Parents often ask me, “Is my child’s defiance just oppositional behavior, or is something bigger at play?” With cases of PANS and PANDAS rising, it’s crucial to rule out these medical conditions when sudden oppositional or defiant behaviors emerge, especially if there’s no obvious stressor or trauma behind the change.
The truth is, when your child’s behavior shifts dramatically, we need to dig deeper and put our detective hat on!
Lyme disease, Epstein-Barr, mold exposure, long-haul COVID, and other infections or toxins can trigger inflammation that affects the brain and nervous system that makes your child act differently than ‘normal’. This inflammation can mimic or contribute to conditions like Oppositional Defiant Disorder (ODD), anxiety, OCD, Autism, and more.
What is ODD?
Oppositional Defiant Disorder (ODD) is a behavioral condition characterized by consistent patterns of uncooperative, defiant, and hostile behaviors toward authority figures, including parents, teachers, or other adults. These behaviors often disrupt daily life, relationships, and activities, particularly in settings like home or school.
What is PANDAS and PANS?
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus) are medical conditions where infections, toxins, or stressors cause the immune system to attack the brain, leading to sudden and severe behavioral and emotional symptoms. A clinical diagnosis is critical for identifying PANS and PANDAS, as there are no specific lab tests available.
With PANS, a variety of triggers like Lyme, viruses, or mold can cause inflammation, while PANDAS disorder specifically results from a preceding strep infection. Both conditions often appear as a sudden onset of OCD, anxiety, rage, or regression, leaving parents wondering, “What happened to my child overnight?”
The good news? With the proper treatment targeting the root cause, healing is possible, and your child can thrive again.
Symptoms Comparison Chart: Is it ODD, PANS or PANDAS?
Category | ODD | PANS | PANDAS |
Onset | Gradual over time | Sudden, abrupt onset of symptoms | Sudden, abrupt onset of symptoms following a strep infection |
Primary Behavioral Symptoms | Persistent defiance, arguing, refusal to comply with rules or authority | Mood swings, emotional instability, rage, anxiety, obsessive-compulsive behaviors (OCD symptoms) | Mood swings, emotional instability, rage, anxiety, OCD symptoms, disabling tics, and unusual movements |
Emotional Symptoms | Anger, irritability, frequent temper tantrums | Anxiety, depression, irritability, emotional lability, eating restrictions, | Anxiety (separation anxiety), depression, irritability, emotional lability, eating difficulties |
Neurological Symptoms | None | Tics, motor abnormalities, and sensory abnormalities | Tics, motor, and sensory abnormalities |
Cognitive Symptoms | May include attention difficulties or learning struggles | Decline in school performance, brain fog, difficulty focusing | Decline in school performance, brain fog, difficulty focusing |
Physical Symptoms | None | Sleep disturbances, increase in urinary frequency, somatic complaints (e.g., stomach aches, headaches) | Frequent urination, sleep disturbances, somatic complaints (e.g., stomach aches, headaches) |
Triggers | Environmental factors, inconsistent discipline | Infections (e.g., Lyme, viruses), toxins, or stress | Group A strep infection (e.g., strep throat, scarlet fever) |
Progression | Stable over time if untreated | Symptoms wax and wane, often worsening during flares | Symptoms wax and wane, often worsening during flares triggered by recurrent strep |
Root Cause | Behavioral and environmental | Immune system dysregulation, brain inflammation | Immune system dysregulation caused by a strep-triggered autoimmune response. |
This chart lays out the key similarities and differences between ODD, PANS, and PANDAS syndrome symptoms—so you can finally stop guessing and start understanding what’s really going on with your child.
Parents often feel frustrated and defeated when their child is labeled with Oppositional Defiant Disorder (ODD) and told there’s little to be done beyond behavior management. But here’s the truth: Oppositional behaviors rarely exist in isolation—they’re usually the result of an underlying issue.
In my 30 years of working with children and families, I’ve never seen a case of ODD that didn’t have a deeper root cause. Conditions like PANS, PANDAS, or AE should always be ruled out, particularly when the behavior changes are sudden or extreme. Infections, inflammation, and toxins often dysregulate the nervous system, causing outbursts and defiance that mimic ODD.
Understanding the Brain-Behavior Connections
Infections don’t just affect the body—they wreak havoc on the brain. Research has shown that tick-borne diseases can lead to anxiety, depression, sensory issues, attention difficulties, memory problems, and neuropsychiatric symptoms. These aren’t just isolated symptoms; the inflammation often causes them, and the stress these diseases place on the nervous system.
To illustrate this connection, a groundbreaking 2021 study by Fallon, Madsen, Erlangsen, and Benros revealed that individuals with Lyme disease had significantly higher rates of mental health challenges, including suicide attempts, compared to those without Lyme.
So, when a child suddenly becomes irritable, defiant, or anxious, it’s not just “bad behavior.” It could be a physiological response to an infection or toxin that’s inflaming their brain and dysregulating their nervous system.
The Dysregulated Brain
Here’s the thing: stress is the number one enemy of your child’s brain and body. When the autonomic nervous system (ANS) is dysregulated and stuck in a hyper-activated, fight-or-flight state, the body can’t focus on healing or functioning properly. Chronic stress keeps the ANS in a constant “rev state.”
This physiological stress response doesn’t just make it harder to fight infections; it shows up in your child’s behavior as defiance, rage, panic attacks, or even obsessive compulsive symptoms. That’s why calming the brain and regulating the nervous system is key to treating conditions like PANS and PANDAS.
Treatment for ODD
- Parent Training Programs: To help parents develop positive discipline strategies and improve family dynamics.
- Behavioral Therapy: To teach children coping skills and how to manage their emotions.
- Social Skills Training: To help children build healthy relationships.
- Collaborative School Interventions: Ensuring children receive appropriate accommodations and support at school.
How to Treat PANDAS/PANS
- Target the Infection or Toxin: Work with a PANS/PANDAS-literate doctor to address underlying infections (e.g., strep, Lyme) or toxins (e.g., mold). Strep bacteria can trigger PANDAS by causing an immune response that leads to neuropsychiatric symptoms. Addressing these bacteria with antibiotic treatment is crucial to prevent associated autoimmune reactions.
- Calm the Brain: Therapies like neurofeedback, PEMF, and biofeedback help regulate the nervous system, reduce inflammation, and stabilize behavior.
- Behavioral and Psychological Support: Incorporate strategies like cognitive-behavioral therapy (CBT) to teach coping skills and build emotional resilience.
At my center, we use the BrainBehaviorReset™ Method to tailor care plans that include neurofeedback, lifestyle changes, and parent education. This holistic approach helps many children and families create a path toward healing and lasting wellness.
If your child has been labeled with ODD but their symptoms seem sudden, extreme, or linked to an illness, don’t stop there. Oppositional behaviors are often a symptom of deeper issues like PANS, PANDAS, or AE. By addressing the root cause, calming the brain, and creating a comprehensive treatment plan, you can help your child heal—and get your family back to a place of calm and connection.
To learn more about how neurofeedback can help, check out my blog: Neurofeedback for PANS and PANDAS. Or, if you’re ready to explore solutions, check out the BrainBehaviorReset™ Program to see how we can help your child thrive.
Parent Next Steps:
If your child is struggling with sudden behavioral changes, here’s what you can do:
- Rule Out PANS and PANDAS: Advocate for testing with a specialist familiar with these conditions. Identifying and treating streptococcal infections is crucial, as these infections can lead to sudden and severe neuropsychiatric symptoms in children with PANDAS.
- Calm the Brain: Explore neurofeedback, PEMF, or other therapies to regulate your child’s nervous system.
- Address the Root Cause: Work with a PANS-literate provider to identify and treat underlying infections or toxins.
- Educate Yourself: Knowledge is power. Understanding your child’s condition is the first step toward meaningful change. Check out Dr. Roseann’s free resources on PANS and PANDAS
- Use the Solutions Matcher to receive personalized treatment options for your child
Can I give SSRIs to my child with ODD?
SSRIs (Selective Serotonin Reuptake Inhibitors) are a type of medication often prescribed to treat anxiety and depression, but they should not be the first line of defense for a child with Oppositional Defiant Disorder (ODD).
ODD behaviors are typically rooted in underlying factors like stress, emotional dysregulation, or conditions such as PANS/PANDAS, ADHD, or anxiety. It's crucial to address the root causes first through behavioral therapy or response prevention therapy, parent coaching, and nervous system regulation techniques.
How is PANDAS Diagnosed and What Are the Symptoms?
PANDAS symptoms can range from sudden-onset OCD, anxiety, or behavioral issues to declines in motor skills or emotional regulation. In severe cases, children may experience a severe onset of symptoms, such as difficulty with fine motor skills or dramatic behavioral changes.
For a PANS diagnosis, your child's doctor will conduct a physical examination, evaluate the child’s history, and look for signs of an inciting infection. Testing often includes a throat culture to identify Group A strep, alongside other diagnostic tools like symptom severity scales (e.g., 0/1–4, 0/2–5, 0/1–2).
While most children respond well to early treatment, prolonged or severesymptoms may require advanced interventions, such as blood plasma therapies in extreme cases. Consulting a PANS/PANDAS-literate provider is essential for accurate diagnosis and care
Is pediatric autoimmune neuropsychiatric disorders an autoimmune disorders?
PANS and PANDAS are not traditional autoimmune disorders but involve an immune response that mistakenly targets the brain after an infection. This immune dysfunction causes inflammation, leading to sudden behavioral and emotional symptoms like OCD, anxiety, or tics.
What is the connection between PANDAS and streptococcal infections?
PANDAS is specifically triggered by streptococcal infections, such as strep throat or scarlet fever. These infections can cause the immune system to produce antibodies that mistakenly attack parts of the brain, leading to sudden-onset OCD, tics, anxiety, or behavioral changes in children.
Can a strep infection cause neuropsychiatric symptoms in children?
Yes, a strep infection can trigger neuropsychiatric symptoms in susceptible children through an autoimmune response. This is seen in PANDAS, where strep-related inflammation affects the brain, resulting in sudden behavioral changes like OCD, emotional instability, or motor tics.
How to diagnose PANDAS / PANS?
To diagnose PANS or PANDAS, medical professionals use diagnostic criteria to evaluate a child’s symptoms and medical history. A diagnosis requires:
- Sudden Onset of Symptoms: Psychiatric disorders like OCD, anxiety, or tics must appear abruptly, often triggered by infections such as a sinus infection or strep.
- Neurological Abnormalities: Children may show motor or sensory changes, such as tics, handwriting difficulties, or movement issues.
- Symptom Severity: PANS and PANDAS Symptoms are assessed to determine how severely affected children are, ranging from mild to debilitating.
- Rule Out Other Medical Disorders: It’s critical to rule out other conditions like rheumatic fever, sore throat or neurological diseases to confirm PANS/PANDAS.
Accurate diagnosis requires a detailed evaluation of psychiatric, medical, and neurological abnormalities, as well as identifying potential infections or triggers. Consulting a PANS-literate provider is essential to properly assess your child’s condition.
Can GAS Infections Trigger Tourette Syndrome or Neuropsychiatric Symptoms?
Yes, GAS infections (Group A Streptococcus) can act as an inciting infection for neuropsychiatric conditions like PANDAS. In these cases, children may exhibit sudden-onset symptoms, including OCD, tics, or behaviors resembling Tourette Syndrome.
Such PANDAS / PANS symptoms are often episodic, waxing and waning over time, with severity ranging from 0/1–5 on a symptom severity scale. Diagnosing these conditions requires careful evaluation of neuropsychiatric and behavioral changes, with consideration of 0/1–3 additional contributing factors, such as immune response and co-occurring triggers.
Dr. Roseann is a mental health expert in Neurodivergence who is frequently in the media:
- Business Insider How to practice ‘autonomy-supported parenting' to boost your family's wellbeing
- Healthline Get Stuff Done: A Realistic Guide to Working From Home with Kids
- Love Shack Live How To Navigate The Parenting Journey As A Couple
Always remember… “Calm Brain, Happy Family™”
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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Dr. Roseann is a Children’s Mental Health Expert and Licensed Therapist who has been featured in/on hundreds of media outlets including The Mel Robbins Show, CBS, NBC, PIX11 NYC, Today, FORBES, CNN, The New York Times, The Washington Post, Business Insider, Women’s Day, Healthline, CNET, Parade Magazine and PARENTS. FORBES called her, “A thought leader in children’s mental health.”
She coined the terms, “Re-entry panic syndrome” and “eco-anxiety” and is a frequent contributor to media on mental health.
Dr. Roseann Capanna-Hodge has three decades of experience in working with children, teens and their families with attention-deficit hyperactivity disorder (ADHD), autism, concussion, dyslexia and learning disability, anxiety, Obsessive Compulsive Disorder (OCD), depression and mood disorder, Lyme Disease, and PANS/PANDAS using science-backed natural mental health solutions such as supplements, magnesium, nutrition, QEEG Brain maps, neurofeedback, PEMF, psychotherapy and other non-medication approaches.
She is the author of three bestselling books, It’s Gonna Be OK!: Proven Ways to Improve Your Child's Mental Health, The Teletherapy Toolkit, and Brain Under Attack. Dr. Roseann is known for offering a message of hope through science-endorsed methods that promote a calm brain.
Her trademarked BrainBehaviorResetⓇ Program and It’s Gonna be OK!Ⓡ Podcast has been a cornerstone for thousands of parents facing mental health, behavioral or neurodevelopmental challenges.
She is the founder and director of The Global Institute of Children’s Mental Health, Neurotastic™Brain Formulas and Dr. Roseann Capanna-Hodge, LLC. Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS), Certified Integrative Mental Health Professional (CIMHP) and an Amen Clinic Certified Brain Health Coach. She is also a member of The International Lyme Disease and Associated Disease Society (ILADS), The American Psychological Association (APA), Anxiety and Depression Association of America (ADAA) National Association of School Psychologists (NASP), International OCD Foundation (IOCDF).
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