For many families, this confusing and frightening experience marks the onset of PANS or PANDAS, two conditions that can appear without warning and dramatically change a child’s behavior overnight. Recognizing PANS and PANDAS symptoms early is crucial, as timely diagnosis and treatment can make a significant difference in a child’s recovery.

At the Ohio Center for Adolescent Wellness (OHCAW), we understand how overwhelming these sudden shifts can be for parents. Our team provides compassionate, evidence-based support for adolescents experiencing complex behavioral and mental health challenges, including the symptoms commonly associated with PANS and PANDAS.

In this guide, we’ll explore what these syndromes are, the causes behind them, the PANS and PANDAS symptoms to watch for, and how early intervention, combined with the right professional support, can help families navigate this challenging journey.

What Is PANS and PANDAS Syndrome?

PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome, while PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. Both conditions involve the body’s immune system mistakenly attacking the brain, leading to sudden and severe changes in behavior, emotions, and motor skills.

The main difference between the two is their trigger:

PANDAS is specifically linked to a strep infection (like strep throat or scarlet fever).
PANS can be triggered by various infections or environmental factors, such as viruses, Lyme disease, or even metabolic stressors.

Despite the difference in cause, both can lead to similar symptoms—such as obsessive-compulsive behaviors, anxiety, and movement abnormalities.

What Causes PANS and PANDAS?

In both Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), the issue begins when the immune system—normally the body’s defense against infection—mistakenly targets healthy parts of the brain, particularly the basal ganglia, which help control movement, emotions, and behavior. This immune error causes brain inflammation, leading to sudden changes in a child’s thoughts, feelings, and actions.

In PANDAS, this reaction usually follows a strep infection. While fighting the bacteria, the body’s antibodies may wrongly attack brain tissue that resembles the infection, causing symptoms such as obsessive thoughts, compulsive behaviors, mood swings, or tics to appear almost overnight.

PANS can be triggered by a wider range of factors—not just strep. Some children may also experience dual diagnosis scenarios, where mental health challenges occur alongside other medical or behavioral conditions, including infections or metabolic issues.

Regardless of the cause, the result is the same: an overactive immune system leads to brain inflammation that disrupts normal communication between brain cells, explaining the sudden and distressing symptoms seen in affected children.

What Are the Common Symptoms of PANS/PANDAS?

The hallmark of PANS and PANDAS is a sudden, dramatic change in behavior. Children who were once happy and well-adjusted may quickly start to:

Develop intense OCD-like behaviors or fears
Experience severe anxiety or extreme mood swings
Struggle with attention, focus, or memory
Become irritable, withdrawn, or depressed seemingly overnight

In addition to these emotional and cognitive changes, children may also show physical symptoms, including:

Tics (sudden, repetitive movements or sounds)
Changes in handwriting or fine motor skills
Sleep disturbances or difficulty falling asleep
Frequent urination or other bodily complaints

What sets these behaviors apart is their abrupt onset and intensity. Unlike typical childhood development, where changes happen gradually, PANS and PANDAS can make it feel as if a completely different child has emerged almost overnight.

How Do Symptoms of PANS and PANDAS Develop?

In most cases, the onset of PANS and PANDAS symptoms is often abrupt, typically occurring within 24 to 48 hours following an infectious trigger. PANS and PANDAS are most frequently observed in children between 3 and 12 years of age, although adolescents may also be affected. The clinical course is often relapsing–remitting in nature, with symptom exacerbations commonly associated with new infections or periods of heightened physiological or psychological stress.

If your child is experiencing sudden behavioral or emotional challenges, connecting with specialized teen mental health treatment can provide the support and guidance needed to navigate these sudden changes effectively.

Key Behavioral and Emotional Symptoms to Watch For

Children with PANS or PANDAS may show common behavioral and emotional symptoms such as:

Repetitive rituals or compulsive behaviors, such as excessive handwashing, checking, or arranging objects in a specific order.
New or intensified fears and phobias may seem irrational or appear suddenly after an illness.
Severe mood instability, including irritability, anger outbursts, depression, or episodes of sudden emotional withdrawal.
Anxiety-related behaviors, such as refusal to attend school, separation anxiety, or clinginess that were not previously present.
Regression in social or academic functioning, including a loss of previously acquired skills or decreased interest in peers and activities.

Parents and teachers are often the first to notice when something feels “off.” A once easygoing child may suddenly become defiant, emotional, or withdrawn—changes that are difficult to explain without knowing about PANS/PANDAS.

Physical and Neurological Symptoms in PANS/PANDAS

Beyond behavioral changes, PANS and PANDAS often involve distinct physical and neurological signs that point to underlying brain inflammation. These may include:

Motor and vocal tics, such as blinking, shoulder shrugging, throat clearing, or involuntary vocalizations.
Sleep disturbances, including difficulty falling asleep, frequent awakenings, or vivid and distressing dreams.
Fine and gross motor difficulties, such as new-onset clumsiness, changes in gait, or a noticeable decline in handwriting ability.
Somatic complaints, including headaches, joint pain, abdominal discomfort, or persistent fatigue not explained by other medical conditions.
Sensory sensitivities, such as heightened sensitivity to light, sound, textures, or touch.

These neurological and physical signs, combined with behavioral changes, help doctors differentiate PANS/PANDAS from typical developmental or psychiatric conditions.

How Is PANS/PANDAS Diagnosed?

Diagnosing PANS and PANDAS can be challenging because there is currently no single laboratory test that confirms either condition. Instead, diagnosis is based on a comprehensive clinical evaluation that considers medical history, physical findings, laboratory results, and the pattern of symptom onset.

A thorough assessment often includes:

Medical and infection history: Reviews recent illnesses and sudden symptom onset linked to possible infectious or immune triggers.
Throat cultures or blood tests: Detect recent or ongoing streptococcal infections through ASO or anti–DNase B antibody tests.
Inflammatory and autoimmune markers: Measure CRP, ESR, or antibody levels to identify signs of systemic inflammation or immune activity.
Neurological and psychological evaluations: Assess cognitive, behavioral, and motor symptoms to distinguish PANS/PANDAS from other neuropsychiatric conditions.
Diagnostic imaging or studies: MRI or EEG may be used to rule out other neurological causes of sudden behavioral changes.

The primary diagnostic goal is to exclude other medical or psychiatric conditions that may present with similar symptoms, while confirming that the child’s onset was abrupt, severe, and temporally associated with an infection or immune-related event.

Why Early Recognition of Symptoms Matters

Early identification of PANS and PANDAS symptoms is crucial for improving outcomes and preventing long-term complications. When symptoms are recognized promptly, treatment can target both the infection and the underlying immune response before lasting neurological or psychological effects develop.

Delayed diagnosis, on the other hand, can allow inflammation to persist, leading to prolonged or recurring episodes of obsessive-compulsive behaviors, anxiety, and cognitive decline. These ongoing symptoms can significantly interfere with a child’s academic performance, social relationships, and emotional well-being.

Timely recognition also helps differentiate PANS and PANDAS from other psychiatric or developmental conditions, ensuring that children receive appropriate medical care rather than being misdiagnosed or treated solely with behavioral or psychiatric interventions.

Early recognition enables more effective management, reduces symptom severity, and offers children the best chance for full recovery.

Treatment Options for Managing Symptoms

Managing PANS and PANDAS requires a comprehensive approach that addresses the underlying infection, controls immune-related inflammation, and supports the child’s mental and emotional well-being. Treatment is often tailored to each child, depending on the severity and type of symptoms.

Addressing the Infection

Antibiotics help eliminate PANDAS-related infections and reduce immune overactivation.

Controlling Inflammation

Anti-inflammatory or immune-modulating therapies, such as corticosteroids or IVIG, can ease brain inflammation and sudden behavioral changes.

Managing Neuropsychiatric Symptoms

Cognitive Behavioral Therapy (CBT) or Exposure and Response Prevention (ERP) helps manage OCD symptoms and anxiety.

Family and School Support

Structured routines, stress reduction, and consistent support from family and school help the child cope daily.

Follow-Up and Monitoring

Regular check-ups allow timely treatment adjustments and early detection of relapses.

Recovery Outlook

With a coordinated approach, most children gradually improve, regaining emotional stability, behavioral control, and normal daily functioning.

Living With PANS/PANDAS: What Parents Should Know

Living with PANS or PANDAS syndrome can feel confusing and stressful, especially when changes in your child’s behavior appear suddenly. It’s important to remember that these changes are not intentional—they are a result of the immune system affecting the brain. Understanding this helps reduce frustration and fosters empathy.

Creating a predictable daily routine is one of the most effective ways to support your child. Consistent meal times, bedtime routines, and homework schedules can reduce anxiety and help your child feel more secure. Small changes should be introduced gradually, and flexibility is key when symptoms flare.

Open communication is essential. Encourage your child to express their feelings and reassure them that their experiences are valid. Praise efforts and celebrate small achievements, as these positive reinforcements can improve confidence and motivation.

Collaboration with teachers, teen therapy specialists, and healthcare providers is critical to ensure your child receives consistent support and guidance. Inform school staff about your child’s needs and triggers so they can provide accommodations, like extra time for assignments or a quiet space when anxiety spikes. Regular check-ins with therapists and doctors ensure that treatment adjustments are made promptly and effectively.

Parents should also take care of themselves. Supporting a child with PANS/PANDAS can be emotionally and physically exhausting. Seeking support groups, talking with other parents, or scheduling respite time can help maintain your own well-being.

Finally, be patient and hopeful. Recovery often takes time, and progress may be gradual, with periods of improvement and setbacks. With consistent care, understanding, and coordinated support, most children regain emotional balance, behavioral control, and the ability to thrive socially and academically.

Supporting Your Child’s Mental Health at the Ohio Center for Adolescent Wellness

If your child is experiencing sudden changes in behavior, anxiety, or emotional challenges, don’t wait—early support can make a real difference. Our team works closely with families, schools, and healthcare providers to create personalized plans that promote stability, confidence, and overall well-being.

PANS and PANDAS Syndrome: Early Signs, Causes, and Treatment for Children