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One day your child is thriving, and the next, they’re flooded with fears, rituals, or intense meltdowns that leave you feeling helpless. It’s heartbreaking to watch—and even harder when doctors dismiss your concerns or can’t explain the sudden shift.
When changes like these appear overnight, it’s often not “just behavior.” For some kids, it’s a sign of PANS or PANDAS. In this article, I’ll walk you through what’s really going on in the brain, what signs to look for, and how you can help your child begin to heal and regulate.
What is PANDAS and How Is It Linked to OCD?
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) occurs when a child’s immune system goes “rogue” and attacks part of the Basal Ganglia after a strep infection.
This event can shift behavior from normal to OCD-like symptoms. And it isn’t only OCD that it triggers, but also other neuropsychiatric issues.
What actually happens:
- Sudden onset of symptoms, typically within days of a strep infection
- Autoimmune mechanism where the immune system attacks healthy brain tissue
- Behavioral changes include obsessive thoughts, compulsions, anxiety, and even motor tics
| Feature | Typical Pediatric OCD | PANDAS-Related OCD |
|---|---|---|
| Age of Onset | Gradual onset, typically between 8–12 years old | Sudden onset, often between 4–14 years old |
| Symptom Onset | Symptoms develop progressively over weeks or months | Abrupt and dramatic onset of symptoms, often described as "overnight." |
| Course of Illness | Chronic course with symptoms that may wax and wane over time | Episodic course with sudden exacerbations, often following infections |
| Common Symptoms | Obsessions (e.g., contamination fears, need for symmetry) and compulsions (e.g., excessive washing, checking) | Obsessions and compulsions accompanied by additional symptoms like tics, separation anxiety, and mood swings |
| Associated Symptoms | May include anxiety and depression | Additional symptoms such as motor abnormalities, urinary frequency, and handwriting deterioration |
| Triggering Factors | Often linked to stress, trauma, or genetic predisposition. | Typically follows a streptococcal infection, leading to an autoimmune response |
| Treatment Approaches | Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP); SSRIs may be prescribed | Antibiotics to address infection, anti-inflammatory treatments, and immunomodulatory therapies; CBT with ERP also beneficial |
How Can I Tell If My Child’s OCD Is Related to PANDAS?
If OCD symptoms appeared out of the blue following a recent strep infection, PANDAS could be the root cause. Timing and severity are important clues.
Other signs to watch for:
- Rapid behavioral changes after strep infection
- Compulsions that were never present before
- Emotional reactivity or rage episodes
- Sudden separation anxiety, food restrictions or regression
Want more tools to help your child regulate their emotions? Take our FREE Brain & Behavior Solution Matcher to get a personalized action plan: drroseann.com/help
What Are The Signs and Symptoms of PANDAS-related OCD?
PANDAS related OCD doesn’t always look the same for all children. OCD behaviors may come with a cluster of other symptoms.
Common Signs Include:
- Obsessive thoughts: fear of contamination, harm, or intrusive images
- Compulsions: repetitive behaviors like handwashing or counting
- Motor or vocal tics
- Mood swings or irritability
- Sleep difficulties
- Loss of academic skills or handwriting regression
How is PANDAS diagnosed?
There is no single test for PANDAS. Diagnosis is based on clinical observation and lab work that suggests a recent strep infection.
Diagnostic Process:
- Thorough medical history, especially around symptom onset
- Blood tests for strep antibodies (ASO and anti-DNase B titers)
- Throat culture or rapid strep test
- Psychiatric and neurological evaluation
Strep Linked to OCD: What Research Says
A growing body of research supports the connection between strep infections and sudden-onset OCD in children.
A pivotal study by Swedo et al. (1998) first described 50 children who developed OCD and tics after strep infections, laying the foundation for the PANDAS hypothesis. More recent research continues to explore the autoimmune mechanisms behind this phenomenon.
What Treatment Options Are Available for PANS/PANDAS-related OCD?
Effective treatment requires addressing both the strep infection and the resulting inflammation and behavior.
Multimodal Treatment Plan:
- Antibiotics: to treat active or recent strep
- Anti-inflammatories (e.g., ibuprofen) to calm immune overactivity
- CBT with ERP: gold standard therapy for OCD
- SSRI medications (when necessary and carefully monitored)
- Immunotherapies (e.g., IVIG or plasmapheresis for severe cases)
- Functional support: diet, sleep, detox, and nervous system regulation
“Early intervention in PANS/PANDAS is critical. Addressing the infection and inflammation can reduce the psychiatric fallout.” — Dr. Susan Swedo, NIH
Tucker’s Road to Recovery from PANS/PANDAS OCD
Tucker was a fun, easygoing 9-year-old until everything changed after a routine strep infection. Practically overnight, he became anxious, rigid, and emotionally explosive. He stopped eating certain foods, developed intense rituals, and had daily meltdowns that left his parents confused and heartbroken.
They tried therapy and even medication, but nothing touched the root cause. When his family came to my office, it was clear his brain was on fire.
Through my BrainBehaviorReset® Program, we used brain mapping, neurofeedback therapy, PEMF, and nutritional support to calm his nervous system and reduce inflammation.
Slowly but surely, Tucker started smiling again, eating without fear, and participating in life. His healing didn’t come from punishment or pushing, it came from understanding and supporting his brain.
What Steps Can Parents Take To Support Their Child?
Your advocacy, patience, and commitment to calming the nervous system can make all the difference.
Parent Action Plan:
- Document symptoms and infection history
- Use co-regulation strategies to model calm responses
- Work with specialists experienced in PANDAS/PANS
- Support immune health: probiotics, omega-3s, low-inflammatory foods
- Educate teachers and family to avoid punishment-based responses
- Stay consistent with routines, therapy, and school supports
What is the difference between PANDAS and PANS?
PANS is an autoimmune condition triggered by various infections, while PANDAS is triggered specifically by strep infections.
Can my child outgrow PANDAS?
With the right care, many children improve significantly while others fully recover. Early intervention is important and may increase the chances of your child’s healing.
Will antibiotics alone cure PANDAS?
Antibiotics are necessary to get rid of the strep infection. But full recovery from the symptoms that it triggered often requires a combination of immune support, therapy, and calming the nervous system.
Is PANDAS genetic?
While genes can influence a child’s susceptibility to PANDAS, the condition is not directly inherited.
Citations
Leonardi, L., Perna, C., Bernabei, I., Fiore, M., Ma, M., Frankovich, J., Tarani, L., & Spalice, A. (2024). Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): Immunological Features Underpinning Controversial Entities. Children, 11(9), 1043. https://doi.org/10.3390/children11091043
Chiarello, F., Spitoni, S., Hollander, E., Matucci Cerinic, M., & Pallanti, S. (2017). An expert opinion on PANDAS/PANS: highlights and controversies. International Journal of Psychiatry in Clinical Practice, 21(2), 91–98. https://doi.org/10.1080/13651501.2017.1285941
Autism Speaks. (n.d.). PANDAS syndrome: How it differs from autism. Retrieved from https://www.autismspeaks.org/expert-opinion/pandas-syndrome-how-it-differs-autism
Dr. Roseann Capanna-Hodge is a licensed mental health expert that is frequently cited in the media:
- CBS2 New York (Article) Experts Offer Tips On How To Help Children Deal With Anxiety.
- Parade Want to Know How to Overcome Social Anxiety? We've got Help!.
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©Roseann Capanna-Hodge 2025
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.
