Cody Casey
Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is a clinical diagnosis given to children who experience a dramatic, sometimes overnight, onset of neuropsychiatric symptoms, including obsessions/compulsions or food restriction. PANS is often accompanied by other symptoms, including restricted eating, anger, and depression. To be diagnosed with PANS, a child must exhibit two of the following seven criteria: behavioral regression, emotional lability, irritability, aggression, and severely oppositional behaviors. PANS is caused by many different disease mechanisms and etiologies, and there are three complementary modes of intervention to treat it.
| Characteristics | Values |
|---|---|
| Diagnosis | Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) |
| Onset of symptoms | Abrupt, acute, dramatic, sudden, overnight |
| Symptoms | Obsessive-compulsive disorder (OCD), severely restricted food intake, depression, irritability, anxiety, anger, emotional lability, suicidal thoughts, aggression, oppositional behaviors, tics, urinary issues, academic difficulties, motor and sensory abnormalities, restricted intake of specific foods or all food groups, hoarding behaviors, ritualized eating behaviors |
| Cause | Unknown, possibly triggered by infections, metabolic disturbances, inflammatory reactions, or immune system response |
| Treatment | Antibiotics, therapy, medicines |
| Severity | Mild, Moderate, Severe |
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What You'll Learn
- Parents notice a dramatic change in their child's behaviour and take them to a paediatrician
- The child presents with a sudden onset of OCD or restricted eating
- The child may also display symptoms of depression, anxiety, anger, or academic difficulties
- The child may have recently had an infection, metabolic disturbance, or inflammatory reaction
- The physician refers the child to a psychologist or psychiatrist for further evaluation
Parents notice a dramatic change in their child's behaviour and take them to a paediatrician
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) are severe forms of obsessive-compulsive disorder (OCD) that manifest in young children, accompanied by other confusing and distressing symptoms. The dramatic and sudden onset of symptoms can be extremely distressing for both the child and their parents.
Parents play a crucial role in recognizing the initial signs and symptoms of PANS and seeking appropriate medical help. When parents notice a sudden and drastic change in their child's behaviour, it is essential that they take their child to a paediatrician or, in extreme cases, to the emergency room. This behavioural change could include the abrupt onset of OCD symptoms, such as obsessions, compulsions, or restricted eating habits. For example, a child may develop new and intense fears or concerns about things being clean or in a specific order. They may also exhibit compulsive behaviours, such as repeatedly performing rituals or seeking constant reassurance from their parents.
It is important for parents to be mindful of their approach when consulting a doctor. Dr. Swedo recommends refraining from insisting that your child has PANS and instead expressing concern about their abrupt behavioural changes. This allows the physician to consider PANS as one possible explanation while exploring other potential causes as well. Parents can describe their observations at home and emphasize how these changes are out of character for their child. By partnering with the doctor in a collaborative approach, parents can contribute to the diagnostic process effectively.
During the initial consultation, the paediatrician will assess the child's symptoms and may recommend a follow-up visit within a few days to monitor the situation. The physician may also refer the family to a psychologist or psychiatrist to address the mental health aspects of the disorder and provide support in managing the associated stress. It is important to start therapy as soon as possible and ensure regular attendance at therapy sessions.
In addition to behavioural changes, parents may notice academic difficulties in their children, such as problems with schoolwork or a deterioration in handwriting skills. Motor abnormalities, including clumsiness, tics, or hyperactivity, may also be observed. These physical and cognitive symptoms can further reinforce the need to seek professional help and ensure early intervention.
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The child presents with a sudden onset of OCD or restricted eating
Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is a clinical diagnosis given to children who exhibit a dramatic and sudden onset of neuropsychiatric symptoms, including obsessive-compulsive behaviours and/or restricted eating. PANS presents with a rapid emergence of OCD symptoms or eating restrictions, accompanied by a debilitating set of neurological and cognitive issues.
The child presents with a sudden onset of OCD when they start exhibiting signs of psychological distress, such as excessive handwashing, new and irrational fears, and worries about feeling sick. These behaviours can develop within a day or two after the initial infection, which is much quicker than typical OCD, which usually develops gradually over time.
Restricted eating in PANS can manifest as a refusal to eat certain foods or a complete refusal to eat. This restricted eating is not due to weight or body image concerns, which would be more indicative of an eating disorder. Instead, it is a result of the child's psychological distress and can be accompanied by other symptoms such as anxiety, depression, and irritability.
To be diagnosed with PANS, a child must present with two or more of the following seven criteria: behavioural regression, emotional lability, irritability, aggression, severely oppositional behaviours, cognitive issues, and/or neurological symptoms. It is important to note that PANS is a diagnosis of exclusion, meaning that other potential causes for the symptoms should be ruled out before a PANS diagnosis is made.
If a child presents with a sudden onset of OCD or restricted eating, parents should seek help from a pediatrician or, in extreme cases, the emergency room. Antibiotics are the primary treatment for PANS, especially if a strep infection is detected. However, if a child does not test positive for strep, doctors may be reluctant to prescribe antibiotics. In such cases, other treatments such as steroids or cognitive behaviour therapy (CBT) may be considered to help manage the psychological symptoms.
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The child may also display symptoms of depression, anxiety, anger, or academic difficulties
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a clinical diagnosis given to children who experience a dramatic and abrupt onset of neuropsychiatric symptoms, including obsessions, compulsions, or food restriction. The cause of PANS is unknown in most cases, but it is often associated with infections, metabolic disturbances, and inflammatory reactions.
When a child presents with possible PANS, it is essential to seek medical attention promptly. Parents may first bring their child to a pediatrician or, in more extreme cases, an emergency room. It is recommended that parents refrain from self-diagnosing and instead present their concerns as a behavioural change that requires investigation. This allows medical professionals to consider PANS and other potential explanations for the observed symptoms.
PANS can be differentiated from other disorders, such as obsessive-compulsive disorder (OCD) or eating disorders, by the sudden onset of symptoms. Children with PANS may also experience symptoms of depression, irritability, anxiety, anger, and academic difficulties. These additional symptoms can have a significant impact on the child's overall well-being and functioning.
Depression in children with PANS can manifest as severe sadness, and in some cases, suicidal ideation. They may experience overwhelming separation anxiety, panic attacks, and constant feelings of panic. Irritability and aggression are also common, further complicating the child's emotional state and interpersonal interactions.
The academic difficulties associated with PANS can be significant. Children may experience a decline in their school performance and have difficulty with schoolwork. Specifically, they may exhibit an abrupt deterioration in their handwriting (dysgraphia), which can be a notable diagnostic feature. Additionally, children with PANS may struggle with attention, exhibiting symptoms similar to attention deficit hyperactivity disorder (ADHD). However, it is important to distinguish this from pre-existing ADHD or learning disabilities, as PANS presents as a distinct change from previous levels of functioning.
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The child may have recently had an infection, metabolic disturbance, or inflammatory reaction
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a clinical diagnosis given to children who exhibit a dramatic and abrupt onset of neuropsychiatric symptoms, including obsessions, compulsions, or food restrictions. The cause of PANS is unknown in most cases, but it is often associated with a recent infection, metabolic disturbance, or inflammatory reaction in the child.
Infections that have been linked to PANS include streptococcal infections, influenza, varicella, and mycoplasma pneumoniae. Lyme disease has also been proposed as a potential trigger for neuropsychiatric symptoms. The onset of PANS symptoms can often be traced back to a specific day or week, with some children experiencing an abrupt onset over a 24-48 hour period.
The immune system's response to these infections is believed to play a crucial role in the development of PANS. Instead of attacking the infection-causing germs, the immune system mistakenly targets the brain, specifically the basal ganglia, which affects thoughts, feelings, movement, and behaviours. This misdirected immune response is thought to lead to the symptoms associated with PANS.
Additionally, metabolic disturbances and inflammatory reactions may also contribute to the development of PANS. However, the exact mechanisms by which these factors trigger PANS are not yet fully understood. Further research is needed to determine the specific disease mechanisms and etiologies that underlie PANS.
It is important to note that PANS is a complex condition, and the presence of other neurological symptoms, such as anxiety, depression, irritability, and academic difficulties, can also provide valuable diagnostic insights.
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The physician refers the child to a psychologist or psychiatrist for further evaluation
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a severe form of obsessive-compulsive disorder (OCD) that appears suddenly in young children, accompanied by other confusing and distressing symptoms. PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) is a subset of PANS, with similar symptoms, but is triggered by a streptococcal infection.
The diagnosis of PANS and PANDAS can be challenging due to the sudden and dramatic onset of symptoms, which can include OCD, eating disorders, depression, irritability, anxiety, and difficulty with schoolwork. The symptoms can be so extreme that parents may notice an overnight change in their child's behaviour.
When parents observe such behavioural changes, they usually first consult a pediatrician or, in extreme cases, go to the emergency room. It is important for parents to approach the doctor with an open mind, describing the abrupt behavioural changes in their child and partnering with the doctor to figure out the possible causes.
Given the complexity of PANS and PANDAS, a pediatrician or physician may not be able to provide a definitive diagnosis or treatment plan on their own. They may refer the child to a psychologist or psychiatrist for further evaluation and specialised care. This referral is crucial, as these mental health professionals have the expertise to assess and treat the specific psychological and behavioural symptoms presented by the child.
The psychologist or psychiatrist will conduct a comprehensive evaluation, which may include clinical interviews, behavioural observations, and psychological assessments. They will delve into the child's thoughts, feelings, behaviours, and any other areas of concern. This process helps to clarify the diagnosis, understand the severity of the condition, and develop a tailored treatment plan.
During the evaluation, the psychologist or psychiatrist will look for specific criteria to establish a diagnosis of PANS or PANDAS. For PANS, there are three severity levels: mild, moderate, and severe. The diagnosis requires an abrupt, acute onset of OCD or restricted food intake, along with concurrent symptoms from a specified list, such as emotional lability, behavioural regression, irritability, or aggression. For PANDAS, the criteria include abrupt "overnight" OCD or disabling tics, relapsing-remitting symptoms, young age at onset, neurologic abnormalities, and a link to a Group A strep infection.
The evaluation by the psychologist or psychiatrist aims to differentiate PANS or PANDAS from other similar disorders, such as OCD or eating disorders. The sudden onset of symptoms is a key differentiating factor. Additionally, the presence of specific symptoms, such as urinary issues, academic difficulties, or motor and sensory abnormalities, can provide valuable diagnostic clues.
Following the evaluation, the psychologist or psychiatrist will communicate their findings to the referring physician and collaborate on the next steps. This may involve recommending a specific course of treatment, which could include medications and therapy. They will also provide guidance and support to the family, as managing PANS or PANDAS can be extremely challenging and stressful for both the child and their caregivers.
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Frequently asked questions
PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome. It is a clinical diagnosis given to children who have a dramatic and sudden onset of neuropsychiatric symptoms including obsessions/compulsions or food restriction.
Children with PANS often display symptoms of obsessive-compulsive disorder (OCD) or an eating disorder. They may also experience depression, irritability, anxiety, and have difficulty with schoolwork. In addition, they may exhibit tics, ritualized eating behaviours, hoarding behaviours, and restricted intake of specific foods or all food groups.
PANS is diagnosed based on the sudden onset of symptoms, which can include OCD or eating disorder behaviours, as well as the presence of additional neurological symptoms. To be diagnosed with PANS, a child must exhibit two out of seven criteria, including behavioural regression, emotional lability, irritability, aggression, and severely oppositional behaviours.
