PANDAS Disorder in Children: Symptoms, Causes, and When to Seek Help

Sudden and significant changes in a child’s behavior after a strep infection can be confusing and distressing. Some children may develop new tics, obsessive thoughts, or noticeable mood swings that appear almost overnight. At the Massachusetts Center for Adolescent Wellness, staff members see families experiencing these challenges and support children who are facing complex mental health challenges.

PANDAS disorder is one possible explanation for these abrupt behavioral changes after a strep infection. The center offers specialized care for pediatric conditions like PANDAS, working with families to help them understand the condition and explore appropriate treatment options. Understanding what PANDAS disorder is can help parents and caregivers recognize the signs and know when to seek professional support.

What is PANDAS Disorder?

PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. This disorder describes a group of symptoms that appear suddenly in children after they have a strep infection, such as strep throat or scarlet fever.

Children with PANDAS disorder may suddenly develop obsessive-compulsive behaviors (OCD), tics, or both. These symptoms often begin abruptly, sometimes within days or weeks of a strep infection, and are noticeably different from the child’s usual behavior.

PANDAS disorder typically affects children between the ages of three and puberty. The main trigger is infection with Group A streptococcus bacteria. Not every child who gets strep will develop PANDAS, but researchers estimate that about 1 in 200 children in the United States may have PANDAS.

The most common signs include sudden onset of OCD behaviors, motor or vocal tics, mood changes, anxiety, and sometimes changes in school performance or handwriting. The symptoms may come and go, often worsening if a child gets another strep infection.

Some medical professionals continue to study and debate PANDAS, but the pattern of rapid behavioral changes following strep infection is recognized by many providers and families. The Massachusetts Center for Adolescent Wellness offers evaluation and treatment for children with symptoms consistent with PANDAS disorder, using an evidence-based and family-centered approach.

How Does PANDAS Disorder Develop After a Strep Infection?

PANDAS disorder forms through an autoimmune process that begins when a child experiences a strep infection, such as strep throat or scarlet fever. The immune system produces antibodies to attack the strep bacteria. In certain cases, these antibodies not only target the bacteria but also mistakenly react with the child’s own brain tissue. This process is called molecular mimicry.

The brain region most affected is called the basal ganglia, which is involved in controlling movement and behavior. When antibodies cross-react with this part of the brain, neuropsychiatric symptoms, such as tics or obsessive-compulsive behavior, can develop quickly.

Not all children who get strep infections develop PANDAS disorder. Genetic susceptibility and other contributing factors influence who is affected. The mechanism is not fully understood, but research supports that immune system confusion after strep infection can lead to PANDAS in some children.

Key Symptoms of PANDAS Pediatric Disease

PANDAS disorder is known for its rapid and noticeable changes in behavior and emotions, often following a strep infection. The symptoms are different from those of typical childhood OCD or tics because they appear suddenly and can be severe.

Common Neuropsychiatric Changes

Obsessive-compulsive behaviors are common and may include repetitive thoughts, excessive handwashing, or checking rituals that begin quickly. Tics can also develop, taking the form of sudden, involuntary movements like eye blinking or facial grimacing, as well as vocalizations such as throat clearing or repetitive sounds.

Some children may experience new or intense anxiety, including separation anxiety and panic attacks. Mood changes can occur, presenting as irritability, frequent emotional outbursts, or even symptoms of depression.

Physical and Behavioral Signs

PANDAS disorder can also affect physical and daily behaviors. Sleep may become disrupted, with problems like trouble falling asleep, nightmares, or a return to bedwetting after being dry at night. Eating habits may shift, including food restrictions, reduced appetite, or difficulty swallowing.

Some children experience a sudden decline in school performance or concentration. Social withdrawal is also possible, with children avoiding friends, family activities, or things they used to enjoy.

How is PANDAS Diagnosis Determined?

There is no single laboratory test or imaging scan that confirms a diagnosis of PANDAS disorder. Diagnosis relies on a careful evaluation by a healthcare provider using established clinical criteria.

Doctors look for five main diagnostic guidelines:

1. Presence of OCD and/or tics: The child has noticeable obsessive-compulsive behaviors, tics, or both.
2. Prepubertal onset: Symptoms begin between ages 3 and 12.
3. Acute, dramatic onset or episodic course: Symptoms start suddenly or show a pattern of intense flare-ups and remissions.
4. Temporal relationship with strep infection: Onset or worsening of symptoms happens soon after a strep infection, such as strep throat or scarlet fever.
5. Association with neurological abnormalities: The child may have unusual movements, changes in coordination, or other neurological findings.

The diagnostic process usually involves gathering a detailed medical history, focusing on the timing of symptoms and recent infections. A physical exam may include checking for signs of a current or recent strep infection, sometimes using a throat culture or blood tests for strep antibodies.

A psychological assessment helps evaluate the presence and severity of obsessive-compulsive symptoms or tics. Healthcare providers also look for other explanations of the symptoms and rule out conditions such as Tourette syndrome, primary OCD, or other autoimmune or neurological disorders. Diagnosis is based on the combination of these findings.

Treatment Options for PANDAS Medical Condition

“Pandas disease treatment” and “pandas medical condition” management is individualized and often requires multiple approaches.

Do Teenagers or Adults Get PANDAS Syndrome Too?

PANDAS disorder is usually seen in children before puberty, often between the ages of 3 and 12. Some teenagers can continue to experience symptoms that began in childhood, but new cases starting in adolescence are uncommon.

When teenagers show a sudden onset of similar symptoms, such as tics or obsessive-compulsive behaviors, health professionals more often consider a diagnosis of PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). PANS includes a wider range of possible triggers, not just strep infections.

Cases of PANDAS disorder that begin in adults are extremely rare. Most research and clinical reports describe PANDAS as a childhood-onset condition, with very few documented cases in adults. Researchers continue to study the long-term effects and possible presentations in older age groups, but current understanding points to PANDAS as a pediatric disorder.

PANDAS vs PANS: What is the Difference?

PANDAS and PANS are both conditions involving a sudden onset of neuropsychiatric symptoms in children and adolescents. Both may feature symptoms such as obsessive-compulsive behaviors, tics, mood changes, or anxiety that begin quickly and sometimes dramatically, but there are differences in what triggers each condition and who they affect.

The table below summarizes key differences:

PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. It is diagnosed when symptoms appear after a documented strep infection in children between the ages of 3 and puberty.

PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome. It is a broader term for cases where similar symptoms occur but may be linked to different infections (such as influenza, mycoplasma, or Lyme disease), metabolic disturbances, or environmental factors, and can affect children outside the typical age range for PANDAS.

PANS includes all cases that meet criteria for the sudden onset of obsessive-compulsive symptoms and/or severely restricted food intake, regardless of the underlying trigger. PANDAS is considered a subset of PANS.

When to Seek Help and What to Expect

Parents and caregivers can look for certain changes after a child has been ill, especially following a strep infection. Some signs that may indicate the need for professional assessment include a sudden change in personality, new obsessive-compulsive behaviors that disrupt daily routines, a sharp rise in anxiety or panic attacks, the appearance of new tics or a noticeable worsening of existing tics, and significant loss of skills or behaviors in a child who was previously functioning well.

When a child is evaluated for possible PANDAS disorder, the process usually involves several steps. Health professionals often gather a medical history, perform a physical examination, and may use lab tests to check for recent strep infection. Psychological assessments help identify symptoms such as tics, OCD behaviors, or mood changes. Evaluators may also look for other possible causes to make sure that symptoms are not due to another medical or neurological condition.

Treatment involves a combination of medical and mental health support. This may include antibiotics for active strep infections, therapy for obsessive-compulsive behaviors or anxiety, and support for the child’s family. Massachusetts Center for Adolescent Wellness uses a collaborative approach, involving families in planning and care throughout the process.

FAQs About PANDAS Illness

Moving Forward with Support for Your Child

Massachusetts Center for Adolescent Wellness provides care for adolescents who experience complex mental health challenges, including PANDAS disorder. The center’s multidisciplinary team includes clinicians with experience in pediatric mental health, autoimmune-related behavioral changes, and family support.

Treatment for PANDAS disorder often involves a combination of approaches. These may include medical management for infections, evidence-based therapy for obsessive-compulsive and anxiety symptoms, and collaboration with families and schools to support daily functioning. Clinical care is informed by current research and is tailored to each child’s needs.

The center supports families throughout the diagnostic and recovery process, addressing not only the child’s symptoms but also the emotional impact on parents and siblings. Access to expert guidance can help families navigate uncertainty and understand next steps in care.

Specialized care is available. Contact us to start your child’s journey to wellness.