Attention Deficit-hyperactivity Disorder in Children: Diagnostic Method and Comparison with Healthy Children

Prevalence of Neurological Soft Signs at Presentation in Pediatric Acute-Onset Neuropsychiatric Syndrome

“…[16][17][18] PANS classification criteria requires abrupt-onset or abrupt-recurrence of obsessive-compulsive symptoms and/or eating restriction with two or more additional new and abrupt-onset neuropsychiatric symptoms which commonly include: emotional lability; irritability, aggression, severely oppositional behaviors; behavioral regression and/or behavior outbursts, deterioration in school performance (often due to new-onset reading and math challenges), sensory amplification, motor abnormalities (most commonly tics, "piano-playing" finger movements, handwriting deterioration, clumsiness), sleep disturbances, and urinary issues (enuresis and urinary frequency). [19][20][21] While "hard" neurological exam findings of basal ganglia dysfunction such as chorea or dystonia suggest a condition other than PANS, "neurological soft signs" (NSS) such as voluntary movement overflow have been described in attention-deficit hyperactivity disorder (ADHD), [22][23][24][25][26][27][28][29][30][31][32] obsessive compulsive disorder (OCD), 22,23,[33][34][35][36][37][38] autism, 22,23,32,[39][40][41][42][43] and Sydenham chorea, [44][45][46][47] and may also indicate basal ganglia dysfunction. The prevalence of these findings in PANS is not known.…”

“…described in attention-deficit hyperactivity disorder (ADHD), [22][23][24][25][26][27][28][29][30][31][32] obsessive compulsive disorder (OCD), 22,23,[33][34][35][36][37][38] autism, 22,23,32,[39][40][41][42][43] and Sydenham chorea, [44][45][46][47] and may also indicate basal ganglia dysfunction. The prevalence of these findings in PANS is not known.…”