Ignore, for a moment, his endless rocking, minus the rocking chair.

And forget about his white, outsized long-sleeved shirt, which he uses to hide the damage caused by his obsessive urge to scrub his hands to kill germs and calm his fears.

Instead, just listen. Spencer Kohalmi of Pembroke has something to say, despite his unique mannerisms. Honest, heartfelt thoughts that illustrate the complex inner workings of a student at Three Rivers School who suffers from an illness – PANDAS – that few have heard of.

Asked if his illness has made it difficult to express himself, Spencer, who turns 12 Monday, said, “I guess I am sort of shy, but I am not completely sure about that. It’s just that there are certain people who scare me.”

And asked to explain his hand-washing habits, Spencer said, “Sometimes when I am nervous I do it. But sometimes it just kind of happens. Sometimes it feels like it should happen.”

With his calm responses and ability to express himself clearly, it was obvious Spencer was having a good day this week at home in the day room, with a giant stuffed gorilla named Coco sitting next to him, and his mother, Bethany Kohalmi, next to Coco, on the opposite end of the couch.

PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorder Association with Streptococcal Infections. The disease follows the strep infection and causes severe physical, neurological, and psychological trouble.

The illness is tricky, with a defense system adept at hiding from the body’s natural defenses. That’s why Bethany wants her voice heard. She was in the dark like many professionals were when Spencer’s symptoms surfaced at age 7. His diagnosis wasn’t officially declared until last year, four years later, although Bethany’s exhaustive online research had told her earlier that her son most likely had PANDAS.

“I think there are other kids out there who were misdiagnosed as well,” Bethany said. “And if you’re trying to treat someone like it was autism when it is actually PANDAS, you won’t get far.”

She learned that medication combined with therapy could help, and that PANDAS follows the strep infection and affects one out of every 200 children, sometimes shutting down their communication skills like a light switch, leading to a blank stare.

Spencer’s other symptoms have included obsessive compulsion behavior, nervous tics, meltdowns, unpredictable mood swings and behavior that leaves faculty at Three Rivers School clueless on how to react. He’s bitten himself, leaving deep marks.

The disease isn’t normally fatal and medical data online says many sufferers will outgrow it by adolescents. But the confusion and fear that PANDAS has created in the Kohalmi family over the past five years are real and ongoing.

And in that time, while the medical community had called Spencer’s condition autism or OCD, Bethany watched his personality change in lightning-quick fashion, seemingly overnight.

Before second grade, Bethany says, Spencer was outgoing, friendly, fun. After strep at age 7, though, the problems began.

Spencer started touching his fingers for no apparent reason. His eyes began blinking a lot. He’d lick his lips nonstop, causing them to be chapped and red. He showed an unnatural passion for winning in school sports, a trait he had never shown before. He became a germaphobe. He’d pull his shirt over his face to shut the world out. If the circle he drew to make a pumpkin wasn’t perfect, or he got an answer wrong on a math test, he tore the papers in anger.

“Now teachers bring extra papers, just in case,” Bethany said. “In the second grade, he was running out of the classroom, shutting down and no teacher could get through to him. They would put him in a secluded room where they just left him because no one knew what to do or why it all of a sudden started happening.”

PANDAS remained off the medical community’s radar, the capital letters tossed around during endless meetings with doctors and psychiatrists, but a final analysis never quite documented that Spencer had an illness with no connection to a cute bear.

Tests eventually showed that Spencer indeed had had strep, back when he was 7 and again earlier this year. Bethany credits the school psychiatrist for diagnosing it and for helping her bring the illness out in the open.

These days, Bethany said Spencer takes antibiotics and has improved. No tics lately. And his behavior is under control as well.

He’s due to visit doctors at Dartmouth Hitchcock Medical Center who specialize in PANDAS, but Bethany worries that her insurance coverage and a deductible of $4,000 will cause problems.

Meanwhile, Spencer covered his hands last week with long sleeves and rocked on the couch, slow and steady. He’s not thrilled about waking early to catch the bus for school, and he loves art.

A clay project recently went awry. The kiln broke overnight.

“I was making a cup, a mug,” Spencer said. “We put them into the kiln to harden and the kiln malfunctioned. That caused a domino effect and some of the clay projects were burned. Mine had that same fate.”

Bethany heard her son’s words, spoken with no delay and confidence. She wasn’t paying attention to his rocking and hands hiding.

“Some of the words he uses,” Bethany said, “I don’t think I knew or used when I was 12.”

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