I would want a few more labs if they haven't already been done, starting with the immune system (IgG total and subclasses, IgM, IgE, IgA, maybe C1 and C4) and more pathogens (HSV, EBV, CMV, and in this case definitely ASO and Anti-DNase B, as strep is known to like joints). Note that steroids can affect bloodwork for some things. Bloodwork that looks at immune system response to detect a pathogen may be inaccurate if taken while on steroids because steroids depress that response. A study for you: Improvement of psychiatric symptoms in youth following resolution of sinusitis. See if you can find a sinus specialist (usually an ENT who extra-specializes in sinus stuff). I would not assume the remaining sinus stuff is necessarily allergy, as opposed to remaining infection. For example, my guy has been on loads of oral antibiotics, and doesn't even have much in the way of sinus symptoms beyond mild postnasal drip, and yet a sinus CT showed some infection hanging out up in the sinuses, where nasal sprays and oral antibiotics often won't reach. He's now on sinus rinse with a gel antibiotic added, though I'm not seeing any difference - we'll see what ENT says.... I do know someone whose child's neuropsychiatric symptoms improved dramatically after sinus surgery to clean out infection. Sometimes low vitamin D may be a result/symptom rather than a cause. I would be careful there - if the supplementation makes any symptoms worse, I'd try pulling back to see if that helps. I've also read that supplementing D can further exhaust magnesium supplies in order to process that. And the gut involvement - harder to manage than one might think. Good luck!

Rose, I'm so sorry to see that you are dealing with a mystery illness. There is far too much of that going around.

It sounds like it's a go :) My only concern would be whether her transcript is competitive enough for her college goals. It sounds like you've already discussed that.

I would think a score without meds wouldn't be especially accurate. SAT has more time per question than ACT but might be less straightforward. In particular, the math questions may be unnecessarily wordy (this criticism has been publicly discussed). There are testing strategies to cut down on the amount of reading. Beyond the obvious (reading the questions before the passage), I do not know what these strategies entail, though my dd is learning them from an experienced SAT tutor. All I know is last week they were working on math strategies that didn't involve her knowledge of math. How much higher would her SAT need to be in order to get admitted to the university you are considering?

Among other things to do while waiting for evals, what I would do first: - get a developmental vision eval to rule out issues or at least go see a COVD optometrist for an annual vision checkup and chat about the possibility of developmental vision issues. Both these types of appts can usually be scheduled pretty quickly and I would jump on that ASAP. Vision symptoms can include reversals, spacing, spelling, and missing words while reading. Memory of math facts could possibly be a downstream effect of vision issues. - teach typing (something an 11 y.o. should be learning anyway). Use white boards for math (visually larger, plus there is less resistance than with paper). - consider possible OT eval as well.

Thinking out loud, besides protein (obvious), I suggest sources of electrolytes/salt and probably fats. I suspect those may be behind the common McDonald's craving. (McDonald's was never so tasty as when I was pregnant...)

Another vote for Pre-AP for a bright kid. At some schools, doors may close to APs later on if the student isn't already in the proper track, not to mention the foundation in skills may be more substantial in the Pre-AP classes. Plus, such classes might be more interesting. If there is any chance at all that this bright student might end up wanting to apply to competitive colleges later, he will want to take some APs if the school offers them. That wouldn't need to be in every subject, but in the spirit of keeping doors open, I'd try to get the bright freshman into as many honors/Pre-AP classes as the school allows - I am not convinced that the workload in an honors/Pre-AP class is likely to be substantially more voluminous than a regular level class, though naturally that would vary by teacher. My biggest piece of advice is that, if he has already taken algebra 1 (or higher), have him do some review this weekend to prepare for math placement testing. Most high schools will require testing to place out of math courses. It is easy to forget over the summer, do poorly on a placement test, remember right afterward, and end up repeating a course for no good reason. Even if he hasn't, if the school requires a math placement test just on prealgebra, I'd have him review that a bit. A couple of days of memory-refreshing can make a huge difference. ETA, same for foreign language, if he has already had the equivalent of a year (or more) of high school foreign language, expect a placement test and review prior to it.

I think the giant, flashing caution signs apply to the idea of APUSH in 8th grade as a long-term goal, as opposed to a short-term solution for an exceptional 8th grader desiring a history challenge. For OP: while some colleges may accept a 3 on the APUSH exam for credit, many selective colleges will require at least a 4. Only 30% of a pool comprised almost entirely of 11th graders score a 4 or 5. (See, e.g., Is AP US History hard?) This older thread might be helpful: 9th grade--which AP courses is it okay or normal to take?

I think we should add the caveat for OP that your kids are not typical but quite extraordinary even among gifted kids.

In most schools, APUSH is taken in 11th grade (in place of regular high-school-level US history) and rarely before. It also has a reputation of being among the more challenging AP tests. I would think that APUSH would be a poor choice for most 8th graders, probably even most gifted ones.

I recently bought regular iPads for two of my kids for school - required. I chose the Logitech keyboard cover to go with ($99), as it had everything I wanted; there are less expensive keyboard covers out there, but there always seemed to be a little something about them that wasn't quite what I wanted. The current price on the iPad was pretty good, though I can't remember offhand how much it was (I bought the iPads at Costco, saved $20 or so per iPad.) FWIW, from everything I read, the Pro versions were not worth the increase in price compared to the regular iPad for my teens' needs despite the fact that they are pretty heavy users of technology. However, in their case, there's no way their iPads will replace their laptops (games, programming, etc).

I think this is a useful thought. Some of the symptoms that OP describes go well beyond typical PANS (though the leading docs are now trying to describe PANS as a different sort of autoimmune encephalitis). I'm thinking of the hallucination symptoms. If any of you have read "Brain on Fire," that is a type of AE, though there are others. Finding expertise for some sort of AE can be even more challenging than for garden variety pans/pandas. When I think of things that can be done at home to provide more clues, in the middle of a symptom flare I would ask her to draw a clock.

Moments ago, we found another mouse, just sitting there at the door to ds's basement bedroom. Ds wouldn't let me kill it (throw it out; garbage truck is coming this morning) so I had him take it down to the dirt road and let it go. I think something was wrong with its health because I was able to catch it (I scooted it into a plastic tub in a grocery bag). I just spent two weeks trying to catch a different mouse - imagine Caddyshack, but with a big mouse, as big as a vole but with bigger ears, ending with my victory at 4:30 am... in my bedroom. I'd so much rather have the snakes in the garage than the mice, though as long as everyone stays in the garage, that's the most important thing :glare:

If I tried to do that over at CC, I probably would have been deleted. And thank you, Kathy, for such succinct answers! A while back I looked around CC and hadn't found final answers on those questions. You made it so easy :)

Thank you! That one is off the list then. Can I squeeze in one more question? Off-topic, but I think you will know the answer. Is Honors Latin 3 (one that prepares a student to follow with the AP course) enough for the Latin SAT2 ? ETA, vague, but here is the course description:

Can I piggyback a quick question - when would be an appropriate time to take the SAT2 in physics? Would after AP Physics 1 be enough?

Just for the sake of completeness, for lurkers reading this thread, OCD is the primary neuropsychiatric symptom involved in PANS/PANDAS. (The symptom list, depending on the version, usually starts with "OCD and/or tics." Many kids have both, though some have only one or the other; e.g. my kiddo has only OCD, without tics.)

While the left brain/right brain has always been a massive oversimplification, I don't think it logically leads to the conclusion that learning differences are a myth. We all know that different people have different strengths and weaknesses in processing.

Sudden onset (or sudden exacerbation) of neuropsychiatric symptoms points to an infectious trigger. For what it's worth, PANDAS is a subset of PANS; the possible triggers go far beyond just strep. Vocal and motor tics would also point directly to PANS/PANDAS. I would not overlook the significance of tics as a clue. I posted some recent links here.

Not about the common app, but I happened to come across this Washington Post article from March: How the SAT and PSAT collect personal data on students — and what the College Board does with it

I'm sorry, I didn't know you were looking at this angle. We have been at this for >3 yrs now, also with a kiddo who has been through a ton of health stuff. This past year, we did more than 10 IVIg infusions - they don't worry me in and of themselves, though dose and frequency are controversial and we are off them for the time being, trying to decide whether to fit one more in before high school starts (in 12 days!). We did see big benefit from IVIg in the areas of attention/exec function/schoolwork (ETA, and how could I forget, social stuff, according to relatives who hadn't seen him in a year), but OCD and strep titers are both stuck, probably not coincidentally. Feel free to PM me if you want to discuss anything.

Yes, it is possible. Sudden onset or sudden exacerbation of neuropsychiatric behaviors points to an infectious cause. Bear in mind the following: - the mechanisms/processes involved are not well understood. (For strep, the current theories involve antibodies that cross over into the brain via the olfactory bulb and react with the basal ganglia via molecular mimicry. But, no one knows why subsequent exacerbations might happen with other, non-strep triggers that would not involve antibodies to the same molecule) - triggers can be many different types of infections, basically anything that can cause an immune system reaction. (lots of bloodwork) - it is not uncommon for there to be an underlying immune system issue, a deficiency or dysregulation of some sort. (lots of bloodwork) - finding a practicioner who is experienced in this emerging area is challenging. It is still controversial. For example, many - maybe most - children's hospitals do not recognize or treat PANS/PANDAS. If you wish to explore this possibility, find an expert or an open-minded ped or other doc who is willing to learn and explore with you.

Interpreting D blood values may not necessarily be straightforward. My kid with issues has a vitamin D (25-hydroxy) level around 30 or 28 or something. But, his calcitriol (1,25 Di-Oh Vit D) is 90, which is high, and that is a sign of inflammation. Supplementing D3 makes his symptoms worse (so, we don't). He also has the VDR taq polymorphism, homozygous. Mine is 30-something, but my calcitriol is 44, normal. Supplementing gives me more energy as long as it isn't too much, isn't every day, and isn't too late in the day (can give me insomnia). (I also am homozygous for the VDR taq polymorphism. But, I don't have the immune dysfunction and immune deficiency that my kiddo has.) Just in passing, I have also read that supplementing vitamin D requires more magnesium to be processed. An article about vitamin D and calcitriol: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160567/

Some new consensus guidelines just came out. As one might suspect, there are still the same differences of opinion among the small group of docs who are experienced with treating PANS/PANDAS, such that certain recommendations may be taken with a grain of salt, i.e., the human body doesn't follow the rules of a consensus lol. But, they may be a starting place for primary care docs to get their feet wet. http://view.liebertpubmail.com/?qs=96fe299c9aa8dd4a19dfbc80aa826564ae2ec58bbce3515043820952c61d8a4ccf7005d7cc19a460298f7ac1cbb7b67e2f5417a130e823f5e115e9beae3312e6de4cca617224cca0 (within this article, there are further links to parts 1, 2 and 3) Discover magazine article from April http://discovermagazine.com/2017/april-2017/hidden-invaders JAMA Psychiatry Aug 2017 Inflammation in the Neurocircuitry of Obsessive-Compulsive Disorder An angle we happen to be looking much more closely at right now: Improvement of psychiatric symptoms in youth following resolution of sinusitis Interesting interview with Stanford's Dr Chang in Clinical Psychiatry News, from February, worth signing up for a free acct to read: http://www.mdedge.com/clinicalpsychiatrynews/article/131114/pediatrics/antibiotics-have-role-pans-even-no-infection As for the bolded, these don't really exist outside of Stanford, which only sees patients in a four-county radius with months-long waiting lists. The most experienced docs are either on their own or working under the radar at their big hospitals due to political pressures.

I just saw this over on CC, a statement from the UCI chancellor https://news.uci.edu/2017/08/02/message-from-uci-chancellor-about-current-admission-issues/