Could your "Difficult" Child be Misdiagnosed? Understanding PANS/PANDAS.

In this video, Dr. Zendi Moldenhauer, Chief Medical Officer, and Lori DiBartolo, Nurse Practitioner discuss Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS/PANDAS) - the symptoms, treatment options, and how you can help raise awareness of this serious condition.

Imagine this: one day, your child is thriving, full of energy and joy. The next, they’re overcome by sudden, debilitating anxiety, obsessive behaviors, or emotional outbursts. As a parent or caregiver, this kind of abrupt change is nothing short of heartbreaking—and confusing.

What if the behaviors you’re seeing aren’t what they seem? For some children, these dramatic shifts may be linked to an immune system reaction, often overlooked or misunderstood. Conditions like Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) could be the missing piece of the puzzle. Let’s explore what these conditions are, why they’re so often misdiagnosed, and how you can help your child recover.

What Are PANS/PANDAS?

PANS/PANDAS are autoimmune conditions that occur when the body’s immune response mistakenly attacks the brain, causing inflammation and sudden-onset neuropsychiatric symptoms.

PANS is a broad condition triggered by infections, inflammation, or environmental factors.

PANDAS is a subset of PANS that specifically follows a streptococcal infection (like strep throat).

What Are Symptoms of PANS/PANDAS?

These conditions can cause an array of sudden and dramatic symptoms, including:

Aggression or irritability

Bedwetting or regression in daily habits

Changes in handwriting or school performance

Motor or vocal tics

Obsessive-compulsive behaviors

Sensory sensitivities

Separation anxiety

Sleep disturbances

These symptoms often feel like they’ve appeared overnight, leaving you searching for answers.

Why Is PANS/PANDAS Diagnosis So Challenging?

One of the most frustrating aspects of PANS/PANDAS is how often it is misdiagnosed—or completely missed. These conditions mimic other mental health and behavioral disorders, leading children to be incorrectly labeled as "difficult" or “acting out.”

Common Misdiagnoses Include:

ADHD

Autism Spectrum Disorder (ASD)

Obsessive-Compulsive Disorder (OCD)

Generalized Anxiety Disorder (GAD)

Depression or Mood Disorders

It’s estimated that a child will see more than five doctors before receiving a proper diagnosis. Worse yet, as many as 1 in 200 children may be suffering from these conditions.

The key to an accurate diagnosis is identifying the sudden onset of symptoms and considering the connection to infections or immune triggers.

Why Early Diagnosis for PANS/PANDAS Matters

When left untreated, PANS/PANDAS symptoms can persist or worsen, becoming a lifelong challenge. Early diagnosis and intervention, however, can dramatically improve outcomes. By addressing the root cause—whether it’s an infection, inflammation, or environmental trigger—you can reduce the immune response and support your child’s healing.

Root Causes of PANS/PANDAS

At Arbor Health, we focus on uncovering and addressing the root cause(s) of PANS/PANDAS. These often include:

Autoimmunity: An immune system attacking healthy tissue.

Environmental Toxins: Mold, heavy metals, or chemical exposures.

Gut Health Imbalances: Dysbiosis or inflammation affecting brain function.

Infections: Streptococcal bacteria, Lyme disease, or viral infections.

Nutritional Deficiencies: Missing nutrients that weaken the immune system.

Systemic Inflammation: Chronic inflammation disrupting normal brain activity.

By understanding your child’s unique triggers, we can create a precise treatment plan tailored to their needs.

Treatment Strategies for PANS/PANDAS

While PANS/PANDAS can be complex, the right combination of treatments can support healing. A Functional Medicine approach focuses on identifying and addressing the root causes. Personalized treatment plans might include:

Identifying and treating infections

Modulating the immune system

Supporting gut health

Supporting mental health

Adjusting environmental exposure

No two children are alike, so their care plans shouldn’t be either. Every step should be designed to meet your child’s unique needs and support their recovery.

You Are Not Alone, Support for Parents Whose Children have PANS/PANDAS

Discovering that your child may have PANS/PANDAS can feel overwhelming, but you don’t have to face it alone. Explore our Clinical Program for PANS/PANDAS to learn if Functional Medicine is right for you.

If your organization is interested in Dr. Zendi coming to speak on PANS/PANDAS or other mental health topics, please contact us.

Research & Resources:

Cooperstock, Michael et al. Journal of Child and Adolescent Psychopharmacology. Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part III-Treatment and Prevention of Infections. https://pubmed.ncbi.nlm.nih.gov/36358106/

PANDAS/PANS Diagnostic and Treatment Guidelines. PANDAS Physicians Network. https://www.pandasppn.org/guidelines/

PANDAS Network. https://pandasnetwork.org/

Sigra, Sofia et at. Neuroscience & Biobehavioral Reviews. Treatment of PANDAS and PANS: a systematic review. https://pubmed.ncbi.nlm.nih.gov/29309797/

Pupillo, Jessica. American Academy of Pediatrics. PANDAS/PANS treatments, awareness evolve, but some experts skeptical. https://publications.aap.org/aapnews/news/12434

Thienemann, Margo et al. Journal of Child and Adolescent Psychopharmacology. Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part I—Psychiatric and Behavioral Interventions. https://www.liebertpub.com/doi/10.1089/cap.2016.0145

Frankovich, Jennifer. Journal of Child and Adolescent Psychopharmacology. Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part II—Use of Immunomodulatory Therapies. https://www.liebertpub.com/doi/10.1089/cap.2016.0148

Cooperstock, Michael et al. Journal of Child and Adolescent Psychopharmacology. Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part III—Treatment and Prevention of Infections. https://www.liebertpub.com/doi/10.1089/cap.2016.0151

Swedo, Susan. Streptococcus pyogenes: Basic Biology to Clinical Manifestations, 2nd edition. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). https://www.ncbi.nlm.nih.gov/books/NBK607260/

Additional source for current research: PANDAS Physicians Network. https://www.pandasppn.org/research-library/

This Website has been created to provide information about functional health care services and is for general informational purposes regarding functional health care that should never be construed as medical advice for any person, including patients of the Practice. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.