Was your child diagnosed with PANS/PANDAS and you’ve been seeing his/her struggle at learning? PANS/PANDAS can cripple a child mentally and emotionally, making learning difficult both at home and in school.
As a parent of neurodivergent child myself, I understand the fear of your child falling behind in school, not reaching his/her potential, and being misunderstood or isolated from their peers. Their ability to function independently can be affected as a result of the symptoms that come with PANS and PANDAS, and coping with the effects is hard without the right support and guidance.
The good news is: once your child is well enough to return to school, a 504 accommodation plan can be set up to help him/her succeed.
Having created probably hundreds of 504 plans for students with PANS/PANDAS or AE, I know how important it is to customize plans that could support “flare” periods – times when the child has a resurgence of symptoms. This way, your child will be able to develop flexibility and coping skills that he/she can use in the future when flare ups happen.
What is PANS/PANDAS and AE?
PANS/PANDAS are separate conditions that occur when a child's immune system produces antibodies that attack the brain, leading to sudden onset of neuropsychiatric symptoms. These symptoms can include obsessive-compulsive behaviors, tics, anxiety, depression, and difficulty with attention and learning. PANS/PANDAS is often triggered by an infection, most commonly strep throat, Lyme Disease, mold, and other infections or toxins.
On the other hand, AE, or autoimmune encephalitis, is a related condition in which the immune system produces antibodies that attack the brain, leading to a variety of neurological symptoms. What distinguishes AE from PANS/PANDAS is that the symptoms don’t suddenly occur. . The source of and the symptoms are otherwise the same.
How PANS/PANDAS Can Impact Your Child’s Education
PANS/PANDAS in children can have a significant impact on their ability to learn, pay attention, and behave in the classroom. Children with PANS/PANDAS may experience sudden onset of symptoms that can make it difficult for them to focus on their schoolwork.
- Sudden onset of symptoms that can make it difficult to focus on schoolwork.
- Anxiety and mood swings that can interfere with learning and classroom participation.
- Anxiety, depression, OCD and other clinical issues that lead to school refusal.
- Anger that impacts social functioning.
- Obsessive-compulsive behaviors that can disrupt classroom activities.
- Tics and other involuntary movements that can be distracting for both the child and their classmates.
- Impulsivity that can lead to difficulty following directions or staying on task.
- Memory problems that can impact learning and retention of information.
- Emotional dysregulation that can cause outbursts or meltdowns.
- Fatigue and lethargy that can impact attendance and participation in school activities.
- Sensory processing issues, which can impact a child's ability to focus and learn in a stimulating environment.
- Difficulty with executive functioning, which can cause problems with planning, organization, and time management.
- Problems with task initiation and completion.
- Problems staying focused while reading and writing.
- Visual issues that impact reading.
- Hyperactivity, which can make it difficult for a child to sit still and focus on their work.
- Regression in developmental skills, such as language, motor skills, or social skills.
- Sleep disturbances, which can impact a child's ability to stay alert and focused during the school day.
- Chronic pain or discomfort, which can be distracting and make it difficult to focus on schoolwork.
- Inconsistent behaviors due to flares.
All of these symptoms can make it challenging for children with PANS/PANDAS or AE to succeed in school without the proper support and accommodations. It is important for parents, guardians, school staff, and health care providers to work together to provide the necessary support for these students to thrive in the classroom.
Steps to Ask for a 504 Plan for PANS/PANDAS
If your child has been diagnosed with PANS/PANDAS or AE, it is important to work with your child's school to create a plan to support their success in the classroom. One option is to request a 504 plan, which is a legal document that outlines the accommodations and modifications that your child needs to receive a free and appropriate education.
To request a 504 plan, a parent should:
- Contact the school's 504 coordinator. Every school district is required to have a designated 504 coordinator who is responsible for overseeing the implementation of 504 plans.
- Request an evaluation. The school will need to conduct an evaluation to determine whether your child is eligible for a 504 plan. This evaluation may include assessments by school personnel, a record review including an examination of school standardized tests, as well as input from your child's mental health or healthcare provider.
- Attend a meeting. Once the evaluation is complete, you will attend a meeting with school staff to discuss the results and determine whether your child is eligible for a 504 plan, which means their PANS/PANDAS has a significant impact on your child’s education.
- Develop a plan. If your child is found to be eligible for a 504 plan, you will work with the school to develop a plan that outlines the accommodations and modifications your child needs to succeed in the classroom.
Qualifying Symptoms for a 504 Plan
To qualify for a 504 plan, a student must have a physical or mental impairment that substantially limits one or more major life activities. I’ve listed down general qualifying impairments below that apply to PANS/PANDAS. This list is not exhaustive, so be sure to consider your child’s specific or unique symptoms and how they may affect their learning and daily functioning.
Eating, Sleeping, or Walking
- Walk: Children with PANS/PANDAS may experience tics or involuntary movements that affect their ability to walk safely or comfortably.
- Eat: Restricted food intake is a hallmark symptom of PANS. Sensory sensitivities, anxiety, or obsessive thoughts may severely limit your child’s diet, sometimes leading to nutritional challenges.
- Sleep: Sleep disruptions are common due to night terrors, separation anxiety, reduced REM sleep, or lengthy bedtime rituals caused by obsessive-compulsive behaviors. These sleep challenges can significantly impact their energy and focus during the day.
Communication
- Speak: Some children with PANS experience selective mutism, making it difficult to communicate in specific environments. Tics or vocal disruptions may also interfere with their ability to speak clearly or consistently.
- Communicate: Anxiety, intrusive thoughts, or emotional dysregulation can hinder your child’s ability to express their needs or feelings effectively, further complicating social and academic interactions.
Focus, Thinking, and Learning
- Concentrate: Many children with PANS struggle with brain fog, which can make it hard to focus on tasks, follow lessons, or complete assignments. ADHD-like symptoms are also common, adding to attention difficulties.
- Think: Intrusive thoughts caused by OCD, a key symptom of PANS, can disrupt rational thinking and problem-solving, leading to frustration and overwhelm.
- Learn: PANS can affect processing speed, executive functioning, and memory. Developmental regression, another potential symptom, may cause your child to lose skills they previously mastered, impacting their academic progress.
Work or Movement
- Work: Tics and motor impairments can make it challenging to complete tasks requiring fine motor skills, such as writing or typing. Dysgraphia, frequently seen in PANS, can hinder written communication, while fatigue from poor sleep may reduce overall academic productivity.
These impairments are only few of many that qualify your child for a free 504 plan. It is important to document your child’s symptoms or changes in behavior, so the school and designated 504 person can better assess and support your child.
Accommodations for PANS/PANDAS
When developing a 504 plan for a child with PANS/PANDAS, there are a variety of accommodations that can be considered depending on what symptoms your child is experiencing. It is important to work with your child's healthcare provider and the school team to determine which accommodations will be most helpful for your child.
504 accommodations for PANS/PANDAS/AE may include:
- Extra time on assignments and tests.
- Reduced workload
- Breaks as needed.
- Access to high protein snacks
- The ability to work in a quieter environment.
- Access to assistive technology, such as speech-to-text software.
- Permission to use fidget toys or other assistive devices
- Sensory supports
- A designated person at school who can help the child manage their symptoms.
- A designated area they can go to when overwhelmed or upset.
- A plan for excused absences or missed assignments due to flare-ups or doctor appointments.
- Flexible or late start schedule.
- Support from a school psychologist or counselor.
- Additional training for school staff on how to support the child with PANS/PANDAS and common co-occuring conditions such as OCD.

PANS/PANDAS can fall under both categories, depending on the severity of the symptoms and their impact on the child's ability to learn. Ultimately, the decision between a 504 plan and an IEP should be made based on the individual needs of the child.

Implementation of the 504 Plan
Once a 504 plan is in place, its success relies on consistent implementation and regular updates to reflect the child’s evolving needs. For students with PANS/PANDAS, this process requires particular attention to the fluctuating nature of their symptoms.
- Teacher Responsibilities: Classroom teachers are primarily responsible for implementing the accommodations outlined in the plan. This ensures that the child receives the necessary support in their day-to-day learning environment.
- Support from Staff: Guidance counselors, special education staff, or other school personnel often assist in managing the plan's implementation, acting as a resource for teachers and a point of contact for parents.
Reviewing the 504 Plan
For children with PANS/PANDAS, regular review of the 504 plan is critical due to the condition’s episodic nature.
- Annual or As-Needed Reviews: The planning team should meet at least annually to assess the effectiveness of the plan. However, more frequent reviews may be necessary if symptoms worsen due to a trigger or improve significantly with treatment.
- Adjustments for Relapse and Remission: Because PANS/PANDAS symptoms can vary widely, accommodations may need to be modified to address new challenges during a relapse or scaled back during periods of remission.
Termination of the 504 Plan
A 504 plan may be discontinued when it is no longer necessary to support the student. This typically occurs when:
- The student’s symptoms no longer impact their ability to learn or participate in school.
- Accommodations are no longer required to address deficits or provide support.
- The student can succeed in a general education setting without additional assistance.
By staying flexible and proactive, families and schools can work together to ensure the 504 plan remains a living document that evolves to meet the child’s changing needs. Remember, your advocacy and partnership with the school play a key role in supporting your child’s success.
Suggestions for Teachers and School Personnel Supporting Students with PANS/PANDAS
Teachers and school personnel can play a crucial role in supporting students with PANS/PANDAS. It is essential that school staff get training in what PANS/PANDAS/AE is and how it affects students.
One of the most common questions I get about PANS/PANDAS is about why the child’s behaviors are so inconsistent. Explaining to staff that it occurs because of how brain inflammation goes up and down with stress, other infections, lack of sleep, problems with detoxification, and the infections and toxins within the body. When the brain is more inflamed, then symptoms increase and when inflammation is lower, behaviors decrease.
Suggestions for how school staff can support these students:
- Learn about PANS/PANDAS and how the condition can impact a child's learning and behavior.

- Work with the parents to understand the child's needs and how they can be supported in the classroom.
- Work with the parents and school team to develop a 504 plan or IEP that outlines the accommodations and modifications the child needs.
- Recognize that the child’s behaviors and issues will be variable and don’t challenge the child or family because of this variability.
- Provide a quiet space for the child to work in when needed.
- Allow for flexibility in the child's schedule and assignments to accommodate for flare-ups or missed days.
- When a student is out of school or has school refusal, be creative and thoughtful in getting a student back to school.
- Provide support for the child's social-emotional needs, such as access to a school counselor or psychologist.
- Work with the child's healthcare provider to ensure that the child is receiving appropriate medical treatment.
- Seek out additional training on how to support students with PANS/PANDAS.
PANS/PANDAS can have a significant impact on a child's ability to learn, pay attention, and behave in the classroom. Working with the school to create a 504 plan or IEP can help provide the support and accommodations that these students need to succeed.
It is important for parents, guardians, and school staff to work together to ensure that students with PANS/PANDAS receive the appropriate school accommodations and support they need to be successful in school.

Citations:
U.S. Department of Education. (2016). Parent and Educator Resource Guide to Section 504 in Public Elementary and Secondary Schools. Retrieved from https://www2.ed.gov/about/offices/list/ocr/docs/504-resource-guide-201612.pdf
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Disclaimer: This article is not intended to give health advice and it is recommended to consult with a physician before beginning any new wellness regime. *The effectiveness of diagnosis and treatment vary by patient and condition. Dr. Roseann Capanna-Hodge, LLC does not guarantee certain results.
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