Surreal illustration symbolizing the complexities of PANDAS/PANS in a child's brain.

PANDAS/PANS in Children: Navigating the Controversies and Finding Evidence-Based Paths

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Reese Marlowe in Health & Wellness December 2025 • 4 min read.

"Demystifying Childhood Autoimmune Neuropsychiatric Disorders for Parents and Caregivers"


Since the late 1990s, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and its broader category, Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS), have become topics of significant discussion and, at times, heated debate. These conditions, characterized by a sudden onset of obsessive-compulsive behaviors, tics, and other neuropsychiatric symptoms in children, have left many parents and healthcare providers searching for answers.

The core of the controversy lies in several areas: the definitive role of streptococcal infections, the natural progression of these conditions, and the most effective treatments. Questions linger around the use of antibiotics, immunotherapies, and psychoactive medications, leaving families feeling uncertain and clinicians seeking clarity. This article aims to address these critical questions, offering a balanced view of current research, diagnostic criteria, and potential management strategies.

While firm proof supporting the autoimmune nature of PANDAS remains elusive, it’s crucial to tackle the questions surrounding diagnosis, treatment, and causes. This article aims to provide an overview of the working definitions of both PANDAS and PANS, assess existing research on interventions, and suggest a practical approach for addressing acute symptoms that align with these criteria. By providing a thorough summary, we want to help families feel supported, informed, and empowered to navigate the challenges of PANDAS/PANS.

Understanding PANDAS and PANS: What Are the Key Differences?

Surreal illustration symbolizing the complexities of PANDAS/PANS in a child's brain.

The concept of PANDAS initially emerged from the idea that its underlying mechanisms might be similar to those of Sydenham's chorea, a neurological disorder resulting from rheumatic fever. In 1998, the first diagnostic criteria for PANDAS were proposed, setting the stage for future research and clinical understanding.

In 2012, a publication highlighted some limitations in the original PANDAS definition, particularly regarding patients who met all criteria except for the association with group A streptococcal (GAS) infection. This led to the development of new diagnostic criteria and a broader diagnostic label: PANS (Pediatric Acute-onset Neuropsychiatric Syndrome).

  • PANDAS: Specifically linked to streptococcal infections, primarily affecting prepubescent children. It focuses on tic disorders and obsessive-compulsive behaviors that appear suddenly following a strep infection.
  • PANS: A broader category that includes cases with similar sudden-onset neuropsychiatric symptoms but not necessarily linked to streptococcal infections. PANS can occur at any age and includes a wider range of triggers beyond strep, such as other infections or environmental factors.
The PANS definition removed tic disorders as a primary criterion and broadened the age range beyond prepubescent children. It emphasizes obsessive-compulsive disorder (OCD) and restrictive eating behaviors. As the authors of these criteria stated, the new working definition of PANS was intended to more precisely define this group and improve standardization in research studies and comparability across different groups. Whether these diagnostic criteria for PANS are narrow enough to clearly define a distinct clinical entity remains uncertain.

Final Thoughts: Empowering Families Through Understanding

The journey through understanding and managing PANDAS/PANS can be complex, but it doesn't have to be traveled alone. By staying informed, working closely with healthcare providers, and seeking support from advocacy groups and other families, parents can play a vital role in advocating for their children's needs. While research continues to evolve, a comprehensive approach that combines medical, therapeutic, and supportive care offers the best path forward for children and families affected by these challenging conditions.

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.

Everything You Need To Know

1

What are Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)?

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a condition characterized by the sudden onset of obsessive-compulsive behaviors, tics, and other neuropsychiatric symptoms in children, typically following a streptococcal infection. It is thought that PANDAS mechanisms might be similar to those of Sydenham's chorea. It is important to note that the role of streptococcal infections in PANDAS, the natural progression and the most effective treatments continue to be debated.

2

What is Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and how does it differ from PANDAS?

Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is a broader diagnostic category that includes cases with sudden-onset neuropsychiatric symptoms similar to PANDAS, but not necessarily linked to streptococcal infections. PANS can occur at any age and includes a wider range of triggers beyond strep, such as other infections or environmental factors. PANS removed tic disorders as a primary criterion and broadened the age range beyond prepubescent children emphasizing obsessive-compulsive disorder (OCD) and restrictive eating behaviors. The development of PANS was motivated by the limitations in the original PANDAS definition.

3

Why is there controversy surrounding PANDAS and PANS?

The controversy surrounding PANDAS and PANS primarily stems from uncertainty about the definitive role of streptococcal infections, the natural progression of these conditions, and the most effective treatments. Questions linger around the use of antibiotics, immunotherapies, and psychoactive medications. Additionally, some debate remains about whether the diagnostic criteria for PANS are narrow enough to clearly define a distinct clinical entity. Despite the controversy, research continues to evolve to provide the best path forward for children and families affected by these challenging conditions.

4

If a child exhibits sudden-onset neuropsychiatric symptoms, what is the recommended approach for parents and caregivers?

The recommended approach involves staying informed, working closely with healthcare providers, and seeking support from advocacy groups and other families. Parents can play a vital role in advocating for their children's needs. A comprehensive approach that combines medical, therapeutic, and supportive care offers the best path forward. While firm proof supporting the autoimmune nature of PANDAS remains elusive, it’s crucial to tackle the questions surrounding diagnosis, treatment, and causes.

5

How did the definition of PANDAS evolve over time, and what led to the development of the PANS diagnosis?

The concept of PANDAS emerged from the idea that its underlying mechanisms might be similar to those of Sydenham's chorea. In 1998, the first diagnostic criteria for PANDAS were proposed. In 2012, limitations in the original PANDAS definition were highlighted, particularly regarding patients who met all criteria except for the association with group A streptococcal (GAS) infection. This led to the development of new diagnostic criteria and the broader diagnostic label: PANS. The PANS definition broadened the age range beyond prepubescent children, removed tic disorders as a primary criterion, and emphasized obsessive-compulsive disorder (OCD) and restrictive eating behaviors.

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