PANDAS syndrome (and the related PANS) is a controversial diagnosis for a few reasons:

  • It’s a fairly new condition
  • It can only be clinically diagnosed (lab tests cannot definitively confirm a diagnosis)
  • Symptoms can change rapidly or appear and disappear
  • A 2018 article published in The Journal of Pediatrics expressed doubt concerning these conditions and their diagnoses
  • PANDAS/PANS resembles other conditions (such as Tourette’s Syndrome, Sydenham Chorea, and Rheumatic Fever)

PANDAS and PANS cause sudden-onset obsessive-compulsive disorder (OCD) in children. Kids with recent strep infections (and, sometimes, with no triggering infection) will suddenly develop symptoms like:

  • Tics
  • Obsessive cleaning rituals or other OCD obsessions
  • Separation anxiety
  • Rage attacks
  • Frequent urination
  • Decline in motor skills

This abrupt onset of OCD symptoms with neurological and somatic symptoms is the classic presentation of PANDAS/PANS.

Is PANDAS a legitimate diagnosis? PANDAS is a legitimate diagnosis. Though PANDAS/PANS are considered new and somewhat difficult to diagnose, this doesn’t make them any less real. 

Let’s review the common myths, controversies, and scientific evidence around this disorder.

Myth: PANDAS Doesn’t Exist

Fact: PANDAS and PANS do exist. Over 2 decades of research support the reality of PANDAS.

Susan Swedo began studying a condition similar to pediatric OCD but preceded by a strep infection. Swedo’s work spanned the 1990’s in the Child Psychiatry Branch of the National Institute of Mental Health (NIMH). 

In 1998, Swedo published her watershed study naming and outlining diagnostic criteria for the condition PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections).

As more researchers studied the condition, they discovered that not all cases stemmed from a strep infection. Some were infection-triggered, and some were not. The symptoms were similar to PANDAS; however, restrictive eating like anorexia were more prevalent in these cases. 

In 2010, clinicians began to outline diagnostic criteria for PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome). This culminated in the 2012 article by Swedo, James Leckman, and Noel Rose.

Since then, others have built upon Swedo’s work. Diana Pohlman started the PANDAS Network in 2013 to help parents of those with PANDAS/PANS. Once the knowledge gap began to close, PANDAS diagnoses increased. 

Now, the PANDAS Network estimates 1 in 200 children in the United States has PANDAS.

Myth: PANDAS is a Mild Condition

Fact: Though mild cases of PANDAS have occurred, PANDAS is not a mild condition. Several serious symptoms can play a role in a case of PANDAS. In fact, it’s the sudden onset of symptoms that first signal parents that their child’s health is at risk.

PANS/PANDAS interventions also carry risks of significant side effects.

How PANDAS Develops

PANDAS starts with a group A Streptococcus (GAS) infection, such as strep throat invading the body. Strep is a clever bacteria with the ability to go undetected by the immune system.

The bacteria hides by placing molecules on its cell walls that are uncannily similar to those found in heart, brain, and joint tissues. This phenomenon is referred to as “molecular mimicry.”

Once the immune system realizes it’s been compromised, it creates antibodies to hunt down the bacteria. Because the bacteria are so good at molecular mimicry, the antibodies can mistake healthy tissue as the bacteria.

The neuropsychiatric symptoms common to PANDAS patients happen when antibodies attack the brain (specifically, the basal ganglia). 

PANDAS symptoms may include the following:

  • Anxiety: general anxiety, phobias, or separation anxiety
  • Behavioral/developmental regression: might revert to “baby talk” or bedwetting 
  • Emotional lability: depression or sudden changes in emotions
  • Oppositional behavior: aggression or irritability
  • Sensory or motor abnormalities: sensitivity to stimuli, clumsiness, or hyperactivity 
  • Somatic symptoms: tics, sleep disturbances, or urinary frequency
  • Deterioration of school performance: lack of focus or preoccupation with their new symptoms

Treatments for PANS/PANDAS

Though antibiotics are the first line of defense to help tackle the strep infection, they may be ineffective (especially if the initial infection has subsided).

Intravenous immunoglobulin (IVIG) is a treatment option to aid patients with immune deficiencies. Immunoglobulin is a part of blood plasma that carries antibodies. When donors give blood, immunoglobulin can be filtered out and administered by IV to patients in need.

Plasmapheresis, also called plasma exchange, is when the liquid portion (plasma) of the blood is replaced with a solution such as saline or albumin. Plasma carries antibodies, and in the case of a PANDAS patient, it can prove useful to flush out antibodies attacking the brain.

Steroids are another treatment option to potentially lessen the impact of future exacerbations/flare-ups of PANDAS, as a 2017 study indicates.

Tonsillectomy is perhaps the most invasive treatment option, as it’s a form of surgery. Tonsils are removed to prevent the recurrence of strep throat.

Controversy: PANDAS Can’t Be Diagnosed With a Blood Test

There are no definitive blood tests to diagnose PANDAS, although some biomarkers may point to this disorder. This doesn’t mean it’s impossible to diagnose; it’s simply trickier to identify. 

Clinicians must also rule out other similar conditions when making a clinical diagnosis. Pediatricians who frequently work with PANDAS, like the M Center team, are a parent’s best chance at getting an accurate PANDAS diagnosis.

Controversy: PANDAS Is an Autoimmune and a Mental Health Condition

PANDAS is not as straightforward as most psychiatric disorders. It cannot be strictly classified as a mental illness or a tic disorder. In fact, recent research conducted by Columbia and Yale Universities indicates that PANDAS is an autoimmune disease.

But treating the condition means addressing the psychiatric symptoms and immune system symptoms.

Cognitive behavioral therapy is often recommended for PANDAS patients. CBT helps with curbing the OCD symptoms.

Probiotics may also boost the immune system and support gut function.

An anti-inflammatory diet may help reduce PANDAS symptoms. We suggest patients avoid refined carbohydrates such as white breads and pastas and highly processed foods such as chips, frozen meals, and sugary cereals. Then, they should increase intake of leafy greens, nuts, lean meats and fish, and fruits.

What if my doctor doesn’t believe me?

It can be frustrating to feel ignored, especially if you’re facing an out-of-control child that was happy and healthy just days ago. There are some things you can do to advocate for yourself at your doctors’ office:

    • Be prepared: Come to the doctor’s office with a notepad, a list of symptoms, medications your child is taking, and questions you wish to ask. This can save you and the doctor valuable time.
    • Keep a health journal: Monitor when symptoms manifest and possible causes or triggers. This journal will allow you to better answer the doctor’s questions and keep you from feeling “put on the spot.”
  • Prioritize symptoms: While the journal will help you keep track of all symptoms, making a list of the top 10 symptoms you hope to address could help your doctor know what’s most important to treat.
  • Ask, “What could this symptom mean?” If you feel a significant symptom is being overlooked or dismissed, ask the doctor about that symptom specifically. What else could the symptom indicate?
  • Refuse to feel rushed: It’s not uncommon for medical professionals to be in a hurry. It can be tempting to try and match their rhythm out of courtesy. But don’t! Express your concerns and ask your questions. 
  • View yourself, not ust your pediatrician, as your child’s advocate: Don’t be afraid to be honest and persistent. Respectfully communicate with the doctor and let them know you feel unheard. 
  • Get a second opinion: Asking for a referral or a second opinion is completely normal, and patient-focused doctors typically welcome them. If your first appointment leaves you without an action plan, or you doubt the diagnosis or treatment suggested, talk to another doctor.

If these tactics don’t work or you’re still struggling to trust your doctor, check out the PANDAS Physicians Network. This practitioner directory can guide you to a doctor who recognizes and treats PANDAS.

Talk To Us About Your Child’s Needs

At The M Wellness Center in Roswell, GA, we strive to listen to the patient and treat root cause of a patient’s symptoms. Contact us to schedule your child’s appointment today!

Read Next: PANDAS and Autism — A Parent’s Guide


  1. Gilbert, D. L., Mink, J. W., & Singer, H. S. (2018). A pediatric neurology perspective on pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection and pediatric acute-onset neuropsychiatric syndrome. The Journal of pediatrics, 199, 243-251. Full text:
  2. Swedo, S. E., Leonard, H. L., Garvey, M., Mittleman, B., Allen, A. J., Perlmutter, S., … & Lougee, L. (1998). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. American Journal of Psychiatry, 155(2), 264-271. Abstract:
  3. 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:
  4. Brown, K., Farmer, C., Farhadian, B., Hernandez, J., Thienemann, M., & Frankovich, J. (2017). Pediatric acute-onset neuropsychiatric syndrome response to oral corticosteroid bursts: An observational study of patients in an academic community-based PANS clinic. Journal of Child and Adolescent Psychopharmacology, 27(7), 629-639. Full text:
  5. Xu, J., Liu, R. J., Fahey, S., Frick, L., Leckman, J., Vaccarino, F., … & Pittenger, C. (2021). Antibodies from children with PANDAS bind specifically to striatal cholinergic interneurons and alter their activity. American Journal of Psychiatry, 178(1), 48-64. Full text: