Ella Walter
PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, is a rare but serious autoimmune condition that can cause a sudden onset of severe OCD symptoms and other extreme changes in a child's behavior. PANS can be confused with the onset of other mental health conditions, and there is currently little evidence about its causes and treatment. If you think your child may have PANS, it is important to seek help from a medical professional right away. A doctor will be able to perform a comprehensive evaluation to determine whether your child meets the criteria for a clinical diagnosis of PANS.
| Characteristics | Values |
|---|---|
| Onset | Abrupt, acute, dramatic, sudden |
| Eating habits | Restricted food intake, severely restricted food intake, refusal to eat |
| Contamination fears | Associated with food or what the food has been exposed to |
| Obsession fears | Choking, vomiting, harm coming to oneself or others |
| Anxiety | Heightened anxiety, separation anxiety, irrational fears, generalised anxiety |
| Mood | Moody, anxious, aggressive |
| Cognitive changes | Impulsivity, aggression, cognitive changes |
| Age | No age limitation, but symptoms typically begin during grade-school years |
| Diagnosis | No specific test, comprehensive evaluation by medical and psychiatric professionals |
| Treatment | Medicine, cognitive behavioural therapy, exposure and response prevention therapy, habit reversal therapy |
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What You'll Learn
Abrupt behavioural changes
Children with PANS/PANDAS may develop a sudden onset of OCD symptoms, food restrictions, and other compulsions. For example, a child may develop obsessions with cleanliness or a fear of contamination, leading to restricted eating habits. They may also exhibit new and intense fears or concerns, heightened anxiety, and irrational fears. Separation anxiety is also common, with children suddenly refusing to be alone and constantly seeking physical closeness and reassurance from family members.
In addition to OCD symptoms, children with PANS/PANDAS may also experience impulsivity, aggression, and cognitive changes. They may develop new tics or ritual behaviours that interfere with their daily lives. These behavioural changes can be frightening and challenging for both the child and their family, and early intervention and treatment are critical for managing the condition.
It is important to note that PANS/PANDAS can be difficult to diagnose, as not every child exhibits the same symptoms, and there is no single test to confirm the diagnosis. However, if you notice abrupt behavioural changes in your child, it is important to seek help from a medical professional right away. A thorough evaluation by a team of medical and psychiatric professionals is necessary to rule out other potential disorders and make a proper diagnosis. Treatment options for PANS/PANDAS include medication, cognitive behavioural therapy, and family support and guidance.
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OCD and food restrictions
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a rare but serious autoimmune disorder that can cause a sudden onset of OCD symptoms and food restrictions in children. The OCD symptoms exhibited by children with PANS differ from typical OCD symptoms as they come on suddenly, usually within a day or two after the onset of the initial infection.
Children with PANS may develop obsessions and compulsions surrounding food, leading to severe eating restrictions. These restrictions can be driven by contamination fears related to the food itself or what it may have been exposed to. For example, children may refuse to eat certain foods due to fears of choking or vomiting, concerns about weight or body image, or fears of harm coming to themselves or others. This can result in significant weight loss and psychosocial dysfunction.
In addition to food restrictions, children with PANS often experience other cognitive, behavioural, and neurological symptoms. These can include anxiety, panic attacks, aggressive behaviour, emotional distress, sleep disturbances, and sensory sensitivities. The onset of symptoms can be abrupt and dramatic, with parents reporting that their child seems to change overnight.
If you suspect your child may have PANS, it is important to seek medical help right away. Doctors can perform a comprehensive evaluation, including medical history, physical and neurological examinations, and tests for infections, to rule out other potential disorders. Early intervention and treatment are critical to improving outcomes and reducing the impact of the illness on the child and family.
Treatment for PANS-related OCD and food restrictions may include cognitive-behavioural therapy, exposure and response prevention therapy, and habit reversal therapy. Medications such as SSRIs may also be prescribed. Supportive parenting and family therapy can also play a crucial role in helping children manage their symptoms and reducing anxiety.
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Neuropsychiatric symptoms
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is an autoimmune disorder characterised by a sudden onset of OCD or restricted food intake. The symptoms of PANS can be frightening for both the child and their family.
- Abrupt and noticeable increases in anxiety levels. This can manifest as separation anxiety, where a child suddenly refuses to be alone and constantly seeks physical closeness and reassurance from family members.
- Aggression, impulsivity, and cognitive changes.
- Food restrictions, which may be due to contamination fears, obsessional fears of choking or vomiting, or beliefs that harm will come to themselves or others if they eat.
- Generalised anxiety, where the child worries excessively about a range of things, from their health to the colour of the sky.
- Extreme obsessions and compulsions, such as intense fears or concerns about things being even, clean, or dirty. These thoughts and concerns can be so strong that the child is hard to comfort.
If you suspect your child may have PANS, it is important to seek medical advice from your child's doctor right away. Early intervention and treatment are critical to improving outcomes.
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Infections
PANS (Paediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) are conditions that a child can develop following an infection, usually streptococcal. PANDAS is a subset of PANS. PANS refers to similar symptoms but has a more vague causality not associated with strep. The symptoms of PANS/PANDAS usually develop and intensify within a day or two, so parents often take their child to the doctor or the emergency department.
PANS cases have also been linked to other infections, including Lyme disease, mononucleosis, mycoplasma (walking pneumonia) and the flu (such as H1N1). Many inflammatory events, like fungal infections or exposure to certain toxins, can also play a part.
PANDAS occurs after a child is exposed to streptococcal infection. Children with PANDAS test positive for a known trigger, such as strep throat, peri-anal strep or scarlet fever. It is still unclear why strep triggers PANDAS — and why this only occurs some of the time. Strep infections have been known to trigger PANDAS symptoms as long as six months after the child has a strep infection.
If your child has had or been exposed to an illness with prolonged coughing, their pediatrician may test for a bacterium called mycoplasma. If a child is diagnosed early and a cause has been identified, the prognosis is usually good.
There is currently no single test to confirm whether your child has PANS/PANDAS, and because it is a newly recognised condition, not all doctors are knowledgeable or experienced in treating these conditions. However, early intervention and treatment are critical to shortening the course of the illness.
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Treatments
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a rare autoimmune disorder that can cause a sudden onset of severe OCD symptoms and other sudden behavioural changes in children. If you suspect that your child may have PANS, it is important to seek medical advice as soon as possible.
There are a variety of treatment options available for PANS, and early intervention is critical to shortening the course of the illness and reducing the impact of its symptoms. Treatment options include:
Medications
Medications are often used to treat the underlying infection that may be causing PANS. Antibiotics can be prescribed to treat strep infections, which can lead to a dramatic improvement in neuropsychiatric symptoms. In some cases, children may need to take a longer course of antibiotics or additional medications such as anti-inflammatory drugs, steroids, or selective serotonin reuptake inhibitors (SSRIs) to manage anxiety.
Cognitive Behavioural Therapy (CBT)
CBT is a form of therapy that can help children with PANS learn to manage their OCD symptoms and associated behavioural and mood changes. Exposure and response prevention (ERP) techniques are used to reduce ritual behaviours associated with OCD. CBT can also help children and their families cope with feelings of anxiety and handle emotional lability.
Psychiatric Treatment
Psychiatric treatment, including medications and psychotherapy, may be recommended for children who do not respond as readily to initial treatments. This can help address the complex behavioural and psychological symptoms associated with PANS.
Specialty Clinics
Specialty clinics, such as the Anxiety Disorders Program at Children's National Hospital, offer comprehensive psychological services tailored to meet the specific needs of children with anxiety disorders, including PANS. These clinics provide detailed assessments and formulate treatment plans that are most suitable for the child and their family.
Habit Reversal Therapy
Habit reversal therapy is a specific type of therapy that can be effective for children with tics or other compulsive behaviours associated with PANS.
Support for Families
Treating PANS can be stressful and challenging for families. Doctors and mental health experts can provide guidance and support to help families navigate through these difficult times. This may include educating parents on how to manage their child's stressful symptoms and providing strategies for comfort and soothing.
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Frequently asked questions
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a rare autoimmune disorder that causes a sudden onset of severe OCD symptoms. If your child has developed a sudden onset of OCD or restricted eating, along with other neuropsychiatric symptoms, you should consult a doctor.
Symptoms of PANS include anxiety, irritability, uncontrolled emotions, depression, tics, and compulsions. Children with PANS may also experience a decline in school performance, emotional lability, and sleep disturbances.
There is no definitive test for PANS, but a diagnosis is typically made through a combination of symptom identification, test results, and the child's medical history. Tests may include a strep test, urine test, and blood work to check for infections or other causes.
Treatment for PANS includes addressing both the infection and the sudden onset of OCD symptoms. Antibiotics may be prescribed if a bacterial infection is detected. Cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) are also effective in improving OCD symptoms.
