Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections

Strep throat, a bacterial infection that many children get, is easily treated and after a few painful days, the infection goes away. However, for children with PANDAS, the case of strep throat is only the beginning.

Imagine, a child, seemingly overnight, undergoing a drastic change in mood and personality. This new child has developed severe symptoms of  OCD, motor tics, and behavioral issues. For example, the boy who ate everything is now refusing to eat out of fear of germs and pickiness. A child with PANDAS, aside from OCD symptoms, may begin to exhibit extreme separation anxiety and panic attacks over even the smallest of situations. Children with PANDAS also fidget, exhibit vocal and motor tics and noncompliant behavior.

What is PANDAS? 

PANDAS – Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections- occurs after an autoimmune response to a streptococcal infection such as strep throat. A child, after becoming infected with the infection, suddenly develops intense behavioral and physical symptoms such as fidgeting, motor tics, and extreme noncompliant behavior. 

PANDAS was discovered in the 1990’s when there were studies investigating children who were randomly developing OCD, vocal and motor tics. All of these children had one characteristic in common- – a recent strep infection.

When someone has strep throat, the antibodies defend the body and begin to attack the bacterial cell. In a child with PANDAS, the antibodies are attacking the host cell as well.

PANDAS Symptoms:

    1. OCD  symptoms: fear of contamination, very rigid and inflexible
    1. Separation anxiety: need to be with parents and may start sleeping in parents bed
    1. mood changes: Depression and suicidal ideation
    1. ADHD like symptoms: Hyperactivity and attentional issues
    1. Verbal motor tics: repetitive sounds and movements
    1. Oppositional behavior: refusing to listen to parents and teachers
  1. Behavioral changes: bad handwriting, decreased math skills

How to diagnose PANDAS?

PANDAS is clinically diagnosed by a doctor or physician and must include the following five criteria. 

  1.  The child exhibits extreme OCD symptoms, tic symptoms or ADHD
  2. These symptoms occur abruptly (suddenly as if out of nowhere).
  3. The child exhibits neurological abnormalities such as hyperactivity, regressive behavior (acting younger) and constant movements
  4. The child is between the ages of three and puberty
  5. The symptoms and mood changes all started after a streptococcal infection


PANDAS is rare and a lesser known disorder so it is quite easy for doctors and parents to misdiagnose a child. Sometimes parents and clinicians will assume a child is developing OCD, severe ADHD or a conduct disorder. A child with PANDAS will be less attentive, have mood swings and experience anxiety. If a child with PANDAS is diagnosed with ADHD or OCD, he or she will receive interventions and medication that can reduce symptoms. However, the strep throat comes back and along with that, the PANDAS symptoms start again.

Treatment for PANDAS

There are many cases of parents not realizing that their child has PANDAS for years. Once a child receives the proper diagnosis, strep and behavioral symptoms can be managed and reduced. Children with PANDAS receive medication and cognitive behavioral therapy which has been proven to be successful.

Work Cited