Kids behave in unexpected ways. Sometimes, that’s just growing up and maturing. Less commonly, sudden behavior changes are a result of the child’s immune system attacking its own brain.

PANDAS is an autoimmune disorder that occurs most commonly in children before adolescence. Though rare, this is becoming increasingly more common and parents should be aware of the signs and symptoms of PANDAS, including mental health and physical effects.

What causes PANDAS?

PANDAS stands for “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections”. This is the only known sub-category of the broader category of this condition, PANS (“pediatric acute-onset neuropsychiatric syndrome”), when streptococcal infections may not be the cause.

This condition is an autoimmune disease because the Group A streptococcal bacteria (that causes strep throat, rheumatic fever, or even scarlet fever) use molecular mimicry — disguising themselves as human cells. The immune system attacks the bacteria as well as the brain.

Although strep infections are the most common causes for PANDAS, there are several potential triggers that cause symptoms classified under PANS:

  • Virus
  • Bacterial infection
  • Mold
  • Allergies
  • Emotional trauma
  • Stress

Children are most vulnerable between the ages of 1-13.  Though 8 is the most common age when strep infections and PANDAS can occur, we have seen many cases appear even earlier.

Boys are twice as likely to develop PANDAS.

Symptoms of PANDAS

There are half a dozen or so important PANDAS symptoms. Knowledge is power when you’re dealing with a child you suddenly don’t recognize, sometimes as rapidly as overnight.

When a child develops PANDAS, the kid’s immune response produces antibodies that cause inflammation in the basal ganglia in the front of the brain. This brain inflammation leads to psychological as well as physical symptoms.

PANS/PANDAS involves rapid onset of OCD, which can happen over the course of months or even days. It is also accompanied by a number of additional symptoms:

  1. Emotional lability/depression
  2. Anxiety
  3. Aggression/irritability/opposition
  4. Behavioral regression
  5. Sensory motor abnormalities
  6. Somatic symptoms


Among the psychological PANDAS symptoms, the sudden onset of obsessive-compulsive disorder (OCD) is the main one. OCD consists of obsessions (recurrent and persistent unwanted thoughts) and compulsions (rituals, repetitive behaviors or mental acts).

A true clinical diagnosis of abrupt onset OCD in kids should still follow the diagnostic criteria set by the DSM (Diagnostic and Statistical Manual of Mental Disorders). OCD symptoms include:

  • Worry over germs, getting sick, or dying
  • Fear of things outside the child’s control
  • Worry about not having necessities
  • Excessive focus on things being done the right way
  • Continual checking and rechecking 
  • Repeated washing or cleaning

Alternatively, OCD may take the form of eating disorders. Compulsive behaviors vary from patient to patient.

PANDAS symptoms can also include emotional lability, when one mood is followed by a completely separate mood. A child with PANDAS may begin to cry uncontrollably even if they do not feel sad — laughing just moments ago.

This can turn into depression. Seldomly, children may have thoughts of suicide.

Other common neuropsychiatric symptoms are aggression and irritability, usually for no apparent reason. This is most noticeable in kids who typically have pleasant, sweet personalities.

Behavioral regression is when a child’s behavior is significantly different than his or her developmental age. For instance, a child with PANDAS might use baby talk after growing out of it years before.

PANDAS symptoms also include loss of concentration and decreased attention span. A child with PANDAS has trouble performing in school. This is only included in the diagnosis of PANDAS if ADHD was not already diagnosed.

There are also several types of anxiety that can manifest as PANDAS symptoms:

Brief hallucinations may also accompany PANDAS.


Accompanying PANDAS may be an increased sensitivity to:

  • Light
  • Sound
  • Smell
  • Taste
  • Textures

The child’s handwriting skills may deteriorate. This is also called dysgraphia.

Children affected with PANDAS often experience sensory-seeking behavior. This means they will have the need to touch and interact with various objects.

Bedwetting is a common PANDAS symptom. However, urination changes in general may happen —such as urinary frequency or greater urgency when going to the bathroom. 

The child’s sleep may be disturbed. This can manifest as night terrors, insomnia, or an unruly sleep schedule.

Along with clumsiness, PANDAS symptoms include physical and/or vocal tics, which may confuse parents or pediatricians with a diagnosis of Tourette syndrome.

Physical tic disorders can turn to Sydenham chorea, when muscles involuntarily and abnormally — some parents describe it like a scene from a horror movie.

Don’t panic. If you observe any of these symptoms or suspect your child has PANDAS, contact us here or call 888-381-8556. We specialize in treating this condition and can provide you with personalized Functional Care to support your family. 

In Summary

  • PANDAS stands for “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections”. Strep bacteria tricks the immune system into attacking your brain.
  • This mainly affects children under 13 years of age. Boys are twice as likely to develop PANDAS.
  • PANDAS symptoms include:
    • Abrupt onset OCD, which can look like eating disorders
    • Sudden mood changes
    • Behavioral regression (including baby talk)
    • Low attention span
    • Anxiety
    • Sensitivity to lights, sounds, smells, and tastes
    • Clumsiness
    • Sleep disturbances
    • Physical or vocal tics
    • Chorea
    • Bedwetting
  • The PANDAS Network or National Institute of Mental Health (NIMH) offer family support groups where you can connect with parents supporting children as they heal from PANDAS.  


  1. Murphy, T. K., Patel, P. D., McGuire, J. F., Kennel, A., Mutch, P. J., Parker-Athill, E. C., … & Dadlani, G. H. (2015). Characterization of the pediatric acute-onset neuropsychiatric syndrome phenotype. Journal of child and adolescent psychopharmacology, 25(1), 14-25. Full text: 
  2. Swedo, S. E., Leckman, J. F., & Rose, N. R. (2012). From research subgroup to clinical syndrome: modifying the PANDAS criteria to describe PANS (pediatric acute-onset neuropsychiatric syndrome). Pediatr Therapeut, 2(2), 113. Full text:
  3. Mental, H. S. A. (2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Table 3.13:
  4. Orefici, G., Cardona, F., Cox, C. J., & Cunningham, M. W. (2016). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). In Streptococcus pyogenes: Basic Biology to Clinical Manifestations [Internet]. University of Oklahoma Health Sciences Center. Full text:
  5. Baytunca, M. B., Donuk, T., & Erermis, S. (2016). Evaluation of a neuropsychiatric disorder: from PANDAS to PANS and CANS. Turk Psikiyatri Dergisi, 27(2). Full text: