Strep Infections Linked to ADHD

November 1, 2010 by Dr.Yannick Pauli

Has your child been acting differently after he or she had that bad sore throat? Have teachers been complaining that your child no longer pays attention in class or that his handwriting is difficult to read? Does your child suddenly become particular about the way she does certain things? Your child’s sore throat might have resulted in a rare condition called PANDAS – pediatric autoimmune neuropsychiatric disorders associated with streptococcus. Believe it or not, the common strep infection can trigger ADHD, obsessive-compulsive disorder (OCD), and other neuropsychiatric conditions if left untreated.

Researchers in the past have suspected a relationship between common strep infections and neuropsychiatric conditions like ADHD.  When the body’s immune system attacks the streptococcal bacteria that cause the sore throat, the strep antibodies experience a small degree of mistaken identity and end up attacking certain regions of the brain.  This mistaken attack is believed to affect related parts of the brain, which triggers a variety of emotional and behavioral problems.

When the effects of PANDAS were first discovered, the condition was linked to OCD, Tourette’s Syndrome, and tics, mostly because the symptoms of these conditions are easily recognized.   For instance, OCD is characterized by uncontrollable, repetitive, and ritualized behaviors that you are compelled to perform because the brain gets stuck on a certain urge, like a needle stuck on an old record.   You’ll definitely notice if your child suddenly spends too much time washing his hands or hoarding certain objects. More recently, PANDAS has been linked to a variety of behaviors, many of which resemble the symptoms of ADHD.

A hyperactive or obsessive child with undiagnosed PANDAS is usually taken to see a pediatrician or psychologist to treat these behavioral problems. Medication is typically prescribed, or a behavioral intervention is initiated.  As the strep infection passes and the number of strep antibodies drop, the behavioral problems subside and the changes are attributed to the intervention.  However, if the child has another strep infection, the ADHD or OCD symptoms return as well.  The problem here is that the brain becomes gradually damaged through the continued attacks by the strep antibodies, and after the infection passes the damaged brain regions may not recover as well as they should.  Eventually, the strep infection could lead to a chronic psychiatric disorder.

Unfortunately, there are no lab tests that can detect PANDAS; the condition is only identified through certain diagnostic criteria. There are no treatments for PANDAS per se either, and antibiotics like penicillin should not be used as a treatment for ADHD or OCD.  Of course, if a child with these disorders is suffering from a sore throat or ear infection, antibiotics should definitely be given to get rid of the bacteria. However, with PANDAS, it is the strep antibodies themselves that cause the neurological damage, not the bacterial infection. Hence, one cannot expect to treat PANDAS or improve behavior with antibiotics.

Even if a child’s ADHD turned out to be due to an immunological reaction to a strep throat, the important part is that the balance in the body and mind be restored. This can be done through non-medical interventions like neurofeedback, by taking nutritional supplements that target brain structure and function, and taking probiotics (good bacteria) to replenish those that antibiotics might have killed in the gut.  Additionally, not all children who have a strep throat will develop PANDAS.  Seek medical help when a sore throat persists, and watch out for changes in behavior that are out of character or completely unexplained.