One of the pervasive issues I get asked about a lot is misdiagnosis, especially when it comes to conditions like PANS, PANDAS, ADHD, and mood disorders. These diagnoses can be incredibly tricky because their symptoms often overlap, such as anxiety, emotional dysregulation, irritability, and even inattention. For many, this overlap tends to cause confusion, delaying the right interventions and often worsening their struggles.
In today's episode, we'll talk about the differences among these conditions to help parents better understand what’s happening with their children. By identifying the specific signs, triggers and patterns unique to each, parents can make more informed decisions about their child’s care.
Misdiagnosis due to overlapping symptoms
Misdiagnosis is common among PANS, PANDAS, ADHD, and mood disorders because these conditions share so many overlapping symptoms. It can leave parents feeling lost and frustrated, especially when clinical conditions co-occur, which is more common now than ever. Getting to the root cause is essential because you can’t get proper help without understanding what’s truly driving your child’s behavior—whether it’s inattention, aggression, anxiety, or emotional dysregulation.
The tricky part is that all these conditions affect the same brain regions responsible for attention, emotional regulation, behavioral control, and impulse control. So on the surface, they can look the same. But the truth is that the underlying causes are very different. Biology, genetics, diet, infections, and even toxins all play a role.
PANS and PANDAS are driven by neuroinflammation caused by infections, which can lead to sudden and dramatic changes in behavior. ADHD, on the other hand, is often a constant struggle tied to executive functioning challenges. Mood disorders are rooted in emotional dysregulation and tend to show up as persistent low frustration tolerance, rejection sensitivity, and negativity.
Another challenge is the rise in “shopping cart diagnoses.” It’s much more common today for kids to have multiple diagnoses than it was 30 years ago, because of changes in diet, higher stress levels, and increased expectations at school and home. While some diagnoses are accurate, PANS and PANDAS are often overlooked.
Parents also face the challenge of not knowing what to look for. People nowadays tend to search online seeking advice, only to get conflicting or incomplete guidance. If your child’s diagnosis doesn’t seem to fit or feels like a collection of unrelated symptoms, it’s time to look deeper—PANS and PANDAS could be a piece of the puzzle.
Common Symptoms among PANS/PANDAS, ADHD, and Mood Disorder
While these conditions share similar symptoms, the underlying causes are fundamentally different. Understanding these distinctions is essential to getting the right support for your child and addressing their specific needs effectively.
One of the common symptoms is inattention. With ADHD, inattention is a constant struggle. It’s like this ever-present cloud hanging over your child’s ability to start, stay focused on, or finish tasks. Mood disorders, on the other hand, tend to tie inattention to emotional states. If a child is feeling overwhelmed, upset, or stuck in their emotions, their focus just evaporates. But with PANS and PANDAS, inattention is different. It comes and goes in waves. One week your child might be able to concentrate just fine, and the next, they’re completely scattered. That shift is usually tied to a flare, which is triggered by an illness or infection.
When it comes to emotional dysregulation, it is immune-driven with PANS and PANDAS. You might see sudden outbursts or shifts in mood, from minor “micro flares” to full-on meltdowns during bigger immune flares. ADHD-related dysregulation, though, is more about impulse control. Kids with ADHD struggle with distress tolerance and tend to react quickly and intensely to situations they find frustrating. With mood disorders, it’s different yet again. The emotional instability is consistent. These kids often have a low frustration tolerance, struggle to see their role in conflicts, and experience rejection sensitivity, where even small setbacks feel like big personal attacks.
And then there’s anxiety, which seems to show up in all three conditions but in very different ways. With PANS and PANDAS, anxiety often fluctuates alongside immune responses. During flares, you might notice a spike in worry, panic, or even obsessive-compulsive tendencies. ADHD-related anxiety, though, is usually tied to executive functioning struggles. Kids might worry about forgetting something important or falling behind on schoolwork, and it often leads to a constant state of nervousness. With mood disorders, anxiety is more tied to chronic negativity. These kids can get stuck in negative thought patterns that feed their worry.
Behavioral and Sleep Disturbances
These conditions may also present with irritability and aggression, behaviors that can emerge suddenly without an obvious cause. ADHD-related irritability is typically tied to frustration or being told “no,” and tends to run in families with low frustration tolerance as a learned behavior. Mood disorders, on the other hand, exhibit more persistent irritability and aggression, often accompanied by mood cycling, such as low-level shifts in depressive or manic states. These behaviors are more constant and may intensify during puberty or with increasing life demands.
Sleep disturbances are another common thread across these conditions, though their causes differ. In PANS and PANDAS, anxiety and OCD-related rituals can interfere with falling asleep. ADHD-related sleep issues often stem from hyperactivity and an inability to wind down, while mood disorders can disrupt sleep depending on the individual’s mood cycle. The onset of symptoms also varies significantly. PANS and PANDAS exhibit a sudden and dramatic onset or worsening, while ADHD symptoms emerge gradually as life demands increase. Mood disorders develop over time, accelerating during key developmental stages.
The key differences among PANS/PANDAS, ADHD, and mood disorders also lie in their triggers and patterns. For PANS/PANDAS, triggers are often infections or toxins, leading to sudden flares in behavior. ADHD, on the other hand, is typically triggered by behavioral demands, such as tasks that are frustrating or unappealing to the child’s brain. However, ADHD kids often exhibit hyperfocus on activities they love, excelling in those areas despite external chaos, a trait that, with the right guidance, can become a strength. Mood disorders are triggered by everyday life challenges, such as feelings of failure, criticism, or the natural ups and downs of mood cycles. These children often exhibit persistent negativity, pushback, and emotional turbulence.
For parents, tracking patterns is essential to understanding triggers and behaviors. This detective work, observing connections between events, like illness, school stress, or specific requests, and behavioral outbursts, can help identify root causes. Unfortunately, many providers lack the clinical experience to piece together these complex patterns, leading to frequent misdiagnoses. Seeking expert care from experienced professionals is crucial for addressing these layered issues effectively.
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