PANS/PANDAS in Children with Autism: What You Need to Know

PANS and PANDAS are two conditions that are often associated with children who have autism.

steven zauderer
Steven Zauderer
September 19, 2023
min read


PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are two conditions that are often associated with children who have autism.

PANS is a condition that occurs when a child experiences a sudden onset of neuropsychiatric symptoms, such as obsessive-compulsive disorder (OCD), tics, anxiety, and behavioral changes.

PANDAS, on the other hand, occurs when a child develops these symptoms after a streptococcal infection, such as strep throat.

While PANS and PANDAS are not specific to autism, studies have shown that children with autism are more likely to develop these conditions than children without autism. In fact, one study found that up to 70% of children with autism also have PANS or PANDAS.

What Causes PANS/PANDAS?

The exact cause of PANS and PANDAS is not fully understood, but it is believed to be related to an autoimmune response. In PANDAS, the immune system mistakenly attacks the basal ganglia, a part of the brain that is responsible for controlling movements and behaviors.

In PANS, the immune system attacks other parts of the brain, leading to the sudden onset of neuropsychiatric symptoms.

It is thought that the immune system is triggered by an infection, environmental toxins, or other factors.

How are PANS/PANDAS Diagnosed?

Diagnosing PANS and PANDAS can be challenging, as the symptoms can be similar to other conditions, such as ADHD, anxiety disorders, and mood disorders. A diagnosis is typically made by a specialist, such as a pediatric neurologist or psychiatrist, who will evaluate the child's symptoms and medical history.

In some cases, blood tests may be done to look for signs of an autoimmune response or a recent streptococcal infection. Imaging tests, such as an MRI or CT scan, may also be done to rule out other conditions.

How are PANS/PANDAS Treated?

Treatment for PANS and PANDAS typically involves a combination of medications and therapy. Antibiotics may be prescribed to treat any underlying infections, while immunomodulatory drugs may be used to help regulate the immune system.

Behavioral therapy, such as cognitive-behavioral therapy (CBT) or exposure and response prevention (ERP), may also be recommended to help manage the child's symptoms.

Common Signs & Symptoms

Children with autism who have PANS or PANDAS may experience a sudden onset of neuropsychiatric symptoms, as well as an exacerbation of their existing autism symptoms.

Some common symptoms of PANS and PANDAS in children with autism include:

  • Obsessive-compulsive behaviors (such as repetitive hand-washing or lining up objects)
  • Tic disorders (such as eye blinking, facial grimacing, or throat clearing)
  • Anxiety and/or panic attacks
  • Irritability, aggression, or mood swings
  • Regression in language skills or social interactions
  • Sensory sensitivities (such as aversion to certain textures or sounds)
  • Sleep disturbances
  • Loss of appetite or weight loss

It's important to note that not all children with PANS or PANDAS will experience all of these symptoms, and the severity can vary widely from child to child. If you notice sudden changes in your child's behavior or functioning, it's important to consult with a medical professional who is familiar with these conditions.

Impact on a Child's Development and Daily Life

PANS and PANDAS can have a significant impact on a child's development and daily life. These conditions can cause sudden changes in behavior, mood, and cognitive functioning, which can be confusing and distressing for both the child and their caregivers.

For children with autism who already struggle with social interactions, communication difficulties, and sensory sensitivities, the onset of neuropsychiatric symptoms can exacerbate these challenges.

Children may become more withdrawn or aggressive, have difficulty sleeping or eating, or experience disruptions in their academic progress.

In addition to these immediate impacts, untreated PANS or PANDAS can also lead to long-term consequences. Some studies have suggested that prolonged inflammation from an autoimmune response may damage brain cells and affect brain development over time.

It is essential to diagnose and treat PANS or PANDAS as early as possible to minimize these negative effects on a child's development. With proper treatment, including medication and therapy, many children with these conditions can recover fully or significantly improve their quality of life.

If you suspect that your child may be experiencing symptoms of PANS or PANDAS, it is crucial to consult with a specialist who is familiar with these conditions. They can help evaluate your child's symptoms, provide an accurate diagnosis, and develop an individualized treatment plan tailored to your child's unique needs.

How to Differentiate Between PANS/PANDAS and Other Conditions that Share Similar Symptoms

Diagnosing PANS/PANDAS can be challenging because many of the symptoms overlap with other conditions such as ADHD, anxiety disorders, and mood disorders. Additionally, some children with autism may experience similar symptoms without having PANS or PANDAS.

To differentiate between PANS/PANDAS and other conditions, specialists typically use a combination of diagnostic tools including medical history, physical exams, lab tests, and imaging studies.

When evaluating a child for PANS/PANDAS, specialists will look for sudden onset of neuropsychiatric symptoms such as OCD-like behaviors, tics, anxiety/panic attacks or anorexia. They will also evaluate whether the child has recently had a streptococcal infection.

A thorough examination may include blood tests to detect autoimmune antibodies (e.g., anti-dopamine receptor antibodies) or evidence of recent streptococcal infection (e.g., elevated antistreptolysin O titers). Imaging studies like MRI or CT scan may be used to rule out neurological conditions that share similar symptoms.

A specialist experienced in diagnosing PANS/PANDAS will use all available information to make an accurate diagnosis. It's important to note that misdiagnosis is not uncommon in children with neuropsychiatric symptoms.

Therefore, if you suspect your child has PANS/PANDAS or any other condition that affects their behavior or cognition, it's essential to seek out a specialist who can provide an accurate diagnosis and treatment plan tailored to your child's needs.

Possible Risk Factors

While the exact cause of PANS and PANDAS is not fully understood, there are some possible risk factors that may increase a child's likelihood of developing these conditions.

One factor may be genetics. Studies have shown that certain genetic variations may increase a child's susceptibility to autoimmune disorders, including PANS and PANDAS.

Additionally, children with autism may have genetic differences that affect their immune system function, making them more vulnerable to infections and autoimmune responses.

Environmental factors may also play a role in the development of PANS and PANDAS. Exposure to toxins or pollutants, such as mold or heavy metals, may trigger an immune response in susceptible children.

Infections other than streptococcal infections, such as viral or bacterial infections, may also contribute to the onset of neuropsychiatric symptoms in some cases.

Finally, stress and trauma may exacerbate symptoms of PANS and PANDAS in children with autism. Children who experience high levels of stress or trauma, such as bullying or abuse, may be more likely to develop neuropsychiatric symptoms associated with these conditions.

It's important to note that not all children with autism who have these risk factors will develop PANS or PANDAS.

However, understanding these potential risk factors can help parents and caregivers take steps to minimize their child's exposure to environmental toxins and reduce stressors in their daily life.

It can also inform discussions with healthcare providers about potential treatment options for children who do develop these conditions.


PANS and PANDAS can be challenging conditions to diagnose and treat, but early intervention can help improve outcomes. If you suspect that your child may have PANS or PANDAS, it is important to seek out the help of a specialist who can provide an accurate diagnosis and develop a treatment plan that is tailored to your child's needs.

steven zauderer

CEO of CrossRiverTherapy - a national ABA therapy company based in the USA.

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