Prevalence of Acute-Onset Subtypes in Pediatric Obsessive-Compulsive Disorder

J Child Adolesc Psychopharmacol. 2017 May;27(4):332-341. doi: 10.1089/cap.2016.0031. Epub 2017 Jan 25.


Background: Pediatric obsessive-compulsive disorder (OCD) is a common, debilitating illness. When childhood OCD symptom onset is described as acute and severe, diagnostic criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) should be considered. However, the frequency and differentiating features of these putative syndromes within pediatric OCD remain poorly understood.

Objectives: To determine the prevalence and characteristics of those meeting PANDAS and/or PANS criteria within pediatric OCD, as determined by parent report and clinician interview.

Methods: Consecutive youth presenting to a subspecialty pediatric OCD clinic were rigorously assessed through the Anxiety Disorders Interview Schedule for DSM-IV, the Children's Yale-Brown Obsessive-Compulsive Scale, and through self- and parent-report measures, including a medical questionnaire. Strict diagnostic criteria for PANDAS and PANS were applied to determine prevalence rates, and comparative analyses were performed between subgroups.

Results: Among 136 youth with a lifetime OCD diagnosis, 5% (n = 7; 95% adjusted Wald interval: 1%-10%) met proposed criteria for PANDAS and/or PANS, of whom two met PANDAS criteria, four met PANS criteria, and one met criteria for both. Those in the PANDAS/PANS subgroup were more likely to have autoimmune illness, less likely to report symmetry factor symptoms, and had greater OCD-related family impairment during their worst OCD episode.

Conclusion: A small yet significant percentage of pediatric OCD outpatients met criteria for PANDAS and/or PANS, justifying routine screening and attention to related characteristics during assessment and management. Longitudinal studies of these putative subtypes are warranted.

Keywords: neuropsychiatric syndrome; obsessive-compulsive disorder; pediatric acute-onset; pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections; prevalence.

MeSH terms

  • Adolescent
  • Autoimmune Diseases / diagnosis*
  • Autoimmune Diseases / epidemiology
  • Autoimmune Diseases / psychology
  • Child
  • Diagnostic and Statistical Manual of Mental Disorders*
  • Female
  • Humans
  • Male
  • Obsessive-Compulsive Disorder / diagnosis*
  • Obsessive-Compulsive Disorder / epidemiology
  • Obsessive-Compulsive Disorder / psychology
  • Prevalence
  • Streptococcal Infections / diagnosis*
  • Streptococcal Infections / epidemiology
  • Streptococcal Infections / psychology
  • Surveys and Questionnaires

Supplementary concepts

  • Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections