Have you ever been in a moment where your child seemed to change dramatically overnight? One day, they seem “normal,” and the next, they are overwhelmed by severe anxiety, obsessive-compulsive behaviors, panic attacks, or uncontrollable rage.
Parents often describe this sudden change as a “switch being flipped.” If this sounds familiar, your child may be dealing with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). Despite its profound impact on children and families, PANS is often misunderstood, misdiagnosed, or dismissed entirely.
Another significant challenge in dealing with PANS is that it is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard reference and diagnostic criteria for psychiatric disorders. Without official recognition in the DSM-5, many clinicians overlook PANS as a potential explanation for sudden-onset symptoms, defaulting to more familiar mental health diagnoses like OCD (obsessive compulsive disorder) or generalized anxiety. This lack of inclusion further contributes to delays in appropriate treatment and care.
Believe me, I know firsthand how overwhelming this journey can be. As a mother of a child with PANS (my son Max was diagnosed with PANS and Lyme disease at the age of 3) and a mental health professional with over 30 years of experience, I have taken this path along with other PANS parents in my clinic, and I assure you there is hope and recovery is achievable.
What is PANS Disease?
Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)
This is a medical condition that leads to a sudden and dramatic onset of neuropsychiatric symptoms. The condition occurs when an infection, toxin, or other stressor triggers an immune system response that attacks the brain, causing inflammation and dysregulation.
Unlike gradual mental health conditions, PANS strikes abruptly. One day, a child may appear perfectly healthy; the next, they’re consumed by obsessive-compulsive behaviors, severe anxiety, emotional outbursts, or regressive behaviors.
Common Signs and Symptoms of PANS Include:
- Obsessive-compulsive behaviors (OCD)
- Motor abnormalities or vocal tics
- Severe anxiety, especially separation anxiety
- Emotional lability / instability, uncontrollable emotions or rage
- Regressive behaviors (e.g., baby talk, bedwetting)
- Sensory abnormalities
- Sudden decline in school performance.
- Sudden decline in academic ability or school performance
- Food restriction or eating restrictions / refusal
- Scarlet fever, rheumatic fever, sore throat, strep throat
These signs and symptoms, with a sudden onset, set it apart from other disorders and mental health conditions. PANS is driven by immune system dysfunction, and addressing the underlying triggers is key to effective treatment.
A clinical diagnosis can help in managing this condition with the right approach. With a proper diagnosis, then we are just trying to fix a broken pipe with a bandaid—you need the right tools and understanding to address the root cause effectively.
The Dysregulated Brain and PANS
PANS is not just a collection of symptoms—it’s a medical condition rooted in immune dysfunction and brain inflammation. Understanding the mechanisms behind a dysregulated brain is essential to grasp why treatment requires addressing both the body and the brain.
What Happens in a PANDAS Brain?
When the brain is inflamed, its ability to regulate emotions, behavior, and thought processes is compromised. This leads to:
- Obsessive-Compulsive Behaviors (OCD): Intrusive thoughts and ritualistic actions.
- Emotional Dysregulation: Sudden mood swings and outbursts of rage.
- Motor and Vocal Tics: Uncontrollable movements or sounds.
- Cognitive Impairments: Brain fog, memory issues, and difficulty concentrating.
Neuroimaging studies show changes in the basal ganglia, a part of the brain responsible for movement and behavior regulation in children with PANDAS.
The Basal Ganglia
The basal ganglia, a cluster of structures deep in the brain, is particularly vulnerable to inflammation in PANS. This area regulates:
- Movement: Leading to tics or motor dysfunction when impaired.
- Emotional Processing: Resulting in mood swings, rage episodes, and emotional instability.
- Behavioral Control: Causing obsessive-compulsive tendencies, rigidity, or impulsivity.
When the basal ganglia is inflamed, communication between brain regions becomes disrupted, amplifying anxiety, OCD behaviors, and even cognitive struggles like brain fog.
The Gut-Brain-Immune Axis
Emerging research highlights the importance of the gut-brain-immune axis in conditions like PANS. The gut is home to trillions of microbes that play a critical role in immune regulation. When gut health is compromised—often through infections, antibiotics, or poor diet—it can exacerbate inflammation and disrupt brain function.
Key connections include:
- Leaky Gut Syndrome: Weakness in the gut lining allows harmful substances to enter the bloodstream, triggering immune responses that can affect the brain.
- Gut Dysbiosis: Imbalances in gut bacteria contribute to systemic inflammation.
- Vagus Nerve: The gut communicates directly with the brain through the vagus nerve, influencing emotional regulation and stress responses.
The Role of the Immune System in PANS
The immune system is designed to protect the body from harmful invaders like bacteria, viruses, and toxins. However, in some children, the immune response goes awry. When exposed to a trigger such as an infection, the immune system mistakenly attacks healthy brain tissue, particularly the basal ganglia, leading to inflammation and neuropsychiatric symptoms.
This malfunction may stem from:
- Molecular Mimicry: The immune system creates antibodies to fight off infections, but those antibodies mistakenly target brain cells that resemble the pathogens.
- Cytokine Storms: An overproduction of inflammatory molecules (cytokines) that damage healthy tissues in the brain.
- Genetic Susceptibility: Mutations such as MTHFR or other immune-related genes may make some children more prone to autoimmune or autoinflammatory conditions.
Strep Infections in PANDAS
For children with PANDAS, a specific type of PANS, the culprit is a strep infection. Here’s how it works:
- Strep bacteria trigger the immune system to fight the infection.
- The immune response becomes misdirected, attacking the brain.
- This inflammation in the brain disrupts normal functioning, leading to sudden OCD, tics, or emotional changes.
If your child has had repeated strep throat infections followed by abrupt behavioral changes, PANDAS may be the underlying cause.
PANS Diagnostic Guidelines
Diagnosing PANS can be challenging due to its broad range of symptoms. The PANS Diagnostic Guidelines recommend looking for:
- Abrupt Onset: Symptoms appear suddenly and are severe.
- Neuropsychiatric Symptoms: OCD, tics, or restricted eating must be present.
- Associated Symptoms: At least two other categories of symptoms, such as anxiety, irritability, or sleep disturbances.
PANS is a clinical diagnosis, meaning it’s based on medical history and symptoms rather than a single test. A series of tests and assessments are necessary to exclude other medical syndromes.
No matter the severity, a multi-pronged approach is key to addressing both the medical and behavioral aspects of PANS.
Natural Solutions for PANS Disease
Neurofeedback in PANS Treatment
Neurofeedback is a science-backed therapy that helps regulate the brain’s electrical activity. For most children with PANS, whose brains are often stuck in a heightened fight-or-flight state, neurofeedback can be a game-changer.
How Neurofeedback Works
- A QEEG Brain Map identifies areas of overactivity, underactivity, or dysregulation in the brain.
- During sessions, a child’s brain receives visual and auditory feedback (e.g., sounds or images) whenever it reaches a healthy brain wave state.
- Over time, the brain learns to self-regulate, reducing symptoms like anxiety, rage, and OCD behaviors.
Benefits of Neurofeedback for PANS
- Calms the Nervous System: Reduces hyperactivity in the brain, helping children feel less irritable and anxious.
- Improves Focus and Cognitive Function: Supports attention and processing speed, often impaired in PANS.
- Reduces Emotional Reactivity: Helps regulate mood and minimize outbursts.
Data from clinical trials shows that after 30–40 neurofeedback sessions, children with PANS often exhibit significant improvements in emotional stability and behavior. Additionally, cognitive behavioral therapy (CBT) combined with exposure and response prevention (ERP) has been shown to significantly improve OCD symptoms in children and adolescents when administered by trained therapists.
PEMF Therapy for PANS Disease
Pulsed Electromagnetic Field (PEMF) Therapy is another powerful modality for calming the brain and body. PEMF uses low-frequency electromagnetic waves to stimulate cellular repair, reduce inflammation, and enhance blood flow.
Why PEMF Is Effective for PANS
- Reduces Inflammation: Targets the root cause of many PANS symptoms by calming overactive immune responses.
- Supports Nervous System Regulation: Helps reset the nervous system, allowing children to move out of chronic fight-or-flight states.
- Enhances Detoxification: Improves lymphatic drainage and cellular repair.
For children with PANS, PEMF therapy can complement neurofeedback and medical treatments by addressing both the neurological and systemic inflammation contributing to their symptoms.
The Importance of Detoxification
Detoxification plays a crucial role in managing PANS, especially in children with environmental triggers like mold or Lyme disease. Toxins overload the immune system, perpetuating inflammation and worsening symptoms.
Detoxification Strategies for PANS
- Gut Support: Probiotics, digestive enzymes, and an anti-inflammatory diet can heal the gut and reduce systemic inflammation.
- Liver Support: Supplements like milk thistle and glutathione help the liver process and eliminate toxins.
- Hydration and Movement: Drinking plenty of water and engaging in gentle exercise can improve lymphatic drainage and toxin elimination.
Dietary Interventions
For children with PANS, diet can be a powerful tool for reducing inflammation and stabilizing symptoms.
Key Dietary Changes
- Eliminate Inflammatory Foods: Avoid gluten, dairy, refined sugar, and processed foods, which can exacerbate inflammation.
- Focus on Nutrient-Dense Options: Incorporate omega-3-rich foods (like salmon), antioxidants (like berries), and leafy greens.
- Balance Blood Sugar: Regular meals with protein and healthy fats can prevent mood swings and irritability.
Supplements for PANS
- Omega-3 Fatty Acids: Reduce inflammation and support brain function.
- Magnesium: Calms the nervous system and supports sleep.
- Probiotics: Restore gut health and balance the immune system.
Somatic Therapy
Children with PANS often carry emotional trauma from the unpredictability of their symptoms and the stress it places on their families. Somatic therapy focuses on helping children reconnect with their bodies and release stored tension.
Techniques Used in Somatic Therapy
- Grounding Exercises: Techniques like deep breathing and sensory awareness help children feel safe and present.
- Movement Therapy: Activities like yoga or dance allow children to release pent-up energy and emotions.
- Trauma Processing: Therapists guide children in safely exploring and resolving traumatic memories.
Case Study: Maya’s Journey to Healing from PANS
Let me share with you a real-life example of one of the PANS cases I managed in my Ridgefield, CT clinic. This will provide a peek into the real-world impact of PANS and its treatment journey.
Maya was a bright and energetic 14-year-old who had experienced a normal, happy childhood until the age of six. That’s when things began to change.
A tick bite and subsequent joint pain seemed to resolve with antibiotics, but what followed was a cascade of unexplained neurological symptoms—difficulty focusing, loss of bladder control, urinary symptoms, metabolic disturbances, obsessive compulsive symptoms, sleeping difficulties an other inflammatory reactions. Over the next several years, Maya’s symptoms grew more severe, culminating in emotional outbursts and behavioral issues that left her family searching for answers.
Like many parents of children with PANS, Maya’s parents endured years of frustration and misdiagnoses before finding the right path to healing. Their persistence and participation in the BrainBehaviorReset™ Program finally gave Maya—and her family—the relief they desperately needed.
Client Background
Maya’s family history also revealed numerous infectious diseases, including Lyme disease, Bartonella, Epstein-Barr, streptococcus, and toxic mold exposure. Despite these challenges, Maya’s birth and early childhood were uneventful, with no signs of behavioral, attentional, or emotional issues.
However, a tick bite at age six marked the beginning of her struggles. Following the bite, she developed joint pain and a viral-like rash. After two weeks of antibiotics, the symptoms resolved, but within months, new issues emerged:
- Difficulty focusing.
- Regression in bladder control.
- Trouble sleeping through the night.
These symptoms gradually worsened over the next year, leading to concerns about ADHD. A strep infection at age seven triggered a dramatic episode of rage and extreme emotionality, setting off years of psychiatric treatments that provided little to no relief.
By age 13, Maya’s parents suspected PANS and sought help from a specialist who identified multiple infections and mold toxicity as root causes.
While initial treatments improved her symptoms significantly, a viral infection triggered a severe flare, leading to emotional dysregulation, sensory overload, and behavioral outbursts. That’s when Maya’s family turned to the BrainBehaviorReset™ Program for comprehensive care, similar to other PANS patients who experience neuropsychiatric symptoms and require specialized medical evaluations and treatments.
Initial Assessment
A QEEG Brain Map revealed significant brain inflammation, with overactive brain wave activity indicating a state of chronic stress. Maya’s brain was in a constant “rev state,” stuck in a fight-or-flight loop that heightened her sensitivity to triggers and made it nearly impossible for her to self-regulate.
Phase One: Calming the Brain
The first phase of Maya’s treatment focused on reducing inflammation and calming her overactive nervous system. This phase included:
- Neurofeedback: Customized protocols helped regulate Maya’s brain waves and reduce overactivity.
- PEMF Therapy: Calmed her nervous system and supported brain regulation.
- Dietary Changes: Focused on reducing inflammation through an anti-inflammatory diet.
- Dietary Supplements: Targeted nutritional deficiencies and supported immune function.
- Detoxification and Gut Support: Addressed mold toxicity and improved gut health to reduce systemic inflammation.
- Parent Coaching: Equipped her family with tools to manage outbursts and create a calming home environment.
As Maya’s brain calmed, the intensity and frequency of her outbursts diminished. This allowed her to engage in somatic therapy, which focused on helping her process emotions and regain control over her body.
Phase Two: Building Resilience and Returning to School
Once Maya’s emotional and behavioral symptoms stabilized, the focus shifted to long-term wellness and reintegration. Phase Two included:
- Nutritional Coaching: Guided Maya’s family in maintaining dietary and lifestyle changes.
- Counseling Sessions: Helped Maya develop coping skills and build emotional resilience.
- Tiered School Reintegration: A gradual return to school allowed Maya to adjust at her own pace without overwhelming her nervous system.
Treatment Outcomes
Maya’s progress was remarkable. After completing 40 sessions of neurofeedback, 13 sessions of PEMF therapy, and a combination of parent coaching and somatic therapy, her brain activity showed significant improvement:
- Brain Wave Activity: Overactive brain waves (Delta and Beta) decreased by more than 50%.
- Behavioral Improvements: Emotional outbursts reduced from three times daily to once every 7–10 days, with significantly less intensity and shorter duration.
- Functional Gains: Maya successfully returned to school, engaged in therapy, and adopted new dietary and lifestyle habits.
Maya’s journey highlights the transformative impact of a comprehensive, science-backed approach like the BrainBehaviorReset™ Program. By addressing the root causes of her symptoms and teaching her family how to support her, Maya reclaimed her ability to thrive.
Every child’s journey with PANS is unique, but with persistence, a tailored plan, and the right support, healing is possible. If you’re facing similar challenges, know that help is available—and hope is within reach.
The BrainBehaviorReset™ Program
At the heart of healing PANS is a comprehensive, personalized approach like the BrainBehaviorReset™ Program. By combining neurofeedback, PEMF, dietary interventions, and family coaching, the program addresses the root causes of PANS and helps children regain their emotional and physical health.
- QEEG Brain Mapping to identify areas of dysregulation.
- Neurofeedback and PEMF Therapy to calm the brain and reduce inflammation.
- Nutrition and Detoxification to support the body’s healing processes.
- Parent Education and Coaching to empower families to create a supportive environment.
The journey through PANS is challenging, but science offers hope. By understanding the mechanisms behind this condition and leveraging evidence-based treatments, families can guide their children toward recovery and resilience.
For more support, explore my BrainBehaviorReset™ Program to learn how we can help your child heal and reclaim their joy.
Parents Action Steps
☐ Trust Your Instincts: If something feels off, keep advocating for your child.
☐ Educate yourself about PANS and PANDAS and consult with a pediatric specialist
☐ Check out Dr. Roseann’s free resources on PANS and PANDAS
☐ Find the Right Provider: Look for a PANS-literate doctor who will address root causes.
☐ Connect with online support groups for parents of children with PANDAS or PANS
☐ Implement healthy lifestyle changes like a nutritious diet, exercise, and sufficient sleep
☐ Create a Calm Environment: Reduce stressors at home and provide predictability.
☐ Focus on Nutrition: Anti-inflammatory diets can support the healing process.
☐ Monitor your child's progress and any changes in the symptoms of PANDAS and PANS
☐ Use the Solutions Matcher to receive personalized treatment options for your child
Is PANS Autoimmune or Autoinflammatory?
PANS falls into a unique medical gray area, combining characteristics of both autoimmune and autoinflammatory conditions:
- Autoimmune: The immune system mistakenly attacks healthy brain tissue.
- Autoinflammatory: The body’s inflammatory response becomes overactive, causing widespread damage.
This dual nature explains the range of symptoms in PANS, from behavioral and emotional challenges to physical issues like tics or sleep disturbances.
What’s the Difference between PANS and PANDAS?
Although PANS and PANDAS share many symptoms, they are distinct conditions.
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome):
- Triggered by a wide range of factors, including infections (e.g., Lyme disease, pneumonia, sinus infections, other infectious agent), environmental toxins, and even stress.
- Symptoms can wax and wane, often worsening during flares.
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus):
- A subset of PANS caused specifically by Group A strep infections (e.g., strep throat).
- Symptoms are directly linked to strep and specifically OCD, tics, and behavioral regression.
- PANDAS patients test positive for a recent streptococcal infection.
Both conditions involve brain inflammation, but PANDAS has a narrower cause, making it slightly easier to diagnose.
My child has sudden rages and meltdowns. Could this be a pediatric autoimmune neuropsychiatric disorder, or is it just a phase?
Sudden and extreme changes in behavior—like rages, meltdowns, or severe emotional instability—are hallmark signs of PANS, especially if they appear out of the blue. While some phases are normal for children, the abruptness and intensity of PANS symptoms stand out. Trust your instincts and consult with a PANS-literate doctor for an evaluation.
My child was diagnosed with anxiety and OCD. How do I know if it’s PANS?
If your child’s anxiety or OCD symptoms appeared suddenly or worsened dramatically after an illness or infection, it could be PANS. Look for other associated symptoms, such as sleep disturbances, sensory sensitivities, or regression, and share this information with your healthcare provider. A detailed history of your child's symptoms, illnesses and behavior changes is key to identifying PANS.
My pediatrician doesn’t think PANS is real. What should I do?
Unfortunately, not all doctors are familiar with PANS. If your pediatrician dismisses your concerns, seek out a PANS-literate doctor or specialist who understands the condition and can provide the necessary testing, physical exam and treatment. You’re your child’s best advocate, and finding the right provider can make all the difference.
Why does my child’s behavior improve for a while and then suddenly worsen again?
This pattern of severe symptoms is common in children with PANS. These “flares” are often triggered by:
- New infections or illnesses (even mild ones).
- Exposure to allergens or environmental toxins (e.g., mold).
- Stress or sleep disturbances. Keeping a symptom diary can help you identify patterns and triggers, which can be invaluable for your child’s treatment plan.
Can my other kids get PANS?
Yes, it’s possible. PANS can have a genetic component, especially in families with immune system or detoxification issues like MTHFR mutations. If you notice symptoms in siblings, consult a PANS specialist to evaluate and address any early signs.
My child’s school doesn’t understand PANS. How can I explain it to them?
PANS is a medical condition with psychiatric symptoms caused by brain inflammation. Share resources like a letter from your child’s doctor or printed information about PANS. Educating teachers and staff about triggers, such as sensory overload or fatigue, can help them create a supportive environment for your child.
How can I handle my child’s extreme separation anxiety?
Separation anxiety is common in PANS and can be overwhelming for both you and your child. Start with small steps, such as practicing short separations and building up to longer ones. Create a predictable goodbye routine, and reassure them that you’ll always return. At the same time, work on calming their brain with therapies like neurofeedback or mindfulness.
Why is my child have a sudden onset of fear?
Irrational fears, or phobias, often develop with PANS due to inflammation in the brain affecting how your child processes emotions and thoughts. These fears can be temporary and improve with treatment, but while they persist, acknowledge your child’s feelings and avoid forcing them into feared situations.
My child refuses to eat. What can I do?
Food restriction is a common symptom of PANS, an eating disorder, often due to OCD or sensory sensitivities. Additionally, studies have shown that 44% of PANS patients report increased urinary frequency as part of a broader range of somatic symptoms. Try offering simple, familiar foods that your child has eaten before. Work with a specialist, such as a dietitian or therapist, to address the underlying issues. Addressing brain inflammation through medical treatment often improves eating behaviors.
Will my child grow out of PANS?
PANS symptoms won’t simply disappear without treatment, but with a comprehensive approach, children can heal and thrive. The key is addressing the root causes—such as infections, inflammation, and immune dysfunction—and supporting their nervous system through therapies, lifestyle changes, and proper medical care.
How do I handle sibling dynamics when one child has PANS?
PANS can take a toll on siblings, who may feel neglected or overwhelmed. Make time for one-on-one interactions with each child, and be honest about the challenges the family is facing. Encourage siblings to express their feelings and consider family therapy to navigate the emotional impact together.
Can stress make PANS worse?
Yes, stress is a major trigger for flares. A dysregulated nervous system in PANS children often overreacts to stress, amplifying symptoms. Creating a calm, predictable environment and teaching stress-reduction techniques like mindfulness or breathing exercises can help.
Do I need to homeschool my child with PANS?
Not necessarily, but school accommodations may be needed. Some children benefit from a reduced schedule, extra breaks, or a quiet place to reset during the day. Work with your child’s school to develop an Individualized Education Plan (IEP) or 504 Plan tailored to their needs.
What’s the difference between a flare and a baseline?
A baseline is your child’s typical level of functioning when their symptoms are stable. A flare is a period of increased symptoms, often triggered by infections, stress, or environmental factors. Tracking these patterns can help you and your provider manage the condition effectively.
How can I manage my own stress while caring for my PANS child?
Caring for a child with PANS can be exhausting and emotionally draining. Remember to prioritize your own self-care, whether it’s through mindfulness, therapy, or leaning on a support group. You can’t pour from an empty cup—taking care of yourself helps you better support your child.
Dr. Roseann is a mental health expert in Neurodivergence who is frequently in the media:
- Business Insider How to practice ‘autonomy-supported parenting' to boost your family's wellbeing
- Healthline Get Stuff Done: A Realistic Guide to Working From Home with Kids
- Love Shack Live How To Navigate The Parenting Journey As A Couple
Always remember… “Calm Brain, Happy Family™”
Disclaimer: This article is not intended to give health advice and it is recommended to consult with a physician before beginning any new wellness regime. *The effectiveness of diagnosis and treatment vary by patient and condition. Dr. Roseann Capanna-Hodge, LLC does not guarantee certain results.
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Dr. Roseann is a Children’s Mental Health Expert and Licensed Therapist who has been featured in/on hundreds of media outlets including The Mel Robbins Show, CBS, NBC, PIX11 NYC, Today, FORBES, CNN, The New York Times, The Washington Post, Business Insider, Women’s Day, Healthline, CNET, Parade Magazine and PARENTS. FORBES called her, “A thought leader in children’s mental health.”
She coined the terms, “Re-entry panic syndrome” and “eco-anxiety” and is a frequent contributor to media on mental health.
Dr. Roseann Capanna-Hodge has three decades of experience in working with children, teens and their families with attention-deficit hyperactivity disorder (ADHD), autism, concussion, dyslexia and learning disability, anxiety, Obsessive Compulsive Disorder (OCD), depression and mood disorder, Lyme Disease, and PANS/PANDAS using science-backed natural mental health solutions such as supplements, magnesium, nutrition, QEEG Brain maps, neurofeedback, PEMF, psychotherapy and other non-medication approaches.
She is the author of three bestselling books, It’s Gonna Be OK!: Proven Ways to Improve Your Child's Mental Health, The Teletherapy Toolkit, and Brain Under Attack. Dr. Roseann is known for offering a message of hope through science-endorsed methods that promote a calm brain.
Her trademarked BrainBehaviorResetⓇ Program and It’s Gonna be OK!Ⓡ Podcast has been a cornerstone for thousands of parents facing mental health, behavioral or neurodevelopmental challenges.
She is the founder and director of The Global Institute of Children’s Mental Health, Neurotastic™Brain Formulas and Dr. Roseann Capanna-Hodge, LLC. Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS), Certified Integrative Mental Health Professional (CIMHP) and an Amen Clinic Certified Brain Health Coach. She is also a member of The International Lyme Disease and Associated Disease Society (ILADS), The American Psychological Association (APA), Anxiety and Depression Association of America (ADAA) National Association of School Psychologists (NASP), International OCD Foundation (IOCDF).
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