A new peer-reviewed medical research article made a big splash in the autism community when it was published earlier this year. The study, “Beyond the brain: A multi-system inflammatory subtype of autism spectrum disorder,” by R.P. Thom, et al, published in Psychopharmacology, explores an immune-mediated subtype of autism that is characterized by systemic, multi-organ inflammation or immune dysregulation with shared mechanisms that drive both behavioral symptoms and physical illnesses. In other words, dysfunction in the immune system can cause the symptoms that appear as autism. 

In the recently published book, Brain Under Attack: A Resource for Parents and Caregivers of Children with PANS, PANDAS, and Autoimmune Encephalitis, many of the practitioners interviewed stated that many or most children with autism also have Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). The syndrome is a result of pathogenic infections crossing into the brain, causing a host of neurological symptoms. It used to be thought that the blood-brain barrier separated the brain from the rest of the body, blocking pathogens and dangerous chemical compounds from reaching it; recent research is proving that is not the case. Researchers recently discovered that the immune system extends into the brain with cells called microglia, and they are subject to infection.

  A study in 2018, “Pediatric acute-onset neuropsychiatric syndrome (PANS) misdiagnosed as autism spectrum disorder,” by M.V.M. Goncalves, et al, in Immunology Letters discussed the overlap between the disorders. Any number of the following symptoms may be present in a child with autism, as well as those with other neurodevelopmental disorders including ADD/ADHD, Sensory Processing Disorder or learning disabilities, which typically have common root causes:

• OCD (Obsessive Compulsive Disorder)

• Excessive anxiety, especially separation anxiety

• Depression

• ODD (Oppositional Defiant Disorder)

• Tics such as hair pulling, eyelash pulling, motor tics, repetitive or compulsive coughing or throat-clearing when not sick 

• Excessive temper tantrums

• Mood swings

• Behavioral regression

• Developmental regression

• Sensory processing difficulties

• Sleep problems

• Gastrointestinal pain

• Bedwetting

• Severe food restriction

• Anorexia

• Decline in handwriting skills

• Decline in math skills

• Hyperactivity

• Inability to concentrate

• Head banging

• Aggression

• Refusal to go to school

• Increased desire to be left alone

• Seizures

A breach in the blood-brain barrier can be caused by antibiotics; traumatic brain injury; toxins such as polysorbate 80; and exposure to electromagnetic frequencies (EMFs), including ultrasounds. The most common microbes believed to be involved in the development of PANS symptoms include, but are not limited to: 

• Mycoplasma pneumoniae 

• Group A Streptococcus

• Borrelia burgdorferi (Lyme disease)

• Babesia 

• Bartonella

• Varicella virus

• Influenza virus

• Epstein-Barr virus

• Herpes simplex virus 

It may be shocking for some to discover that peer-reviewed medical research studies dating back to the 1960s showed the connection between herpetic viral infections and autism. Most of these articles described how encephalitis from a herpes simplex virus caused temporal lobe damage that resulted in symptoms of autism.

Another way to think of PANS, as well as any neurodevelopmental disorder such as autism, ADD/ADHD, Sensory Processing Disorder and even learning disabilities, is that these disorders may fall under the larger umbrella of autoimmune encephalitis (AE), a disorder in which the immune system attacks the brain, impairing function. Encephalitis is inflammation and swelling of the brain, often due to infection, which in many of these cases causes an autoimmune attack on the microglia cells of the brain. The research article, “N-methyl-d-aspartate (NMDA) receptor antibodies encephalitis mimicking an autistic regression,” by Y. Hacohen, et al, published in 2016 in Developmental Medicine & Child Neurology, explained this mechanism. It’s important to remember that the brain’s immune system may not really be attacking itself, but instead may be going after pathogens in the brain.

Parents should be aware that PANS is a clinical diagnosis, meaning that a child’s blood test titer results may be negative, but they could still have the disorder based on their symptoms. Titer results for specific infections are not always indicative of an infection because titers often are only moderately elevated, or not elevated at all, in children with PANS.

Typical tests that are run to determine a PANS diagnosis are:

• The Cunningham panel

• Serum ASO titer (Anti-Streptolysin O)

• Serum ASDB titer (Anti-Streptococcal DNase B)

• Lyme disease titers

• Titers for specific viruses, especially herpetic viruses such as Epstein-Barr virus and herpes simplex viruses

• Pathogenic bacterial infection titers, such as Staphylococcus aureus

• Mycoplasma pneumoniae infection titers

• Influenza infection titers

• Heavy metals and other toxins

Also keep in mind that, typically, there is not just one infection involved in PANS, so if practitioners focus on tests only for Lyme disease or PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections), the results could be inconclusive. Practitioners interviewed for Brain Under Attack noted that they typically see both viral and bacterial infections simultaneously, so be sure your practitioner looks at the whole picture. 

Maria Rickert Hong is a former Wall Street sell-side equity research analyst who is now a Certified Holistic Health Counselor, as well as the Education and Media Director for Epidemic Answers, a non-profit that lets parents know recovery is possible. She is the author of the bestselling book, Almost Autism: Recovering Children from Sensory Processing Disorder, A Reference for Parents and Practitioners, and the co-author of Brain Under Attack: A Resource for Parents and Caregivers of Children with PANS, PANDAS, and Autoimmune Encephalitis. She can be reached at MariaRickertHong.com.