Understanding PANS and PANDAS: What Mental Health Symptoms May Be Telling Us

Parents know their children better than anyone. When a child begins experiencing severe anxiety, obsessive thoughts, restrictive eating, emotional outbursts, or sudden changes in behavior, it can be frightening and confusing.

Many families are told it is just anxiety, or a phase, or that the symptoms will eventually pass. Others receive one or more diagnoses such as anxiety, OCD, ADHD, ODD, ARFID, or sensory processing disorder. These diagnoses may accurately describe what a child is experiencing. However, they do not always explain why those symptoms developed.

Instead of asking only which diagnosis fits the symptoms, it is equally important to ask what those symptoms might be telling us. One possibility is PANS or PANDAS, two conditions that have gained increasing attention among pediatricians, neurologists, psychiatrists, psychologists, immunologists, and researchers over the past two decades.

What Are PANS and PANDAS?

PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome. PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.

Both describe conditions in which changes in a child’s emotional, behavioral, and neurological functioning may relate to an underlying immune response. The main difference between the two is the trigger.

PANDAS

PANDAS is associated specifically with a recent Group A Streptococcal infection, commonly known as strep.

PANS

PANS is broader. Potential triggers may include:

• Viral infections
• Mycoplasma pneumonia
• Influenza
• Lyme disease and other tick-borne illnesses
• COVID-19
• Immune system activation
• Significant inflammation
• Other environmental or medical stressors

Researchers believe these triggers may activate the immune system in susceptible children. That response can lead to inflammation affecting areas of the brain involved in emotion regulation, movement, anxiety, and behavior.

What Happens in the Brain?

The symptoms seen in PANS and PANDAS are not simply behavior problems. Research suggests that inflammation may affect the basal ganglia, a group of structures deep within the brain involved in:

• Habit formation
• Movement and motor control
• Emotional regulation
• Decision making
• Cognitive flexibility

When these circuits become disrupted, children may lose abilities they previously had, develop overwhelming fears, or struggle to control obsessive thoughts and compulsive behaviors. Many parents describe feeling as though their child has become a different person almost overnight.

Common Symptoms of PANS and PANDAS

Every child is different, and symptoms vary considerably. Below are the categories parents most often notice.

Restrictive eating in these cases can sometimes resemble anorexia, even though the underlying driver is different. That distinction matters for treatment planning.

Why Are PANS and PANDAS Often Missed?

Many of these symptoms overlap with anxiety disorders, OCD, ADHD, eating disorders, tic disorders, and mood disorders. Those diagnoses may describe a child’s symptoms accurately. However, they do not always explain what is contributing to them.

PANS and PANDAS also remain areas of ongoing research, and not every provider is familiar with the current diagnostic criteria. As a result, many families spend months, and sometimes years, searching for answers.

The PANDAS Physicians Network maintains diagnostic and treatment guidelines for clinicians, along with a directory of providers experienced in evaluating these conditions.

How Are PANS and PANDAS Diagnosed?

PANS and PANDAS are clinical diagnoses, which means no single laboratory test confirms either condition. Diagnosis is made by a physician and is based on:

• A detailed medical history
• Physical examination
• Evaluation for recent infections
• Laboratory testing when appropriate
• Ruling out other medical conditions

Depending on the child’s symptoms, medical providers may also assess immune function, inflammatory markers, evidence of recent infection, and other conditions that could contribute to neuropsychiatric symptoms. Because the picture can be complex, evaluation is typically performed by physicians experienced in these conditions.

Treatment Often Requires a Team Approach

Every child is unique, and treatment should be individualized. Because PANS and PANDAS can involve both medical and psychological factors, children often benefit from care that addresses the whole child rather than isolated symptoms.

Medical providers may evaluate and treat potential underlying triggers. Meanwhile, mental health professionals help children regain emotional regulation, reduce anxiety, strengthen coping skills, and return to everyday life. Treatment may include:

• Medical evaluation and treatment as directed by the child’s physician
• Individual and family therapy
• Parent education and support
• School accommodations
• Stress reduction strategies
• Sleep support
• Occupational therapy when appropriate
• Ongoing collaboration among providers

Many children also benefit from rebuilding the foundations that support a well-regulated nervous system, including quality sleep, balanced nutrition, regular movement, and steady daily routines. For some families, tools such as biofeedback and nervous system regulation training become a helpful part of that work.

Our Whole-Person Approach

At Cornerstone Therapy and Wellness, we recognize that mental health is shaped by biology, psychology, relationships, lifestyle, and environment. Rather than focusing only on a diagnosis, we work with families to understand the full picture.

For children with PANS or PANDAS, therapy may include:

• Managing anxiety, OCD, and emotional dysregulation
• Helping parents respond effectively to challenging behaviors
• Supporting school success and collaboration with educators
• Teaching emotional regulation and coping skills
• Rebuilding confidence and resilience during recovery
• Coordinating care with pediatricians and other providers when appropriate

Our goal is not simply symptom reduction. We want to help children return to learning, friendships, family life, and the activities they enjoy, while supporting the long-term well-being of the entire family.

When Should Parents Seek an Evaluation?

Consider speaking with your child’s pediatrician or another knowledgeable provider if your child experiences:

• OCD symptoms or intrusive, ruminating thoughts
• Severe or sudden anxiety
• Noticeable changes in personality or behavior
• Motor or vocal tics
• Restrictive eating or significant changes in eating habits
• A decline in school performance or daily functioning
• Emotional or behavioral symptoms that began after an illness or infection

Early evaluation helps determine whether additional medical investigation or specialized care makes sense for your child. Families looking for additional background and support can also visit PANDAS Network, a national nonprofit that provides parent resources and tracks current research.

Frequently Asked Questions

What is the difference between PANS and PANDAS?

Both involve sudden neuropsychiatric changes that may be linked to an immune response. PANDAS is tied specifically to a recent Group A Streptococcal infection. PANS is broader and may follow other infections, inflammation, or immune activation.

How quickly do symptoms appear?

Onset is often described as abrupt. Many parents can identify a specific week, or even a specific day, when their child changed. That sudden onset is one of the features that distinguishes these conditions from a gradually developing anxiety disorder.

My child already has an anxiety or OCD diagnosis. Does that rule this out?

Not necessarily. An existing diagnosis describes the symptoms your child is experiencing. It does not always identify what triggered them. If the onset was sudden, or if symptoms followed an illness, the question is still worth raising with your pediatrician.

Does therapy still help if PANS or PANDAS is involved?

Yes. Therapy supports emotional regulation, reduces anxiety and OCD symptoms, gives parents practical tools, and helps children rebuild daily functioning. It works best alongside appropriate medical care rather than in place of it.

How do we get started at Cornerstone?

Reach out through our scheduling page to learn about availability, insurance, and next steps. No referral is needed. We accept most major insurance plans and offer online therapy throughout Pennsylvania for families who prefer remote sessions.