Brita List - Clinical Psychologist

27/01/2026

5am in Australia, but recordings available as well!

britapsych.com

💛 1 Week to Go: PANS, PANDAS & Neurodivergence Webinar
🗓 Jan 29 | 1:00 PM – 2:30 PM EST

If you’re feeling uncertain, overwhelmed, or unsure how to help your child with PANS/PANDAS alongside neurodivergence, this webinar is for you.

Helen Edgar and Laura Hellfeld will share insights from lived experience and professional expertise, offering practical, compassionate strategies to support children and young people at home and in educational settings.

You don’t have to figure this out alone—come join a caring space where your questions, struggles, and hopes are welcomed.

Join us for a safe, compassionate, neuroaffirming webinar with AuDHD Educator Helen Edgar and PDA AuDHD Nurse Consultant Laura Hellfeld.

🎟 Secure your spot: https://buff.ly/gdn6mP2

27/01/2026

The preprint for CANMAT and ICOCS 2025 International Guidelines for the Management of Patients with Obsessive-Compulsive Disorder was made available online Jan 17, 2026.
286 pages.
https://doi.org/10.1016/j.jpsychires.2025.12.039
I was keen to see where PANS/PANDAS featured! Mostly 6.2 and 6.4.7.

4.2 Immunotherapy p105 (preprint PDF)
Brief mention of potential benefit in certain adults with OCD, not only in PANDAS/PANS (inferring children?); plus minimal research and unclear benefits for immunotherapy studies.

6.2. PANDAS/PANS p134 (preprint PDF)
1/2 Page.
Describing the conditions & criteria and summarising the literature, with this angle: "nosological validity of these entities remains controversial" (referencing old papers - Gilbert 2018; Kurlan 2008). They actually acknowledge it might be an "example of a broader class of immune- or inflammatory-mediated neuropsychiatric illness" BUT THEN they refer to challenges with replicating immunological findings in lots of different studies, and needing lots more research to validate it as a subtype of OCD.
** I personally don't think that calling it a subtype of OCD is helping anyone, with its plethora of other symptoms.

6.4.7. Treatment of PANDAS/PANS-Associated OCD p148-9 (preprint PDF)
1 page.
Describing the only difference between PANS OCD and regular OCD as acuity of onset. They refer to mixed evidence for medical interventions; concluding that since we have nothing else for sure, "follows the same first-line guidelines (SSRIs and CBT-ERP), and immunomodulatory interventions (e.g., antibiotics, corticosteroids, IVIG, plasmapheresis) lack a clear evidence base and may best be restricted to research contexts or multidisciplinary specialized evaluation."
** Deviating from treatment guidelines; Recommending SSRIs WITHOUT warnings like 'start low, go slow': Concerning!!
** Neglecting comorbid symptoms inherent in PANS diagnostic criteria, which blend with and significantly interfere with provision of OCD-based intervention, e.g,. violence and risk to self, others and property - Clinical observations from myself and peers, but also from STAKEHOLDERS - parent and child reports in published literature. Examples: Ringer 2022, 2023 (there are more).
https://doi.org/10.1080/23311908.2023.2259745
https://doi.org/10.1080/17482631.2022.2080906
** Depriving neuroimmune clients of medical intervention to address underlying medical aetiology is medical neglect. Pity they haven't read the Han et al. 2025 published in Nature, showing biological validity of epigenetic factors in PANS?!?! https://www.nature.com/articles/s41380-025-03127-5

Box: Key Points p158 (preprint PDF)
"Conventional OCD pharmacotherapies and psychotherapies are helpful for children presenting with PANDAS/PANS."
** Again! My PANS clients who start SSRIs in a flare get intrusive homicidal and suicidal thoughts, increased aggression and impulsivity, significantly increased risk to self and others. When they start low and go slow, they tend to benefit. When they start SSRIs out of a flare e.g., at baseline, they tend to benefit. Listen to Dr Kiki Chang speak about it on the podcast "PANS/PANDAS Stories" or here: https://rephonic.com/episodes/3v91s-panspandas-stories-interview-with-dr-kiki-ch

Knowledge Gaps Related to Pediatric OCD Treatment. p180 (PDF preproof)
"The construct of PANDAS/PANS will remain controversial until reliable biomarkers can be identified."

1.5 pages, a few sentences, and 'just do regular OCD stuff'. Disappointing!

britapsych.com

22/01/2026

Hello PANS Families and Health Professionals! I used Claude (Anthropic's AI) to teach me about functions of the basal ganglia, associated neurotransmitters and cortical loops. Dopamine receptors in the basal ganglia approve or reject actions, and the balance is broken. I think future research must explore this angle further to inform assessment and treatment.
23.1.26: I used a prompt from evolving.ai that starts with "You are a master explainer who channels Richard Feynman’s ability to break complex ideas into simple, intuitive truths"...
britapsych.com

18/01/2026

I coach parents on using declarative language for mitigating escalations in PANS flares. A quote from this post:
+++
To the child:
• Questions, prompts, directives put me on the spot!
• I feel pressured; “What do they want?” “What do I say?” “What do I do?”
• My initial response is to “FREEZE!”
• Then I want to escape or avoid!
• When put on the spot, I get anxious and find it hard to respond.
• If they keep pressuring me, I get overwhelmed!
• If you invite me to speak, but not force it, I can relax, find the right words, and enjoy talking.
+++
britapsych.com

14/01/2026

A new Special Interest Group for PANS/PANDAS!
britapsych.com

26/12/2025

People with PANS/PANDAS are trying so hard, all the time: "high-masking". Until they fall apart in the safety of home, or until they can't any more.

britapsych.com

Link in 1st comment

15/12/2025

It's not "bad parenting".

britapsych.com

14/12/2025

Note: US time zone EST!

Important therapist education is happening!!

PANS/PANDAS Training for Mental Health Clinicians

February 27 | 10 AM – 12 PM | 2 CEs

I’m excited to share an introductory CE training I’ve been developing on PANS/PANDAS—conditions that can cause sudden-onset OCD, tics, eating restriction, anxiety, and dramatic behavioral changes.

Families often describe it as “my child went to bed one kid and woke up another.” Despite how acute and debilitating these symptoms can be, access to informed medical and psychological care is limited. Advocacy and increased training on these disorders is essential to help families receive proper assessment, diagnosis, and treatment.

Training Includes:

-Definitions: PANS vs. PANDAS
-Differentiating from non-PANS OCD & neurodevelopmental disorders
-2025 research updates: immune dysregulation, neuroinflammation, RNA sequencing
-Evidence-based interventions: ERP, SPACE, DBT crisis strategies
-ARFID/eating restriction within PANS presentations
-Scope of practice & referral pathways with medical teams
-Worksheets & flowcharts for assessment, referral, and treatment planning

Why this training matters:

-Families often come to therapists first
-Proper rule-outs are essential, even when it’s not PANS
-Coordinated mental health + medical care is critical when it is PANS

CE Information:

-2 CEs for NYS LMHCs, LMFTs, LCSWs, LMSWs, LCATs & Psychologists
-Provided through Hudson Valley Professional Development
Register here: https://www.eventbrite.com/e/panspandas-an-evidence-based-approach-for-mental-health-professionals-tickets-1976257528467

I hope to see you there!

For more PANS/PANDAS resources, visit: barbshepardcounseling.com

12/12/2025

This 2h webinar is free! It was so good to hear from leaders in this field about what's happening right now in their work. Hopefully they will make more of these webinars, too! I will go through my notes and share my highlights over the next month or so.
britapsych.com

Watch experts examine the roles of neuroimmune and epigenetic factors in children with PANS/PANDAS, and discuss whether these conditions are best understood as autoimmune, autoinflammatory, or both. The on-demand video webinar is now available at https://www.pandasppn.org/neuroimmune-epigenetic-webinar

This webinar is presented in collaboration with PANDAS Physicians Network and PANDAS Network.

01/12/2025

“Abstract: ...This underscores the importance of clinicians being vigilant for new neuropsychiatric symptoms in pediatric patients, even if they do not immediately meet PANS criteria.

Access the full article here: https://karger.com/dne/article/47/4/270/925277/Defining-Clinical-Course-of-Patients-Evaluated-for

britapsych.com

“Abstract: Patients evaluated for PANS at the IBH Clinic showed diverse clinical presentations and illness courses over the long term, with most experiencing a relapsing-remitting clinical course but some exhibiting persistent symptoms. Many experienced neuropsychiatric flares before meeting PANS classification criteria. This underscores the importance of clinicians being vigilant for new neuropsychiatric symptoms in pediatric patients, even if they do not immediately meet PANS criteria. Based on these data, we propose terms and definitions for characterizing patient status, flares, and clinical course, which we hope the clinical and research communities will build on and refine.”

Access the full article here: https://karger.com/dne/article/47/4/270/925277/Defining-Clinical-Course-of-Patients-Evaluated-for

29/11/2025

I always hope my clients can return to baseline! I have seen recovery, what was "lost" returned to them! Biological intervention is a priority, so keep looking! I also assembled some ideas for looking further, here:

https://www.britapsych.com/panspandas/clinical-observations
https://drive.google.com/file/d/13l1xGXsjl3cbproI4BQ6l_xdYjtC5QUA/view?usp=drive_link
britapsych.com

A child can unravel completely while their MRI remains entirely normal.
That single fact changes everything.
The brain is not broken.
The regulation is.

Parents see the change first.
A child who connected now withdraws.
A child who coped now startles.
A child who spoke now struggles for words.
The Child, who was steady now swings between fear and agitation.

None of this appears on a scan because the structure is intact.
It’s the regulatory environment that has collapsed.

I came across a 2020 longevity study that should have rewritten the conversation.
Neurons under pressure don’t lose their abilities.
They lose access to them.
The chemistry shifts.
The signalling falters.

It means the problem is access, not ability - and access can be restored.

When inflammation settles, when infections clear, when the gut stops sending danger messages, when the metabolic load drops, the child returns.
Not because they relearn everything.
Because the brain becomes accessible again.

This is why the return of function can be sudden, precise and unmistakable.
Why a word reappears.
Why a fear drops.
Why a meltdown vanishes.
Why a child reconnect as if pressure has finally lifted from their nervous system.

Regression is not loss.
It’s blocked access to the abilities a child already holds.

Full breakdown in the blog.
Link in comments 👇

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