I have a confession: I have been a child counselor for a while now, and I had never heard of PANS or PANDAS until fairly recently. It wasn’t covered in my graduate school program, or in my postgrad training. As far I was concerned PANS and PANDAS were kitchen implements and cute fuzzy bears from China.
All of a sudden, this year I began receiving many calls from parents looking for help for their kids who had been diagnosed with one of these two conditions. In this post, I’ll share what I’ve learned about PANS and PANDAS as a possible cause of sudden-onset OCD symptoms in kids. I’ll also let you know how therapy can help.
What Are PANS and PANDAS?
PANS stands for Pediatric Acute-Onset Neuropsychiatric Syndrome. In a child with PANS, anxiety and OCD-type symptoms develop very suddenly and severely due to an infection that has affected the child’s neurological system. Many types of infections are linked to PANS, including some fairly common ones like mononucleosis and Lyme disease.
PANDAS, or Pediatric Autoimmune Neuropsychiatric Syndrome Associated with Streptococcus, is a form of PANS. In PANDAS patients, the child’s rapid-onset symptoms are believed to be caused by the Strep A bacteria. Some researchers believe that PANDAS and is an autoimmune condition, in which the child’s body is attacking the brain instead of the bacteria causing the infection.
PANDAS was first identified in 1998, making it a relatively new condition. Because it’s so new, doctors and therapists are still learning about the causes of PANDAS and how best to help affected children.
What Are the Symptoms of PANS and PANDAS?
The most important detail to remember about PANDAS and PANS is that the symptoms come on very quickly. Usually, OCD and anxiety disorder symptoms develop gradually, over the course of months or years. Parents of children with PANDAS and PANS often describe the symptoms as almost coming out of the blue, developing over a weekend or a few days. These symptoms can quickly become so severe that they start to interfere with the child’s day-to-day life.
According to the International OCD Foundation, symptoms of PANS and PANDAS can include:
Symptoms of OCD, like ritualized behavior or repeated worries
Anxiety symptoms, like sudden separation anxiety
Tics and other unusual movements, or problems with coordinated movement like handwriting
Changes in eating and bathroom habits
A recent strep infection (or other infection, in the case of PANS)
How are PANDAS and PANS Diagnosed and Treated?
PANDAS and PANS are diagnosed by a medical doctor. If the doctor thinks a child’s symptoms sound like they could be PANDAS, they will order tests like a throat culture or blood test that can detect a recent strep infection. If these tests come back positive, a doctor may choose to prescribe antibiotics to treat the infection. If child’s symptoms are due to PANDAS, they should subside along with the strep. PANS is diagnosed in a similar fashion, with tests and medications prescribed according to the infection that is suspected to be causing problems. Sometimes, when a child’s symptoms aren’t responding well to other medicines, doctors will use a more in-depth treatment called intravenous immunoglobulin (IVIG).
Doctors also often recommend therapy for PANS and PANDAS patients to treat the symptoms of anxiety and OCD caused by the illness. Although PANS and PANDAS may have a different cause than other anxiety disorders, kids with these conditions can still get relief from their symptoms with counseling.
Controversies: Are PANS and PANDAS Real Illnesses?
Because PANDAS and PANS are so new, doctors and researchers still are not in total agreement about what causes them. Some doctors are very convinced that strep and other infectious illnesses are the cause of PANS and PANDAS, while others feel there isn’t enough evidence yet to be certain. Some doctors feel more comfortable than others prescribing antibiotics to treat PANS and PANDAS symptoms, especially if the testing shows that the infection wasn’t extremely recent.
I’m not a medical doctor so I can’t speak to what really causes PANDAS and PANS or the best way to medically treat it. I do know that many children have had these symptoms since doctors first identified PANDAS in 1998, so whatever the cause, the problems children are suffering from are real. I also know that counseling, especially cognitive behavioral therapy, can be really helpful for these children.
Can PANS and PANDAS be Cured?
PANS and PANDAS are believed to be curable. Usually, if the symptoms are being caused by an infection, they get a lot better when the infection is treated. Counseling can also support kids in recovering from PANS and PANDAS and help them resolve any remaining anxiety after their medical treatment is done.
CBT for Children with PANS and PANDAS
Therapy can be helpful for kids with PANDAS and PANS for a few reasons:
Learning coping skills to deal with anxiety might help symptoms resolve more quickly.
Sometimes, even after medical treatment a child still shows signs of separation anxiety or OCD-type worrying. For these kids, the anxiety might have become a habit. They may have avoided the things causing their anxiety for so long, that now it is difficult to get back into their normal routine.
PANS and PANDAS can be really frightening for kids. Children sometimes describe feeling out of control of their bodies. Having some support to work through the experience of suddenly getting sick can also help children to feel better.
Cognitive behavioral therapy, or CBT, is often recommended for kids with PANDAS and PANS. This kind of therapy helps children to notice when they’re having unhelpful thoughts that lead to worrying, and learn how to face their fears rather than avoiding them. It’s more goal-oriented and structured than some other forms of child therapy, so kids can really focus on the triggers for their anxiety.
ERP for Kids with OCD Symptoms Due to PANS and PANDAS
For children who have sudden-onset OCD symptoms, a special kind of CBT called Exposure and Response Prevention, or ERP, is often the best fit. This kind of therapy helps children to gradually face the fears that set off OCD worries and behavior. Children learn how to handle triggering situations without resorting to rituals or repeated behavior to help calm them down. Over time, kids feel more in control of their thoughts and less bothered by worries.
Help for PANS and PANDAS in Davidson, North Carolina
I’m a counselor who practices in Davidson, North Carolina, where I specialize in using CBT to help children combat anxiety. If you’d like to hear more about how I might be able to help your child with PANS or PANDAS, reach out to me here.
Not located near Davidson? I can provide online therapy throughout North Carolina, New York, and Florida. I also have an online coping skills course for kids with anxiety called Worry-Free Tweens. Because it’s education-based and not therapy, it’s available everywhere.
You can also get more in-depth information by checking out the references below.
International OCD Foundation’s PANDAS Page
Parents.com’s feature on PANDAS
PANDAS Physicians Network on how CBT helps PANDAS
