Marianne Martinez
PANS and PANDAS are severe forms of obsessive-compulsive disorder (OCD) that appear suddenly in young children, accompanied by other confusing and distressing symptoms. The widespread psychological reactions to coronavirus infection have also led to an increase in research into why pathogens can affect the brain of some people but not others. PANS stands for Pediatric Acute-Onset Neuropsychiatric Syndrome, while PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections. If you think your child may have PANDAS or PANS, it is important to contact your child's doctor right away and start therapy as soon as possible. Treatment includes medication and cognitive behavioral therapy (CBT), specifically Exposure and Response Prevention (ERP), which helps children gradually face their fears and resist the urge to perform compulsive rituals.
| Characteristics | Values |
|---|---|
| Cause | PANS and PANDAS are caused by an infection, usually strep. |
| Symptoms | Sudden onset of severe OCD symptoms, accompanied by other extreme behavioural changes, such as restricted eating, anger, and depression. |
| Diagnosis | Doctors will ask questions about symptoms, perform an exam, and test for infections. |
| Treatment | Treatment includes medication for the infection and cognitive behavioural therapy (CBT), specifically Exposure and Response Prevention (ERP). |
| Parental Support | Parents should be caring and understanding, empathise with their child, and encourage them to face their fears. |
| Self-Care for Parents | Take breaks, practice meditation, find support groups, and start journaling. |
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What You'll Learn
Recognise PANS/PANDAS symptoms
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 appear suddenly in young children, accompanied by other confusing and distressing symptoms. PANS is a more general term that does not specify the type of infection thought to trigger the symptoms, whereas PANDAS is used when the triggering infection is strep.
PANS and PANDAS cause a sudden onset of severe OCD symptoms, as well as other abrupt changes in a child's behaviour. These can be so extreme that a parent may say their child seemed to "change overnight". Children with PANS or PANDAS will have sudden and severe obsessions, compulsions, or both.
Obsessions may include new and intense fears or concerns about things being even, clean, dirty, or a set way. Stressful thoughts or images may come to mind repeatedly. These fears, thoughts, and concerns can be so strong that a child may be hard to comfort. Compulsions (rituals) may include a child washing, touching, doing, or repeating things and feeling unable to stop. For example, they may walk in and out of a doorway many times, trying to do it "right". Other symptoms may include restricted eating, anger, and depression.
PANS/PANDAS is characterised by the sudden onset of OCD and/or severe eating restrictions, along with at least two other cognitive, behavioural, or neurological symptoms, such as anxiety, irrational fears, separation anxiety, panic attacks, tics, or anger.
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Seek professional help
If you suspect your child may have PANS or PANDAS, it is important to seek professional help as soon as possible. These conditions are characterised by the sudden onset of OCD symptoms, and can be frightening and disruptive for both the child and their family.
The first step is to contact your child's doctor or pediatrician, who will be able to assess your child's symptoms and make a diagnosis. It is important to approach this with an open mind, as there may be other explanations for your child's behaviour. Be prepared to answer questions and provide information about your child's symptoms, and be open to the doctor's suggestions and recommendations.
Your child's doctor may refer you to a mental health therapist or a trained mental health provider who specialises in cognitive behavioural therapy (CBT) for OCD in children. This form of therapy can help children to identify unhelpful thoughts and learn to face their fears, rather than avoiding them. A specific type of CBT called Exposure and Response Prevention (ERP) therapy is commonly used to treat OCD symptoms. ERP therapy gradually exposes your child to their fears while they learn to resist the urge to perform compulsive rituals.
In addition to therapy, your doctor may also prescribe medication to treat any underlying infections and manage your child's symptoms. It is important to give your child all the medicines recommended by the doctor and to follow their guidance.
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Treat the infection
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) is believed to be caused by an infection that affects the child's neurological system. The most common cause of PANS is a bacterial infection, usually strep, but it can also be caused by other infections, such as Lyme disease, mononucleosis, walking pneumonia, or the flu.
If your child is diagnosed with PANS, the first step in treatment is to address the underlying infection. This is typically done through a course of antibiotics, with the goal of eliminating the infection and stopping the OCD symptoms. In some cases, more intensive treatments such as plasmapheresis (the exchange of blood plasma) or IVIG (intravenous immunoglobin) may be recommended. These treatments provide children with antibodies from multiple donors to help fight the infection.
While antibiotics are a common treatment for PANS, some doctors disagree with this approach, arguing that there is insufficient evidence to prove that infections are the direct cause of PANS symptoms. These doctors recommend treating PANS the same way as regular OCD, focusing on managing the OCD symptoms rather than treating an underlying infection.
In addition to antibiotics, anti-inflammatory medications such as corticosteroids can be used to treat the autoimmune response associated with PANS. However, these medications should be used with caution in children, as long-term use can have negative side effects.
It is important to work closely with your child's doctor to determine the best treatment plan for their specific needs.
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Practice CBT/ERP therapy
PANS and PANDAS can cause a sudden onset of OCD symptoms in children. CBT/ERP therapy is an effective treatment for youth anxiety and OCD. Here are some ways to practice CBT/ERP therapy to help a child with PANS or PANDAS:
Understand the Basics of CBT/ERP Therapy:
Cognitive Behavioral Therapy (CBT) is a structured and goal-oriented form of therapy that helps children identify unhelpful thoughts and learn to face their fears. Exposure and Response Prevention (ERP) is a type of CBT specifically designed to treat OCD. ERP gradually exposes individuals to their fears while teaching them to resist the urge to perform compulsive rituals.
Find a Qualified Therapist:
Therapists specializing in CBT/ERP for pediatric OCD are trained to address the unique needs and cognitive capabilities of children. They can guide your child through the therapy process and help them navigate their fears and anxieties.
Collaborate with the Therapist:
Active family involvement is crucial in CBT/ERP therapy. Collaborate closely with the therapist to understand your child's treatment plan and how you can support them at home. This may include learning about exposure and habituation techniques to help your child tolerate anxiety and resist rituals.
Prepare Your Child for Therapy:
Ensure your child understands the purpose of CBT/ERP therapy and how it can help them manage their OCD symptoms. Use age-appropriate metaphors, analogies, and games to explain the concepts and reduce any fears or ambivalence they may have about facing their anxieties.
Implement Therapy Techniques at Home:
Work with your child's therapist to learn how to create a supportive environment at home. This may include practicing exposure techniques, helping your child identify and challenge unhelpful thoughts, and encouraging them to face their fears gradually.
Provide Reassurance and Support:
As a parent, it's important to be caring and understanding. Reassure your child that they will get better and encourage them to express their emotions. Help them understand that OCD rituals are not protective against anxiety and that facing their fears is an important step toward recovery.
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Support your child
PANS and PANDAS are severe forms of obsessive-compulsive disorder (OCD) that appear suddenly in young children, accompanied by other confusing and distressing symptoms. They are caused by a problem with the immune system's response to an infection. Instead of attacking the germs, the immune system targets a part of the brain called the basal ganglia, which affects thoughts, feelings, movement, and other behaviours.
If you suspect your child might have PANS or PANDAS, it is important to seek professional help from a doctor or mental health provider. They can help diagnose and treat the condition. Treatment typically involves medication to address the infection and cognitive behavioural therapy (CBT) to manage OCD symptoms.
As a parent, there are several ways you can support your child:
- Empathize and reassure: Try to understand what your child is feeling and reassure them that they will get better. Show them love and support, and remind them that OCD is not their fault.
- Encourage your child to face their fears: Help your child learn to face their fears and deal with their emotions, rather than avoiding them or resorting to compulsive rituals.
- Gradual exposure therapy: Work with your child's therapist to gradually expose them to their fears in a controlled way. This can help reduce the stress and anxiety they feel over time.
- Practice calming techniques: Teach your child coping and calming skills to manage their anxiety. This could include deep breathing, meditation, or other relaxation techniques.
- Medication adherence: Ensure your child takes any prescribed medications as directed by their doctor. This may include antibiotics to treat the underlying infection and/or anti-depressants or SSRIs to reduce OCD symptoms.
- Therapy participation: Attend therapy sessions with your child whenever possible. This will help you understand their diagnosis, learn how to respond to their OCD symptoms, and support their progress.
- Praise and encouragement: Recognize your child's efforts and progress. Show them how proud you are of their bravery and resilience in facing their fears and managing their OCD symptoms.
- Self-care: Caring for a child with PANS or PANDAS can be stressful and challenging. Make sure to take time for yourself, practice self-care, and seek support from support groups, friends, or loved ones. It's important to take breaks and prioritize your own well-being so you can be there for your child.
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Frequently asked questions
PANS stands for Pediatric Acute-Onset Neuropsychiatric Syndrome, and PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections. Both conditions cause a sudden onset of severe OCD symptoms, but PANDAS is specifically used when the triggering infection is strep.
Children with PANS or PANDAS may experience intense fears or worries, and they may develop rituals to try to calm themselves down. They may also exhibit restricted eating, anger, and depression.
It is important to seek professional help from a doctor or mental health provider. Treatment for PANS and PANDAS typically involves medication and cognitive behavioral therapy (CBT), specifically Exposure and Response Prevention (ERP). ERP therapy helps children gradually face their fears and learn to resist the urge to complete compulsive rituals.
