Relationship of movements and behaviors to Group A Streptococcus infections in elementary school children

Biol Psychiatry. 2007 Feb 1;61(3):279-84. doi: 10.1016/j.biopsych.2006.08.031. Epub 2006 Nov 27.


Background: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus (PANDAS) research is based on the hypothesis that infections trigger changes in behavior and movement in children.

Methods: We enrolled 693 children (ages 3 to 12 years) into a systematic, longitudinal study. Data were collected monthly for 8 months (October-May) to determine point prevalence of Group A Streptococcal (GAS) infections, tics, behavior, and choreiform movements. Simultaneous throat cultures were obtained, and relational analyses were made between GAS and movement/observation ratings.

Results: Combined behavior/GAS associations (concurrent with or 3 subsequent months to GAS) revealed a strong relationship, relative risk (RR) of 1.71 (p < .0001). Detailed analysis revealed that balance/swaying and non-tic grimacing were responsible for a significant proportion of this association (RR = 2.92, p < .0001). A strong seasonal pattern was found, with fall being more significant for GAS infections and observation ratings (p < .0001) compared with winter/spring. Children with repeated streptococcus (n = 64) showed higher rates of behavior and distal choreiform observations (p = .005).

Conclusions: Motor/behavior changes were noted to occur in relationship to positive GAS culture with support that repeated GAS increases risk.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Child
  • Child Behavior Disorders / epidemiology*
  • Child Behavior Disorders / psychology
  • Child, Preschool
  • Chorea / epidemiology*
  • Chorea / physiopathology
  • Data Interpretation, Statistical
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Neurologic Examination
  • Pharynx / microbiology
  • Prospective Studies
  • Seasons
  • Streptococcal Infections / epidemiology*
  • Streptococcal Infections / physiopathology
  • Streptococcal Infections / psychology
  • Streptococcus pyogenes*
  • Tic Disorders / epidemiology
  • Tic Disorders / psychology