me to an article about some research out of Tel Aviv University that has not yet been published, but it will be of interest to those interested in “PANDAS” or the strep connection to Obsessive-Compulsive Disorder (OCD):

… Prof. Daphna Joel and her team of researchers at Tel Aviv University’s Department of Psychology have now scientifically demonstrated that strep can lead to brain dysfunction and OCD. Dr. Joel says their breakthrough could lead to new drugs for treating OCD, and may in the future prevent the psychiatric disorder altogether.

Conducted by the PhD student Lior Brimberg and in collaboration with Prof. Madelaine W. Cunningham of the University of Oklahoma, the research, recently presented at the 13th Congress of the European Federation of Neurological Societies in Florence, Italy, is expected to be published by the beginning of next year.

[...]

Working with the world’s leading specialist in strep-related heart disease, Prof. Cunningham, the researchers developed a new animal model to show how exposure to strep affects the brain and leads to a number of physical and mental ailments.

In her Tel Aviv University laboratory, Prof. Joel and Brimberg created an animal model using rats exposed to the strep bacteria. Comparing them to a strep-free control group, Prof. Joel measured a distinct difference in behavior in the strep-exposed animals.

First, the strep-exposed rats developed a strep antibody which deposited in their brain, confirming the suspicions of previous researchers. Those exposed also developed balance and coordination difficulties, as well as compulsive behaviors such as increased and repetitive grooming.

More important, they also found that the strep antibody binds itself to dopamine D1 and D2 receptors in the brain. This finding is in harmony with the fact that one of the main drugs for treating Sydenham’s Chorea, a motor disorder associated with strep, targets these same dopamine D2 receptors.

“We were able to show that these antibodies are binding to receptors in the brain and changing the way certain neurotransmitters operate, leading to brain dysfunction and motor and behavioral symptoms,” Prof. Joel says.

Read the article on American Friends Tel Aviv University.

New research calls connection between strep infections and tics and obsessive-compulsive symptoms into question

PANDAS – a possible connection between strep infections and acute exacerbations or dramatic onset of tics or obsessive-compulsive symptoms – has been quite controversial since it first started being investigated in the early 1990′s.  Now a new study by Dr. James Leckman and his colleagues finds no evidence for PANDAS in children who meet established diagnostic criteria for PANDAS.

Here’s the abstract from their study, “Streptococcal Upper Respiratory Tract Infections and Exacerbations of Tic and Obsessive-Compulsive Symptoms: A Prospective Longitudinal Study,”  which is published in the February, 2011 issue of the Journal of the American Academy of Child and Adolescent Psychiatry:

Objective
The objective of this blinded, prospective, longitudinal study was to determine whether new group A β hemolytic streptococcal (GABHS) infections are temporally associated with exacerbations of tic or obsessive-compulsive (OC) symptoms in children who met published criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). A group of children with Tourette syndrome and/or OC disorder without a PANDAS history served as the comparison (non-PANDAS) group.

Method
Consecutive clinical ratings of tic and OC symptom severity were obtained for 31 PANDAS subjects and 53 non-PANDAS subjects. Clinical symptoms and laboratory values (throat cultures and streptococcal antibody titers) were evaluated at regular intervals during a 25-month period. Additional testing occurred at the time of any tic or OC symptom exacerbation. New GABHS infections were established by throat swab cultures and/or recent significant rise in streptococcal antibodies. Laboratory personnel were blinded to case or control status, clinical (exacerbation or not) condition, and clinical evaluators were blinded to the laboratory results.

Results
No group differences were observed in the number of clinical exacerbations or the number of newly diagnosed GABHS infections. On only six occasions of a total of 51 (12%), a newly diagnosed GABHS infection was followed, within 2 months, by an exacerbation of tic and/or OC symptoms. In every instance, this association occurred in the non-PANDAS group.

Conclusions
This study provides no evidence for a temporal association between GABHS infections and tic/OC symptom exacerbations in children who meet the published PANDAS diagnostic criteria.

These findings, although not based on a large sample, will undoubtedly stimulate a lot of discussion among professionals. If 12% of new infections trigger an acute exacerbation of symptoms, how do we explain that? And can we predict which children will experience that problem? If the diagnostic criteria are not supported by the data, are there any diagnostic criteria that would be? And will children who experience the problem once experience it every time they have a strep infection?

I haven’t read the full study yet, but I look forward to reading it.

PANDAS: The girl who couldn’t stop sneezing

One of the most controversial conditions is something abbreviated as PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. PANDAS is not a recognized disorder in terms of it being in the diagnostic manual, and some physicians argue that it really is not a separate disorder at all. But what we do know is that there are a subset of children who, shortly following a common strep infection, have an acute worsening of tics or obsessive-compulsive symptoms. For other kids with no history of tics or obsessive-compulsive symptoms but who have a family history of tics or obsessive-compulsive problems, a strep infection may be followed by the child seeming to erupt in tics and obsessions and compulsions. If nothing else, PANDAS is dramatic.

Consider the case of 12-year old Lauren Johnson, who was interviewed on MSNBC because she couldn’t stop sneezing. For months and months, Lauren sneezed, sometimes up to 12,000 times per day. You can watch the MSNBC segment from November 2008 below. Interestingly to me, Dr. Nancy Snyderman picked up on the fact that the sneeze was not a true sneeze and that it was more likely to be a tic. Sadly, she then blew it (in my opinion) by not making the connection to the preceding head cold. Instead, she suggested that the problem was psychological.

Read more