Imagine waking up one morning to find your child suddenly acting like a completely different person. They may refuse to leave the house, wash their hands obsessively, or be paralyzed by fears none of you can explain. The change is drastic, bewildering, and heartbreaking. As a parent, you’re left wondering: What happened? Did I miss something?
In my 30 years of helping dysregulated kids cope and get better, I’ve met dozens of parents who have exactly been in your shoes.
Unfortunately, while mood swings and “weird behavior” seem common in toddlers and children, this abrupt onset of obsessive-compulsive behaviors and anxiety may not be random.
It could be the result of a medical condition known as PANDAS or PANS, where an infection triggers a misdirected immune response that affects the brain.
What is PANS?
Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is a clinical diagnosis characterized by the sudden onset of severe changes in a child’s mental health and behavior. It is believed to result from immune system dysregulation, leading to brain inflammation—specifically in areas which are responsible for mood, behavior, and motor control (Chang et al., 2015).
How PANS Begin
Studies on PANS are still evolving, but researchers have been investigating its underlying mechanisms. For example, neuroimaging studies have shown inflammation and functional changes in the basal ganglia and other brain regions in affected children (Miller et al., 2015).
PANS can be triggered by various underlying factors, including infections (e.g., strep throat, influenza, or Lyme disease), environmental toxins, or psychological stress. Unlike many mental health disorders that develop gradually, the symptoms of PANS often emerge overnight or within just a few days, causing a sudden and dramatic shift in the child’s ability to function (Frankovich et al., 2015).
This immune-mediated inflammation can cause abrupt symptoms such as obsessive-compulsive behaviors (OCD), debilitating anxiety, emotional outbursts, and even physical symptoms like motor tics or joint pain (Swedo et al., 2012).
The abrupt nature of PANS symptoms, particularly the acute onset of OCD or anxiety, is one of its hallmark features. For example, a child who was thriving socially and academically might suddenly display compulsive rituals, irrational fears, or debilitating school avoidance, leaving families and caregivers scrambling for answers.
Early recognition and intervention are critical. Timely treatment, including addressing the underlying infection or inflammation and dysregulation therapies (e.g. neurofeedback, somatic therapy, etc.), can significantly improve outcomes.
How is PANS Diagnosed?
In children, PANS presents itself as an abrupt, dramatic onset of obsessive-compulsive disorder or severe restriction in food intake.
According to Swedo (2012), this must be accompanied by the concurrent presence of additional neuropsychiatric symptoms with similarly severe and acute onset, from at least TWO of the following seven categories:
- Anxiety, Separation Anxiety
- Emotional Lability and/or Depression
- Irritability, aggression and/or severely oppositional behaviors
- Behavioral (developmental) Regression
- Deterioration in School Performance
- Sensory or Motor Abnormalities
- Somatic signs and symptoms, including: Sleep disturbances, enuresis or urinary frequency
What is PANDAS?
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a subset of Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). There’s not much difference between PANS and PANDAS as the symptoms are very much the same. However, in PANDAS, all the symptoms immediately follow after an infection with Group A Streptococcus (GAS) specifically.
How PANDAS Begin
The core mechanism of PANDAS lies in an autoimmune response. After a child contracts a strep infection, their immune system produces antibodies to fight the bacteria. In some cases, these antibodies mistakenly target the brain—specifically the basal ganglia—due to a phenomenon called molecular mimicry.
Molecular mimicry is when the strep bacteria develops structures similar to brain tissue, confusing the immune system and driving it to attack healthy brain tissue (Kirvan et al., 2006).
The basal ganglia, which play a crucial role in motor control, emotional regulation, and behavior, become inflamed and impaired by this autoimmune response. This inflammation can result in the sudden and dramatic appearance of symptoms like OCD, severe anxiety, tics, mood swings, and other neuropsychiatric changes (Giedd et al., 2000).
Sometimes, PANS/PANDAS can be confused with Autoimmune Encephalopathy, so it’s important to consult with a healthcare specialist the moment you observe any of the signs and symptoms of PANDAS/PANS, so you are guided accordingly.
What is Criteria for a PANDAS Diagnosis:
For a diagnosis of PANDAS, all five of the following criteria must be met:
- Presence of obsessive-compulsive disorder (OCD) or a tic disorder
- Prepubertal symptom onset (now can be adult onset)
- Acute symptom onset and episodic (relapsing-remitting) course
- Temporal association between Group A streptococcal infection and symptom onset/exacerbations
- Association with neurological abnormalities
Pre-existing conditions often confuse people. But here’s the thing, your child may have had anxiety already at first, but then it skyrockets, or it morphs into a more dramatic symptom such as OCD.
Are the Symptoms for PANS/PANDAS Constant?
Another sign that it’s PANS/PANDAS is how the symptoms appear and disappear following an infection, in what is called a “FLARE”.
A PANS or PANDAS flare is a sudden and intense worsening or reappearance of symptoms after a period of stability or improvement. During a flare, your child may experience obsessive-compulsive behaviors, severe anxiety, unpredictable mood swings, motor or vocal tics, regression in skills or behavior, physical pain, frequent urination, or sleep disturbances. These flares are often triggered by an infection or other stressors, with symptoms sometimes improving temporarily before worsening again.
How Common is PANS/PANDAS
PANS and PANDAS are believed to be relatively rare, but the exact prevalence is difficult to determine due to the variability in diagnosis and the overlap of symptoms with other mental health and neurological conditions.
In PANDAS, however, studies estimate that PANDAS could affect between 1 in 200 to 1 in 1000 children, although this can vary depending on the population and diagnostic criteria used (Swedo et al., 1998; Pavone et al., 2020). PANDAS is most commonly diagnosed in children aged 3 to 12, with boys being slightly more likely to be affected than girls (Swedo et al., 1998).
What Do I Do If I Suspect My Child Has PANS/PANDAS?
When there’s an infection-related symptom, the rule of thumb is always to treat the source, oftentimes with antibiotic medications. However, in the world of PANS/PANDAS, there’s more to the treatment than your regular oral medications.
Nervous System Regulation
If you suspect your child has PANS/PANDAS, it is critical to consult with a mental health provider who understands stress hyperactivation in the nervous system. When the brain is inflamed, your child’s nervous system undergoes intense stress and it’s important to bring it into a parasympathetic relaxed state.
Without working on the nervous system, you’re going to be stuck, and that’s the truth.
Detoxification
Most of the PAN/PANDAS patients I’ve worked with for years have genetic mutations at different levels. These can be caused by improper detoxification of the body.
Here at our center, we work remotely with people with PANS/PANDAS all the time; where we do a lot of brain-based treatment and parental support. I have been fortunate to help hundreds of families over the years, and now I am working hard to train providers about PANS and PANDAS and how to identify the signs early, as early treatment is best for our kids.
Check out my blog on Holistic Health Remedies for PANS/PANDAS to learn more about how to treat PANS/PANDAS.
Is PANS/PANDAS Curable?
The outlook for children with PANS/PANDAS can be different for each child. Some children recover completely, particularly when treatment begins early. For others, symptoms may come and go, or they may continue to experience some ongoing challenges. However, with the right care, symptoms often improve over time. Early diagnosis and prompt treatment are key to helping your child get the best possible outcome, so it’s important to seek medical guidance as soon as possible.
To learn more about PANS/PANDAS, read my blog on how PANS/PANDAS cases are on
Citations:
- Chang, K., Frankovich, J., & Cooperstock, M. (2015). Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): Recommendations for diagnosis and treatment. Journal of Child and Adolescent Psychopharmacology, 25(1), 3-13. 10.1089/cap.2014.0084
- Frankovich, J., Thienemann, M., Rana, S., & Chang, K. (2015). Five youth with pediatric acute-onset neuropsychiatric syndrome of differing etiologies. Journal of Child and Adolescent Psychopharmacology, 25(1), 31-37. 10.1089/cap.2014.0056
- Giedd, J. N., Rapoport, J. L., & Leonard, H. L. (1996). Case study: Acute basal ganglia enlargement and obsessive-compulsive symptoms in an adolescent with PANDAS. Journal of the American Academy of Child & Adolescent Psychiatry, 39(9), 1131–1132. 10.1097/00004583-199607000-00017
- Kirvan, C. A., Cox, C. J., & Swedo, S. E. (2006). Antibody-mediated neuronal cell signaling in behavior and movement disorders. The Journal of Neuroimmunology, 179(1-2), 173-179. 10.1016/j.jneuroim.2006.06.017
- Miller, E., McLellan, D., & Bernstein, G. A. (2015). Neuroimaging abnormalities in pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS). The Lancet Psychiatry, 2(5), 415-425.
- Swedo, S. E., Leonard, H. L., & Garvey, M. (2012). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Molecular Psychiatry, 12, 261–276.
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She is the founder and director of The Global Institute of Children’s Mental Health and Dr. Roseann Capanna-Hodge. Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS), Certified Integrative Medicine Mental Health Provider (CMHIMP) 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) International Society for Neurofeedback and Research (ISNR) and The Association of Applied Psychophysiology and Biofeedback (AAPB).
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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.