PING (Psychiatry Immunology and Neurology Group)

The PING (Psychiatry Immunology and Neurology Group) Clinic provides care for children, adolescents, and young adults with complex neurological and psychiatric disorders that occur following an infection or illness. Our team of providers works with a diverse group of specialties to help give our patients comprehensive care.

New patients

If you feel your child should be seen in the PING Clinic, please have your primary care provider send a referral to our clinic. Once you have received your child's appointment, download the intake information form and age-appropriate questionnaire for your child below. Fill these out in advance and bring them to your child's first appointment with us.

Please refer to the following sections on this page:

Conditions we treat

We evaluate and treat the following conditions:

  • Childhood post-infectious autoimmune encephalopathy (CPAE) or pediatric autoimmune neuropsychiatric disorder (PANS)
  • Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS)
  • Neuropsychiatric illnesses associated with autoimmune conditions such as:
    • Inflammatory bowel disease
    • Lupus

What are CPAE, PANS, or PANDAS?

Both CPAE and PANS are descriptive names for the same group of conditions. They happen when a child’s immune response to an infection causes inflammation in the brain. The inflammation can cause the sudden onset of behavioral, neurological, and personality changes. It's called 'sudden onset' because the changes occur quickly, usually within 2 to 3 days. These conditions are diagnosed in children aged 3 years to puberty. These sudden symptoms include one or both of the following:

  • Obsessive-compulsive disorder (OCD)
  • Severe avoidant or restrictive eating habits

PANDAS is a subset of PANS where symptoms are triggered by a streptococcus infection, like strep throat. Children who have had a recent infection or illness are at the highest risk for any of these 3 conditions - CPAE, PANS, or PANDAS. To be diagnosed with CPAE, PANS, or PANDAS, a child must have either OCD or restrictive eating, and 2 or more of the following neuropsychiatric symptoms:

  • Anxiety (often social or separation)
  • Behavioral or developmental regression (for example, baby talk)
  • Change in school performance, ADHD-like symptoms, memory, and cognitive changes
  • Depression or mood swings
  • Irritability or aggression
  • Sensory or motor changes (for example, new tics)
  • Trouble sleeping, bedwetting, or urinary accidents

Our services

We focus on helping patients, their families, and physicians understand these complex conditions. Our team provides:

  • Comprehensive evaluation
  • Consultation
  • Ongoing care
  • Treatments that incorporate medical and behavioral health including:
    • Managing medications
    • Preventing and treating infection and inflammation
    • Treating neuropsychiatric symptoms and providing family support with psychotherapy

As part of their evaluation or treatment your child may see providers from one or more of these specialties:

Research

We focus on improving diagnosis and treatment for patients with neuroinflammatory conditions. Our program includes ongoing clinical, epidemiological, and scientific research. We are part of the PANS Research Network as well as the CPAE Clinics of Excellence Network.

Referrals and appointments

  • If your child is a returning patient: You may use myD-H to communicate securely with your child's providers, request or change appointments, review your child's medical record, and more.
  • If you are a health care professional: To make sure the child you are referring is seen in the PING Clinic, please make sure you include PING as part of the referral.

Our team

Juliette C. Madan, Psychiatry provider.

Juliette C. Madan, MD, MS

Psychiatry

Areas of focus

  • General pediatrics
  • Child and adolescent psychiatry

Locations

  • Lebanon

View profile

Richard P. Morse, Pediatric Neurology provider.

Richard P. Morse, MD

Pediatric Neurology

Areas of focus

  • Neurodegenerative disorders
  • Pediatric epilepsy
  • Pediatric epilepsy surgery

Locations

  • Lebanon

View profile