In this video, Dr. Zendi Moldenhauer, Chief Medical Officer and Co-Founder, 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. 

Explore Our PANS/PANDAS Clinical Program

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 PANS/PANDAS 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 Functional Medicine & Psychiatry, 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. 

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.