Surreal illustration of a child in a maze representing the complexities of PANDAS/PANS.

PANDAS/PANS in Children: What Parents Need to Know About Controversies and Evidence

Theo Raines in Health & Wellness November 2025 • 4 min read.

"Understanding the complexities of PANDAS/PANS: Navigating diagnosis, treatments, and controversies with evidence-based insights for parents and caregivers."

Since first defined in 1998, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and its later, broader iteration, Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), have garnered significant attention and controversy. For parents and caregivers, this can be a confusing and stressful landscape to navigate. Understanding the nuances of these conditions is essential for advocating for your child's health.

The role of streptococcal infection in children with explosive onset obsessive-compulsive disorder and new onset tics, the natural history of this entity, and the role of symptomatic and disease-modifying therapies, including antibiotics, immunotherapy, and psychoactive drugs, are all issues that have yet to be definitively addressed. This article aims to provide clarity and guidance on these complex topics, helping you make informed decisions.

While definitive proof of the autoimmune hypothesis of PANDAS is lacking, given the heightened attention to this entity and apparent rise in use of this diagnostic category, addressing questions around diagnosis, treatment, and etiology is imperative. Here, we review current working definitions of PANDAS/PANS, discuss published evidence for interventions related to this entity, and propose a clinical approach to children presenting with acute symptoms satisfying criteria for PANDAS/PANS.

Decoding PANDAS and PANS: What Are the Key Differences?

Surreal illustration of a child in a maze representing the complexities of PANDAS/PANS.

The concept of PANDAS arose out of the hypothesis that their pathogenesis may be similar to that of Sydenham's chorea. Diagnostic criteria for PANDAS were first proposed in 1998. These criteria initially focused on the association with group A streptococcal infections, setting a specific context for diagnosis.

In 2012, recognizing the limitations of the original PANDAS definition, experts introduced the concept of PANS. This broader definition includes cases with similar neuropsychiatric symptoms but without a confirmed streptococcal infection. The expansion aimed to classify a wider range of patients who might benefit from similar diagnostic and treatment approaches.

PANDAS (1998): Requires a confirmed association with Group A Streptococcus (GAS) infection. Key symptoms include OCD and/or tic disorders. Primarily affects prepubescent children.
PANS (2012): Does not require a confirmed GAS infection. Includes a broader range of neuropsychiatric symptoms beyond OCD and tics, such as anxiety, emotional lability, and behavioral regression. Can affect individuals of any age.

Understanding these definitions is crucial for parents. If your child presents with sudden onset OCD or tics, it's essential to discuss both PANDAS and PANS with your healthcare provider. Recognizing which criteria best fit your child’s symptoms will guide appropriate evaluation and management strategies.

Recommendations for Primary Care Providers

The abrupt onset of neuropsychiatric symptoms in a previously well child warrants close and careful assessment, including a detailed history, examination, and investigations to rule out underlying etiologies. As the need to understand this group of children and standardize the clinical approach to this population is great, we provide an algorithmic approach to evaluation of a child suspected of having PANDAS/PANS.

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Everything You Need To Know

What are the key differences between PANDAS and PANS, and why is this distinction important?

PANDAS, first defined in 1998, specifically links neuropsychiatric symptoms to Group A Streptococcal (GAS) infections. The primary symptoms include obsessive-compulsive disorder (OCD) and/or tics, predominantly affecting prepubescent children. In contrast, PANS, introduced in 2012, is a broader definition that does not require a confirmed GAS infection. PANS encompasses a wider range of neuropsychiatric symptoms, such as anxiety, emotional lability, and behavioral regression, and can affect individuals of any age. Understanding the difference is crucial because it guides the evaluation and management strategies your healthcare provider will consider for your child's symptoms.

What are the main diagnostic criteria for PANDAS?

The diagnostic criteria for PANDAS, as initially proposed in 1998, center on the association with Group A streptococcal infections. A child must present with sudden onset of OCD and/or tic disorders, which are key symptoms. The diagnosis of PANDAS typically involves a careful evaluation to establish a clear link between the onset of symptoms and a recent GAS infection.

How does PANS differ from PANDAS in terms of the range of symptoms?

PANS includes a broader range of neuropsychiatric symptoms compared to PANDAS. While PANDAS primarily focuses on OCD and tics associated with GAS infection, PANS considers additional symptoms. These include anxiety, emotional lability, behavioral regression, and other neuropsychiatric manifestations. This broader scope allows for the inclusion of cases where the triggering infection is not specifically identified as GAS.

Why was the definition of PANS created?

The definition of PANS was introduced in 2012 to address the limitations of the original PANDAS definition. Experts recognized that there were children experiencing similar neuropsychiatric symptoms but without a confirmed streptococcal infection. The expansion aimed to classify a wider range of patients who might benefit from similar diagnostic and treatment approaches. This broader definition acknowledges that various factors beyond GAS infections could trigger similar conditions, thus broadening the scope of potential treatments and management strategies.

If I suspect my child has PANDAS/PANS, what steps should I take?

If you suspect your child has PANDAS/PANS, the first step is to discuss your concerns with your healthcare provider. The abrupt onset of neuropsychiatric symptoms in a previously well child warrants a close and careful assessment, including a detailed history, examination, and investigations to rule out underlying etiologies. Recognizing whether your child's symptoms align more closely with the criteria for PANDAS or PANS will guide the appropriate evaluation and management strategies. It is essential to work with your provider to determine the best course of action for your child.