January 16, 2024

Help! OCD, autism, ADD…Is there a causal link?

Is your child struggling with OCD (obsessive compulsive disorder), ADD (attention deficit disorder), autism and/or frequent infections? Did you know infections and these symptoms can be related? Did you know by treating the underlying infections and toxicities you could get your kid back? Keep reading to learn more about two conditions known as PANS/PANDAS.

Is your child struggling with OCD (obsessive compulsive disorder), ADD (attention deficit disorder), autism and/or frequent infections? Did you know infections and these conditons can be related? Did you know by treating the underlying infections and toxicities you could get your kid back?

OCD, ADD, and autism have some related causes: INFECTIONS and TOXINS. When strep or other infection or toxin enters the body it triggers an immune response leading to brain inflammation and an attack on brain cells through microglia (brain immune cell) activation…

What does this look like?

At first, the child may experience some fears which he or she calms downs with subtle rituals that may actually go unnoticed or applauded by the caregivers such as hand washing or brushing teeth. However, these fears may progress and become more intense and overwhelming leading to an exacerbation of the rituals along with disturbances in sleep, decline in school performance, social decline, and physical symptoms like rashes, constipation, diarrhea, anger, depression, and food intolerance or sensitivity (keep reading for a bigger list of symptoms). There is usually a trigger for these behaviors to intensify and this is where the diagnosis of PANS/PANDAS comes in.

PANDAS = pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection

PANS = pediatric acute-onset neuropsychiatric syndrome

What causes PANS/PANDAS?

PANS/PANDAS are both complex conditions. There are some known triggers (potential stimuli for the current condition) and mediators (things sort of hanging around that are not allowing for improvement) that have been identified in these conditions: INFECTIONS, TOXINS and STRESS. A good functional appointment which provides an in-depth history and exam will help to identify the triggers and mediators specific to your case….

It is important to note that a child with PANS/PANDAS has a pre-existing immune depleted state. This immune depletion can be present from birth. If mom has reduced mitochondrial functioning / immune depletion from exposures before or during pregnancy (which may not be known to her), then the baby can be born with reduced mitochondrial functioning / immune depletion as well as toxins or infections passed in utero. Toxins and infections can be passed to the fetus during pregnancy? Yes, some toxins and infections such as lyme and mycotoxins can be passed in utero. Toxins are just as important to investigate and remove as infections. In my practice, I find that a number of my PANS/PANDAS kids are exposed to mold either in-utero, currently or in the past. Glyphosate is another big trigger as well as everyday personal care and cleaning products containing BPA, phalates, PFA’s etc and heavy metal exposure. Remember these kids are in an immune depleted state so any toxin exposure has the ability to accumulate and wreak havoc on their brains and bodies.

So is mom to blame?

Not at all. It is through education on these conditions that we can change the trajectory for the future generations. We are learning more and more about the effect of environmental triggers on our bodies and our ability to process or detox from these triggers. Through this learning we can spread the word and the importance of “clean” living to our future generations as well as provide effective treatments for those currently affected by these conditions.

What about the gut?

This all coexists with microbiome alteration (70% of our immune system resides in our guts!) which leads to microglial (brain immune cell) activation (insert gut-brain connection) and resultant dopamingeric signaling alterations. In other words, these kids have higher than normal dopamine levels resulting in an excitatory state and obsessions, compulsions, attention deficit disorders, anxiety and sleep disturbances.

Remember this is a wax and wane illness with excitatory stimuli (infection, toxins, stress) causing immune activation. The excitation is usually followed by a dip and resulting depression and fatigue. As a caregiver, you may notice the child ramp up with OCD and ADHD behaviors followed by a time period of calmer behavior. Usually an exposure or infection is to blame. The up and down nature of PANS/PANDAS makes typical psychotropic drugs difficult to manage.

Other factors, otherwise known as epigenetic factors, like stress, diet, activity (or lack of activity), and pharmacological treatments (frequent antibiotics, acid blockers, laxatives, stimulants etc) are other contributors to the current symptoms and the development of PANS/PANDAS.

What is the difference between PANS/PANDAS?

There is a lot of overlap between PANS and PANDAS. Both are characterized by a pre-existing immune depleted state with an autoimmune trigger such as an infection or toxin. PANS is not associated with a streptococcal infection while PANDAS is associated with streptococcal infection and the presence of anti-streptococcal antibodies. Although the lines do get blurry at times….

How are PANS/PANDAS similar?

Here are some clinically observed symptoms in both PANS/PANDAS1

Separation anxiety

Inability to concentrate

Urinary frequency, urgency, or urinary accidents

Handwriting deterioration

Alterations in sleep – insomnia, night terrors, inability to sleep alone

Behavioral regression

Hyper-alert appearance; enlarged pupils

Hyperactivity, inattentiveness


Learning difficulties

Short-term memory loss


Sensory alterations – hypersensitive or insensitive

History of repeat UTIs or sinusitis

Disordered eating

Obsessive compulsive behavior


As you can see there is a TON of overlap. The main differentiator is strep infection or strep antibodies present. It’s also important to keep in mind that as infections come and go or worsen the symptoms will wax and wane. So it can be very confusing for the caregiver.

Is this all real or just bad parenting?

I hope if you are reading this you have not been exposed to a clinician that has blamed you for your child’s behavior. Unfortunately this happens all too often. Yes parenting can play a role in behavior but children and teens with PANS/PANDAS have a lot more going on. This is a complex, chronic, in-it-for-the-long-haul condition.

Can these kids ever return to normal functioning? I would like to answer with a resounding YES! However, while most kids can and will go on to live “normal” lives they will, however, likely need support for their immune system along the way.

I hope you find this article helpful and if you or someone you know is struggling with a child or teen who could be dealing with something described here please schedule a FREE consult today to find out how we can help!


  1. Rea I, Guido CA, Spalice A. Clinical Features in Patients With PANDAS/PANS and Therapeutic Approaches: A Retrospective Study. Front Neurol. 2021 Sep 28;12:741176. doi: 10.3389/fneur.2021.741176. PMID: 34650513; PMCID: PMC8505529

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