What is PANS/ PANDAS?

Hailey Kohler
Oct 20
4 min read

As therapist providing OCD therapy, I at times find myself getting the call that lines up with PANS/PANDAS. A sudden onset of symptoms in a young child where parents will commonly say, "I put them to bed one kid, and they woke up a different kid." I wanted to create a post to support awareness and provide resources for those impacted.

What are PANS and PANDAS?

PANS and PANDAS are related but distinct syndromes that refer to a sudden onset of neuropsychiatric symptoms in children, often including obsessive‐compulsive behaviors, tics, food‐intake changes, mood/behavioral shifts, and sometimes urinary or motor symptoms.

The term PANDAS was coined first. It stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. In short, it’s the idea that a streptococcal (“strep”) infection triggers an autoimmune reaction that affects the brain, leading to abrupt onset of symptoms.
The broader term PANS stands for Pediatric Acute‑onset Neuropsychiatric Syndrome. It includes cases of abrupt onset neuropsychiatric symptoms even when a strep infection is not clearly identified.
Thus: PANDAS can be considered a subset of PANS (i.e., abrupt onset linked to strep).

In short: A child who was doing more or less “okay,” then quickly (sometimes seemingly overnight) develops dramatic changes — new obsessive thoughts, compulsive behaviors, tics, sometimes severe anxiety or mood changes, eating restrictions, etc. That’s the hallmark.

What might cause it?

The exact causes remain under investigation, and the syndromes are somewhat controversial in some medical circles — partly because it can be hard to definitively prove the autoimmune/infectious trigger in every case. But here’s what is known or hypothesized:

In the case of PANDAS: A strep (Group A Streptococcus) infection precedes the onset of the symptoms (or a clear temporal link). The body’s immune response to the strep infection is thought to mis‑fire and attack parts of the brain (basal ganglia is often mentioned) leading to neuropsychiatric symptoms.
In PANS: The trigger may be broader — various infections (viral, bacterial, mycoplasma, etc.), metabolic disturbances, environmental stressors may act as triggers. Because of this heterogeneity, PANS is a broader category.
There is also thought to be some immune‑mediated (“autoimmune”) component: the immune system begins reacting in a way that affects brain function (rather than simply the direct effect of an infection). For example, one web source states: “The syndrome is thought to be triggered by one or more pathogens … immune reaction.”

So while a trigger may be infection, the major issue is the sudden neuropsychiatric symptoms that follow.

How do PANS / PANDAS differ from “typical” OCD or tics?

A key point is the abruptness and severity of symptom onset.

In typical OCD, symptoms often build gradually over weeks, months or years.
In PANS/PANDAS the hallmark is rapid onset (sometimes within days) of OCD or restrictive eating plus additional symptoms.
For example: A child with no prior tics gets overnight vocal tics; or a previously stable child suddenly refuses most food, shows intense anxiety, OCD symptoms, mood changes. That sudden change should raise a red flag.
Also in PANDAS, the episodic/relapsing nature is important: symptoms may worsen with subsequent infections or triggers.
Behavior/cognitive/neurologic symptoms may include: anxiety, separation anxiety, irritability, mood lability, regression in school performance, handwriting changes, urinary frequency, sleep disturbances, motor/sensory abnormalities.

Recognizing the symptoms

Here are some of the major symptoms and features to look for (though of course diagnosis always involves a healthcare professional).

Possible presenting signs

Sudden onset of OCD (obsessions/compulsions) or severely restricted food intake (in PANS)
New or dramatic onset of tics (motor or vocal)
Abrupt mood and behavioral changes: anxiety, irritability, aggression, separation anxiety
Cognitive or academic decline: drop in grades, difficulty with tasks, handwriting changes
Motor/sensory changes: clumsiness, sensory amplification, movement abnormalities
Sleep disturbances, bed‑wetting or new urinary frequency/incontinence
Eating changes: refusal, restrictive eating, selective eating beyond usual picky behaviors
Trigger history: recent infection (in PANDAS especially) or other physiologic stressor

Treatment approaches

Treating PANS/PANDAS typically involves multiple tracks: addressing infection/immune issues, managing symptoms, and supporting recovery. Because each child is different, an individualized plan is key.

1. Addressing infection / immune trigger

In the case of PANDAS (linked to strep) antibiotics are used to treat the strep infection.
In broader PANS cases, treatment may include antimicrobials or addressing other infectious triggers.
Immunomodulatory treatments (in more severe cases) — for example anti‑inflammatory therapies, IVIG (intravenous immunoglobulin), steroids/plasmapheresis may be considered under specialist care.

What can parents, caregivers or educators do?

Here are some practical suggestions if you suspect PANS/PANDAS or are supporting a child:

Document the timeline: When did the symptoms start? Was there a recent infection? How rapidly did they appear? This helps clinicians.
Seek a multidisciplinary team: Pediatrician, child psychiatrist/psychologist, infectious disease/immunology if needed, neurologist if motor/tic issues.
Coordinate with the child’s school: Share information, request appropriate support, communicate about recent changes (e.g., sudden drop in grades, handwriting issues, tics interfering with class).
Support the child’s mental health: Early therapy (CBT/ ERP therapy) can help reduce suffering even as underlying cause is addressed.
Take care of the family: Sudden onset of neuropsychiatric illness in a child is stressful. Make sure caregivers get support. Connect with a support group if available.
Monitor for recurrence: Because triggers may re‑emerge (infections, stress), have a plan for what to do if symptoms flare again.
Educate yourself: Understand the disorder but also verify sources — some information online may be inaccurate or conflated with unproven treatments.

Three Resources

Here are three trusted resources where you can find up‑to‑date information, clinician directories, family support and more:

PANDAS Physicians Network (PPN) – Comprehensive information, diagnostic/treatment guidelines, practitioner directory and family resources.
Website: “What is PANS/PANDAS?” and Guidelines pages. PPN+1
PANDAS Network – Offers resources for families and clinicians, latest research, videos, physician finder. pandasnetwork.org +1
National Institute of Mental Health (NIMH) – “PANS and PANDAS: Questions and Answers” – A concise, authoritative overview for families and clinicians. National Institute of Mental Health