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PANDAS Syndrome

What is PANDAS Syndrome?

PANDAS is an acronym for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections.

About 1 in 200 children ages 3 to 12 may experience the sudden onset of symptoms associated with Obsessive Compulsive Disorder (OCD) and/or a tic disorder following a strep infection.

These symptoms are very noticeable and happen quickly within 2-3 days of the infection.

Symptoms of PANDAS Syndrome can include physical motor tics and verbal tics, obsessive thinking, compulsive behavior, moodiness, and anxiety such as separation anxiety.

What causes PANDAS?

PANDAS is caused by streptococcal A (strep) bacterial infection.

This bacteria is very tricky and it tries to hide from your child’s immune system by making itself look molecularly similar to heart, skin, joint, and brain molecules. This way the bacteria can invade those various areas and attack the tissue.

The immune system eventually detects the bacteria and attacks it but not before your child has experienced the symptoms of strep.

Symptoms of strep:

  • Sore throat Painful swallowing

  • Red and swollen tonsils, sometimes with white areas of pus

  • Tiny red spots on the area at the back of the roof of the mouth (soft or hard palate)

  • Swollen, tender lymph nodes in your neck

  • Fever

  • Headache

  • Rash

  • Nausea or vomiting

  • Body aches

What are the symptoms of PANDAS?

Sudden onset of the following symptoms after detection of strep A infection:

Obsessive-compulsive disorder symptoms (OCD)

Obsessions are unwanted intrusive thoughts, images, or impulses/urges that cause intense feelings of shame, guilt, and doubt. This can trigger uncomfortable levels of anxiety, including panic attacks (aka anxiety attacks).

Compulsions are behaviors or rituals that are used to decrease the intensity of the obsessions and anxiety. Compulsive behaviors can also be said to neutralize the feeling of anxiety caused by the obsessive thoughts and beliefs. But the compulsive behavior only provides short-term relief from anxiety.


Tics are sudden, uncontrolled, and repetitive movements or vocal sounds that are common with OCD, Tourette’s, and ADHD. There are 2 kinds of Tics, motor and vocal.

Motor Tics or simple motor tics include head twitching, eye blinking, nose twitching, facial grimacing, and shoulder shrugging. More complex motor tics include skipping, jumping, kicking, and smelling hands or other objects.

Vocal Tics include throat clearing, coughing, grunting, barking, and hissing. More complex vocal tics include yelling, making animal sounds, and repeating words and/or phrases.

Other symptoms include:

Separation anxiety, panic attacks, moodiness, symptoms of ADHD (inattention, hyperactivity, impulsivity), difficulty sleeping, joint pain, and changes in motor coordination such as difficulty writing and jerky physical movements.

These symptoms appear suddenly and get worse before they get better. Symptoms improve slowly with antibiotics but may persist for several weeks with ups and downs. Any new or subsequent strep infection will cause the symptoms to return.

How is PANDAS treated?

If you believe your child could have PANDAS it will be helpful and important to seek consultation with a medical professional to first verify the diagnosis and then receive appropriate treatment.


Your child’s doctor will take a swab from the back of the throat to test for strep. Results usually take just few minutes. If the test comes back positive for strep your child’s doctor will prescribe antibiotics.

Antibiotics will treat the strep infection and the symptoms of PANDAS will then diminish.


Anti-depressant medications are also effective at reducing symptoms of anxiety and OCD. This helps dampen the physical and emotional effects of anxiety and increases a person’s capacity to cope with stressful situations.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is a well-researched and highly effective form of talk therapy that focuses on learning more helpful ways of thinking and behaving.

You learn different ways of responding to the symptoms of OCD and to your feelings of anxiety.

CBT helps challenge and change unhelpful beliefs that cause anxiety by restructuring automatic thinking and changing the way you behave in response to obsessive thoughts.

CBT sessions also provide education on the symptoms of OCD and how to manage the emotional and physical symptoms of anxiety.

Replace toothbrushes

Replace toothbrushes and sterilize any necessary mouth device to get rid of any strep bacteria left on them. This will help avoid reinfection of the bacteria.

Can my child have OCD without PANDAS?

Yes it is estimated that about 1 out of 200 kids and teens can be diagnosed with OCD without having a strep infection.

What is PANS?

Pediatric Acute Onset Neuropsychiatric Syndrome (PANS) is diagnosed when there is a sudden onset of symptoms associated with Obsessive Compulsive Disorder (OCD) or food restriction when laboratory tests do not indicate a strep infection.

The cause of PANS is not known in the majority cases but is thought to be triggered by infections (other than strep), metabolic disorders, and other inflammatory reactions.

For More Information and for a list of specialists who treat PANDAS, visit pandasnetwork.org


Attacking Panic System

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Dr Hunter's Qualifications

My name is Dr. Russell A Hunter, PsyD and I am a Licensed Clinical Psychologist recognized by the National Register of Health Service Psychologists as meeting the National Register’s stringent requirements for education and experience as a healthcare professional.


I specialize in the field of Clinical Psychology and I am an expert in the treatment of Panic Disorder, Anxiety Disorders,  ADHD, and Neurocognitive Disorders. I provide CBT and psychological testing at Northern Virginia Psychiatric Associates within the Prince William Medical Center.

I published a book titled, "Attacking Panic: The Power to Be Calm" and it is available on Amazon and Barnes & Noble. 


Attacking Panic: The Power To Be Calm. Copyright © 2017 Russell A. Hunter, Psy.D. All rights reserved. Attacking Panic is available in paperback and Kindle edition at Amazon and in paperback at Barnes & Noble and other online retailers.

How to Stop A Panic Attack Quickly.

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