Rothman Center for Pediatric Neuropsychiatry

Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)/Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal (PANDAS)


Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is associated with the sudden onset of obsessive-compulsive disorder (OCD) symptoms, anxiety, tics, personality changes, sensory sensitivities, and/or restrictive eating habits. The symptoms associated with OCD include the presence of unwanted thoughts, impulses, or images (obsessions) that cause anxiety followed by behaviors done to reduce the anxiety (compulsions). The symptoms associated with PANS often cause sudden and significant impairment in daily life and functioning. The occurrence of the dramatic shift in symptoms is often the result of infectious diseases, non-infectious health problems, or environmental factors. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal (PANDAS) follows the same trajectory and symptoms as PANS but is specifically associated with streptococcus.

What are the causes of this condition?

Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is the result infectious diseases, environmental factors, or non-infectious health problems leading to an inappropriate immune response resulting in inflammation of the brain. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal (PANDAS) is specifically triggered by Group A Streptococcus.


PANS/PANDAS symptoms often include unwanted thoughts, images, or impulses (obsessions) along with personal rituals to reduce the anxiety caused by the obsessions (compulsions). Additional symptoms of PANS/PANDAS can include food refusal, emotional instability and/or depression, irritability, developmental regression, worsening of school performance, sensory or motor abnormalities, and somatic symptoms such as sleep problems urinary control issues.

  • Obsessions
    • Recurring thoughts, images, or impulses, that cause distress and anxiety
    • Recognition that the thoughts are unreasonable
  • Compulsions
    • Activities repeated to reduce anxiety over an obsessive thought
    • The acts, though intended to help, are either excessively done or not related to the source of anxiety
  • Emotional instability and/or depression
  • New onset food restriction/refusal/avoidance
  • Irritability
  • Developmental regression
  • Worsening of school performance
  • Sensory or motor abnormalities
  • Somatic symptoms such as sleep problems, urinary frequency and urinary control issues


An initial evaluation is conducted under the supervision of Dr. Justyna Wojas or Dr. Tanya Murphy, an international expert in PANS/PANDAS, and includes a comprehensive assessment of the presenting concerns, developmental history, nutritional history, medical history, history of illness course, and level of psychosocial functioning in order to obtain a proper diagnosis and medication evaluation. This evaluation will assess what neuropsychiatric disorders are currently evident and identify other disorders that need to be ruled out. Recommendations are made at the conclusion of the evaluation for services that, in the opinion of the team, would be most beneficial to address the identified problems. In addition, laboratory testing is frequently used to help identify any underlying medical basis of symptoms. Treatment is tailored to the child's history and clinical presentation.

The first line of treatment for PANS/PANDAS is to treat any infection or inflammation that may be present, which may include antibiotics. In addition, Cognitive Behavioral Therapy (CBT) with Exposure Response Prevention (ERP) is often recommended, which is offered in weekly or intensive (daily) versions. Other options include medication management.

Children should be monitored for acute changes and behavior and screen for potential infectious trigger. Treatment of the precipitating infection may help reduce symptom severity.