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PANS - pediatric acute-onset neuropsychiatric syndrome - is the rapid onset of OCD symptoms accompanied by other confusing and distressing behaviors in young children. Within 24-48 hours, the full symptom presentation has developed and is a significant departure from the child's normal behavior. The development of PANS has been linked to Lyme disease, mononucleosis, mycoplasma (walking pneumonia) and the flu.  PANDAS - pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections - is a subset of PANS and refers to the same symptom presentation that is linked to a strep infection. The part of the body impacted by these infections is the immune system, which is effectively attacking the brain and causing these neuropsychiatric disturbances. Both PANS and PANDAS are not wholly embraced by the medical community as there is still considerable debate as to their validity.

OCD vs.

  • The typical progression of OCD is gradual with the early obsessions and compulsions being private experiences that go unnoticed by others even for children and parents. PANS/PANDAS develops overnight for most children and reaches full intensity by 48 hours.

  • Because of the gradual progression of OCD, the disordered behavior may not seem completely in opposition to your child's typical behavior. However, PANS/PANDAS symptoms are in such opposition to a child's normal behavior that parents report being deeply confused and even wonder if their child is possessed. 

  • The etiology of OCD is not exactly known by those who study the origin and development of the disorder. It has been shown that there is a genetic component but much is still unknown about why some people develop OCD and others do not. For PANS/PANDAS, research indicates that there is a link between certain infections and the development of symptoms associated with these syndromes. PANDAS, in particular, is widely acknowledged as a misdirected immune response to the strep infection.

  • OCD is a disorder that remains fairly constant in intensity and severity unless actively treated. Stress, illness or environmental changes can make a slight to moderate impact but the underlying disorder remains constant. PANS/PANDAS, however, is episodic with symptom flares coming and going alongside exposure to infection and illness. Therefore there may be stretches of time with fewer symptoms present.

Additional Symptoms:

  • constant reassurance seeking

  • fear of choking, contamination and vomiting leading to severe food restrictions

  • compulsive hand-washing

  • separation anxiety

  • panic attacks

  • behavioral regression including baby talk or clinginess

  • oppositional behavior that may or may not include aggression

  • inattentiveness, difficulty concentrating, hyperactivity

  • loss of academic knowledge or competence

  • memory loss

  • dramatic changes in handwriting

  • difficulty falling and staying asleep

  • sensitivity to light or sound

  • bedwetting


Treatment for PANS/PANDAS is multifaceted to address the areas of etiology and impairment. Doctors refer to the treatment approach as that which targets the symptoms, the source of the infection and the immune system. Neurology and psychiatry are important components for most cases. Cognitive behavior therapy and medication have been shown helpful to address the symptoms. The source of the infection is medically managed through a pediatrician or PANS-knowledgeable physician. And the immune system is treated medically in an effort to restore immune system functioning.

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