Surreal digital illustration of a child amidst colorful representations of thoughts and emotions related to PANDAS/PANS.

PANDAS/PANS in Children: Decoding the Diagnostic Dilemma and Charting a Path Forward

Lena Voss in Health & Wellness December 2025 • 5 min read.

"Navigating the Controversies, Unraveling the Evidence, and Understanding the Complexities of Childhood Neuropsychiatric Disorders."

Childhood can be a whirlwind of joy, growth, and, at times, unexpected challenges. Among these, the emergence of sudden and dramatic changes in behavior, mood, and even physical function can be particularly alarming for parents and caregivers. When these changes are accompanied by obsessive-compulsive behaviors, tics, or severe food restriction, the possibility of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) or Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) may arise. These conditions have garnered significant attention and, with it, a fair amount of controversy. Understanding the nuances of PANDAS/PANS is crucial for anyone seeking to support children experiencing these conditions.

First defined in 1998, PANDAS and its broader iteration, PANS, have sparked debate within the medical community and among families affected by these disorders. The core challenge lies in differentiating these conditions from other psychiatric or neurological disorders, and in determining the most effective treatment strategies. This article delves into the current understanding of PANDAS/PANS, offering insights into the diagnostic criteria, the role of streptococcal infections, and the existing evidence for various interventions.

Our goal is to provide a balanced and informative overview of PANDAS/PANS, aiming to equip readers with the knowledge to navigate the complexities of these conditions. We will explore the controversies surrounding these diagnoses, examine the current evidence base, and discuss how a practical and supportive approach can be taken to help children and families facing these challenges. This article is intended for informational purposes and should not be considered as a substitute for professional medical advice.

Unpacking PANDAS/PANS: Definitions, Criteria, and the Role of Infection

Surreal digital illustration of a child amidst colorful representations of thoughts and emotions related to PANDAS/PANS.

PANDAS was first defined in 1998, focusing on children who experienced a sudden onset of obsessive-compulsive disorder (OCD) or tics, along with a documented streptococcal infection. The criteria also included a pediatric onset (between the ages of 3 and puberty), an episodic course of symptoms, and the presence of neurological abnormalities. The concept of PANS emerged later, as a broader diagnostic umbrella, encompassing a wider range of neuropsychiatric symptoms and not necessarily requiring a documented streptococcal infection.

The diagnostic criteria for PANS are outlined in Table 2 of the original research paper. The primary criteria involve the abrupt onset of OCD or severely restricted food intake. The other criteria include the presence of additional neuropsychiatric symptoms, such as anxiety, emotional lability, behavioral regression, sensory or motor difficulties, and somatic signs or symptoms. PANS also requires that the symptoms are not better explained by another neurological or medical disorder. It's important to recognize that these criteria are intended to help clinicians evaluate a child's symptoms, although the application of these criteria can sometimes be inconsistent.

PANDAS: Focuses on children with OCD or tics, linked to a streptococcal infection.
PANS: A broader category encompassing various neuropsychiatric symptoms.
Key Criteria: Include sudden onset, specific symptom profiles, and exclusion of other medical causes.
Diagnostic Challenges: Require careful evaluation and differentiation from other conditions.

The connection between streptococcal infections and the development of neuropsychiatric symptoms remains a central, and often debated, aspect of PANDAS/PANS. While the exact mechanisms are still being investigated, it's proposed that the body's immune response to a strep infection may, in some cases, mistakenly target the brain. This autoimmune response could lead to inflammation and subsequent neuropsychiatric symptoms. However, the evidence supporting this theory is still evolving, and more research is needed to fully understand the relationship between strep infections and these complex disorders.

Moving Forward: Recommendations for Families and Healthcare Providers

Navigating the landscape of PANDAS/PANS can be challenging, but armed with knowledge, understanding, and a collaborative approach, families and healthcare providers can work together to support children. A thorough evaluation, a focus on evidence-based treatments, and a commitment to ongoing research are essential steps towards improving the lives of those affected by these complex conditions. Continued research and collaboration are vital to advancing the understanding, diagnosis, and treatment of PANDAS/PANS, ultimately leading to better outcomes for children and families.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1093/pch/pxy145, Alternate LINK

Title: Pandas/Pans In Childhood: Controversies And Evidence

Subject: Pediatrics, Perinatology and Child Health

Journal: Paediatrics & Child Health

Publisher: Oxford University Press (OUP)

Authors: Colin Wilbur, Ari Bitnun, Sefi Kronenberg, Ronald M Laxer, Deborah M Levy, William J Logan, Michelle Shouldice, E Ann Yeh

Published: 2018-12-09

Everything You Need To Know

What are the key differences between PANDAS and PANS?

PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, specifically focuses on children who experience a sudden onset of obsessive-compulsive disorder (OCD) or tics following a streptococcal infection. The onset is typically between 3 years old and puberty. PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, is a broader category that includes a wider range of neuropsychiatric symptoms, such as anxiety, emotional lability, or behavioral regression, and doesn't necessarily require a documented streptococcal infection. While PANDAS has a defined trigger, PANS encompasses cases with various potential triggers or no identifiable trigger.

What are the primary diagnostic criteria used to identify PANS in children?

The primary diagnostic criteria for PANS involve the abrupt onset of obsessive-compulsive disorder (OCD) or severely restricted food intake. Additional criteria include the presence of concurrent neuropsychiatric symptoms, such as anxiety, depression, emotional lability, behavioral regression, sensory or motor abnormalities, and somatic signs or symptoms. Importantly, the symptoms must not be better explained by another medical or neurological disorder. The rapid onset and cluster of symptoms are key in distinguishing PANS from other conditions.

How might a streptococcal infection be related to the development of neuropsychiatric symptoms in PANDAS?

It is proposed that in PANDAS, the body's immune response to a streptococcal infection mistakenly targets the brain. This autoimmune response leads to inflammation and subsequent neuropsychiatric symptoms. The exact mechanisms behind this are still being investigated, but the theory suggests that antibodies produced to fight the strep infection cross-react with brain tissue, particularly the basal ganglia, causing the sudden onset of OCD, tics, and other neuropsychiatric symptoms. Further research is needed to fully understand this complex relationship.

Given the controversies surrounding PANDAS and PANS, what approach should families and healthcare providers take to support affected children?

Families and healthcare providers should adopt a collaborative and evidence-based approach. A thorough evaluation is crucial to rule out other potential causes of the neuropsychiatric symptoms. Treatment strategies should focus on managing the specific symptoms presented, which may include cognitive-behavioral therapy (CBT) for OCD and anxiety, as well as considering immunomodulatory therapies in certain cases. A commitment to ongoing research and open communication between families, healthcare providers, and researchers is essential to improving the understanding and treatment of PANDAS and PANS.

What are the long-term implications for children diagnosed with PANDAS or PANS, and what kind of ongoing support might they require?

The long-term implications for children diagnosed with PANDAS or PANS can vary. Some children may experience a resolution of symptoms with appropriate treatment, while others may have a more chronic or relapsing-remitting course. Ongoing support may include continued therapy to manage residual OCD, anxiety, or other neuropsychiatric symptoms. Academic accommodations might be needed to address any learning or attention difficulties. Additionally, families may benefit from support groups or counseling to cope with the challenges of managing these complex conditions. Continued monitoring by healthcare providers is crucial to address any relapses or new symptoms that may arise.