PANDAS and PANS
When OCD or Tics Appear Suddenly in a Child What Parents Need to Know
Natalie Noel, LMHC | Anxiety & OCD Treatment Specialists | Tampa, FL
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Your child was fine on Monday. By Wednesday, they are consumed by OCD. They cannot stop washing their hands. They will not eat. They cannot sleep. They are having tics they never had before. The change happened almost overnight.
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For most parents, this experience is terrifying and confusing. Sudden-onset OCD or tics in a child who previously seemed fine is not typical. And in some cases, it has a name and a medical explanation.
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This page is about PANDAS and PANS two related conditions that cause sudden, dramatic psychiatric symptoms in children following an immune system trigger. Understanding them is the first step toward getting the right help.
In-person sessions are provided in Tampa and virtual sessions are available throughout Florida and New York.
Important: Medical Evaluation Is the First Step
PANDAS and PANS are medical conditions that require evaluation and treatment by a physician typically a pediatrician, pediatric neurologist, or PANDAS specialist before or alongside behavioral therapy.
If your child has suddenly developed intense OCD, tics, or other psychiatric symptoms, please contact your pediatrician immediately. Do not wait. Behavioral therapy plays an important supporting role in PANDAS and PANS but medical treatment comes first. This page is for information and to help families understand what behavioral support looks like once medical care is underway.
What Is PANDAS?
PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. It describes a condition in which a child develops sudden, dramatic OCD symptoms, tics, or both following a Group A streptococcal infection most commonly strep throat.
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The theory is that in some children, the immune system’s response to the strep bacteria mistakenly attacks brain tissue specifically the basal ganglia, the part of the brain involved in movement and habit formation. This inflammatory response produces neuropsychiatric symptoms that can appear almost overnight.
Quick Answer: What Is PANDAS?
PANDAS is a condition in which OCD symptoms, tics, or both appear suddenly and dramatically in a child following a streptococcal infection. The hallmark is abrupt onset symptoms that appear within days, not weeks or months. PANDAS requires medical evaluation and treatment first. Behavioral therapy including ERP for OCD and CBIT for tics is an important part of recovery once medical treatment is underway.
What Is PANS?
PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome. It is a broader category that includes PANDAS but also includes cases where sudden OCD or tic symptoms are triggered by other infections, environmental factors, or immune system disruptions beyond just strep.
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In PANS, the trigger may be:
- Other bacterial or viral infections (Lyme disease, flu, mycoplasma)
- Environmental triggers (mold exposure, certain toxins)
- Metabolic or autoimmune disorders
- Sometimes, no clear trigger can be identified
The distinction between PANDAS and PANS is primarily about the trigger but the presentation, the distress, and the need for both medical and behavioral treatment are similar.
What Are the Symptoms of PANDAS and PANS?
The hallmark of both PANDAS and PANS is sudden, dramatic onset. Symptoms that would typically develop over months appear within days or even overnight. Common symptoms include:
| Primary Symptoms | Associated Symptoms |
|---|---|
| Sudden, intense OCD symptoms | Severe separation anxiety |
| New or dramatically worsening tics | Sleep disturbances or refusal |
| Extreme anxiety or panic | Regression baby talk, clinginess |
| Emotional lability rapid mood changes | Deterioration in handwriting |
| Irritability or rage episodes | Urinary urgency or frequency |
| Sensory sensitivities | Difficulty concentrating or school refusal |
The sudden onset is the key diagnostic feature. If your child’s OCD or tics developed gradually over months, PANDAS or PANS is less likely. If they appeared dramatically seemingly overnight or within a few days and especially if they followed a recent illness, PANDAS or PANS should be evaluated by a physician immediately.
How Are PANDAS and PANS Diagnosed?
There is no single definitive test for PANDAS or PANS. Diagnosis is clinical based on the pattern of symptoms, the abruptness of onset, and evidence of a preceding infection or immune trigger. Physicians may use:
- Throat culture or strep blood tests (anti-streptococcal antibody titers ASO and anti-DNase B)
- Complete blood count and other inflammatory markers
- Neurological examination
- Psychiatric evaluation to document symptom severity and onset
- Referral to a PANDAS specialist, pediatric neurologist, or pediatric immunologist
If you believe your child may have PANDAS or PANS, the most important first step is contacting your pediatrician and requesting evaluation. The PANDAS Physicians Network (PPN) maintains a directory of knowledgeable providers.
How Are PANDAS and PANS Treated?
Medical Treatment First
Medical treatment is the foundation of PANDAS and PANS care and must come first. Depending on the trigger and severity, this may include:
- Antibiotics to treat active strep infection or other bacterial triggers
- Anti-inflammatory medications to reduce brain inflammation
- IVIG (intravenous immunoglobulin) or plasmapheresis for severe cases
- Ongoing prophylactic antibiotics to prevent future flares
Behavioral Therapy An Essential Part of Recovery
Once medical treatment is underway and the child is medically stable, behavioral therapy is a critical part of helping the brain recover functional patterns. Even when the medical cause is addressed, OCD compulsions and tic habits can persist because the brain has learned them and these patterns need to be unlearned through behavioral intervention.
- ERP (Exposure and Response Prevention) for OCD symptoms gradually facing triggers without performing compulsions, helping the brain relearn that the anxiety can decrease on its own.
- CBIT (Comprehensive Behavioral Intervention for Tics) for tic symptoms teaching competing responses to the premonitory urge, reducing tic frequency and intensity.
- Parent coaching helping parents respond to symptoms in ways that support recovery rather than inadvertently reinforcing OCD or tic behaviors.
How We Work With PANDAS and PANS Families
We are behavioral therapists, not physicians we do not diagnose or medically treat PANDAS or PANS. Our role is the behavioral component of a coordinated care team.
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We work with families who:
- Have a confirmed or suspected PANDAS/PANS diagnosis and need behavioral support
- Are in active medical treatment and ready to begin ERP or CBIT alongside it
- Have completed the acute phase of medical treatment but still have residual OCD or tic symptoms that need behavioral intervention
We coordinate with your child’s physician and any other providers on your team. We are experienced with the specific presentation of OCD and tics in PANDAS/PANS and adjust our approach accordingly.
In-Person and Virtual Sessions
In-person
730 S Sterling Ave, Suite 306, Tampa, FL 33609
Virtual
Available throughout Florida
Frequently Asked Questions
My child had strep last month and now has OCD. Could this be PANDAS?
It is possible and worth evaluating. The timing you describe OCD symptoms appearing after a strep infection is consistent with PANDAS. Contact your pediatrician right away and describe the onset clearly, including when symptoms started relative to the illness. Ask specifically about PANDAS evaluation. The sooner it is identified and treated, the better the outcome tends to be.
Can PANDAS be mistaken for Tourette's Disorder?
Yes particularly in the early stages. Both can involve tics and OCD-like behaviors. The key difference is onset. Tourette’s develops gradually, typically over months, beginning in early childhood. PANDAS appears suddenly, often within days, and is usually linked to a recent infection. If tics or OCD appeared abruptly, PANDAS evaluation is warranted before a Tourette’s diagnosis is finalized.
Does PANDAS go away on its own?
In some cases, symptoms improve with antibiotic treatment of the underlying infection. In others, symptoms persist or recur with subsequent infections particularly if prophylactic antibiotics are not used to prevent future strep exposure. Behavioral therapy helps address persistent OCD and tic symptoms that remain after medical treatment. Early, comprehensive treatment generally leads to better long-term outcomes.
Is PANDAS recognized by mainstream medicine?
PANDAS is a recognized condition, included in medical and psychiatric literature and acknowledged by major medical organizations including the NIH. However, it remains a subject of ongoing research diagnostic criteria are still being refined and not all physicians have equal familiarity with it. If you believe your child has PANDAS and your pediatrician is unfamiliar, seeking a second opinion from a PANDAS-experienced provider is reasonable and often necessary.
You Do Not Have to Navigate This Alone.
PANDAS and PANS are frightening especially when you watch your child change almost overnight. The medical side requires a physician. The behavioral side requires a therapist trained in OCD and tic disorders. We provide the behavioral component and coordinate closely with your medical team to support your child’s full recovery.
