PANDAS is definitely on the differential, except we couldn't find an initial infection. He definitely had several weird illnesses surrounding the onset but it was a chronic cough and then multiple days of diarrhea. but no obvious strep. It did get way worse after this last strep infection, but he'd need speech even if it is PANDAS so I'm just kinda in limbo land until the neurologist appointment. The SLP says it could still be developmental technically, but he has some actual blocks and other scary things that make her concerned. She's definitely willing to learn to treat him specifically and is doing research on how to best help him. He does have an expressive speech delay with articulation issues. When he was evaluated at 2 he didn't flag for a language delay, but now we wonder because sometimes it seems like he doesn't seem to understand questions when asked them. He's very very intelligent but has what we think is severe ADHD. I'm sure it's all connected somehow, but the blocks are really scary and when he gets stuck on a word I feel so so bad for him. The strangest part is how it'll get better and then worse again but there isn't anything (aside from the strep) that I can contribute it too. Like we had a very chill day yesterday and it was worse than it's ever been.