PANS/PANDAS
Some children experience a sudden and often distressing change in their behaviour and emotional wellbeing.
You may have noticed:
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Sudden onset of OCD behaviours (such as washing, checking or needing things to feel “just right”)
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New or increased tics
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Heightened anxiety or panic
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Changes in mood, sleep or eating
These changes can feel confusing and frightening for both children and their families.
In some cases, this pattern may be linked to conditions known as PANS (Paediatric Acute-onset Neuropsychiatric Syndrome) or PANDAS.
What are PANS/PANDAS?
PANS and PANDAS are understood as conditions where a child experiences a sudden onset of symptoms, often following an illness or infection.
Possible triggers may include:
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Infection (including strep)
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Immune system responses
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Environmental or physical stressors
Every child’s experience is different, and understanding what may be contributing can take time.
What might this look like?
Parents often describe:
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Symptoms appearing almost overnight
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Periods of improvement followed by “flare-ups”
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A combination of OCD, tics and anxiety
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Rapid changes in mood or behaviour
If this is your experience, it can feel overwhelming—and it makes sense that you may be searching for answers.
Can therapy help?
PANS and PANDAS are medical conditions, and therapy does not treat the underlying cause.
However, many children experience symptoms such as OCD, tics, anxiety and emotional overwhelm—and these can be supported therapeutically.
Approaches such as ERP (for OCD), CBIT (for tics) and ACT can help children:
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Feel less distressed
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Better understand what they are experiencing
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Develop ways to cope with urges, fears and big emotions
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Feel more confident and in control
For some children, symptoms may come and go in “flares.” During more difficult periods, support may focus on helping your child feel safe and understood. At other times, children may be more able to engage in structured therapeutic work.
Support is always adapted to your child’s needs.
What does the research say?
Research into PANS and PANDAS is still developing, and there is currently no single therapy that specifically treats the underlying cause.
However, there is strong evidence that children can be helped by therapies that support the symptoms they are experiencing.
Approaches such as:
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ERP for OCD
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CBIT for tics
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ACT for managing thoughts and feelings
are widely used and recommended for children experiencing these difficulties.
A gentle, flexible approach
Every child’s experience is unique.
During more intense periods, support may focus on:
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Emotional safety
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Reducing overwhelm
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Feeling understood
At other times, children may be more able to engage in structured approaches such as ERP or CBIT.
Often, the most helpful support includes:
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Medical guidance where appropriate
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Therapeutic and functional support
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Parent involvement
You are not alone
If your child has experienced a sudden change in behaviour or wellbeing, it can feel incredibly unsettling.
With the right support, children can begin to feel safer, more understood, and more able to cope with what they are experiencing.
You can read more about support for OCD and tics here:
You can also read more about the emotional impact of PANS/PANDAS on families here:
What does the research say about therapy for PANS/PANDAS?
Research into PANS and PANDAS is still developing, and there is currently no single therapy that specifically treats the underlying cause of these conditions.
PANS/PANDAS are understood to be medical conditions, often involving the immune system, so medical guidance is an important part of support.
So where does therapy fit in?
Although therapy does not treat the cause, there is strong evidence that children can be helped by approaches that support the symptoms they are experiencing.
Many children with PANS/PANDAS experience:
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OCD
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Tics
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Anxiety
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Emotional distress
For these difficulties, there are well-established, evidence-based therapies, including:
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ERP (Exposure and Response Prevention) for OCD
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CBIT for tics
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ACT (Acceptance and Commitment Therapy) for managing thoughts, feelings and distress
These approaches are widely used and recommended for children experiencing these symptoms, whether or not PANS/PANDAS is present.
An individual and flexible approach
Research and clinical experience suggest that children may engage differently with therapy depending on how they are feeling.
During more intense periods or “flares,” children may need:
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More emotional support
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A focus on feeling safe and understood
At other times, they may be more able to engage in structured approaches such as ERP or CBIT.
A balanced and hopeful approach
The most helpful support often brings together:
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Medical understanding
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Therapeutic and functional support
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Parent involvement
While therapy does not “cure” PANS/PANDAS, it can:
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Reduce distress
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Improve daily functioning
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Help children feel more in control
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Support the whole family
If you would like to understand how this might look for your child, you’re very welcome to get in touch to talk things through.
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Living with PANS/PANDAS: The Hidden Emotional Toll on Families
If you are parenting a child with PANS or PANDAS, you are likely carrying more than most people can see.
You may have watched your child change suddenly and frighteningly.
You may have seen symptoms appear almost overnight — intense anxiety, OCD, tics, rage, restriction, fear.
You may have felt confused, helpless, desperate to understand what is happening.
And alongside that, you may have felt profoundly alone.
The unpredictability of flare-ups can leave families living in a constant state of alert. Not knowing when symptoms will return, what will trigger them, or how severe they will be creates a level of stress that is hard to explain to others. Particularly with PANS, triggers can feel endless and unclear — infection, strep, allergies, mould, stress, Lyme disease. So many unknowns.
When there are no clear answers, the nervous system rarely rests.
The Pain of Not Being Believed
For many families, the illness itself is only part of the trauma.
Parents often tell me they have been:
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Judged or blamed for their child’s behaviour
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Told they are “too anxious” or “overreacting”
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Accused of poor parenting
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Met with disbelief from professionals
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Faced with accusations such as Fabricated or Induced Illness (FII)
Some families have experienced social services involvement. Others have been threatened with legal action over school attendance. Many describe school staff misunderstanding sudden regression as deliberate defiance.
Being disbelieved when you are already frightened for your child creates a deep wound.
It can make you question your own reality.
It can erode confidence.
It can isolate you from support networks you once relied upon.
The Impact on the Whole Family System
PANS/PANDAS does not just affect one child — it affects the entire family.
Parents often become full-time carers, sometimes giving up careers. Financial pressure increases. Sleep becomes fragmented. Chronic stress takes its toll physically and emotionally.
Siblings may feel confused, frightened, or overlooked. Some describe trying to be “the easy one” so they don’t add to the strain. Others feel unsafe because of the unpredictability at home.
Many families live in a state of high alert — a nervous system braced for danger. When routines, school, work, and even trusted professionals no longer feel reliable, the world can begin to feel unsafe.
If this is your experience, it makes sense that you are exhausted.
How Integrative Psychotherapy Can Support Healing
PANS/PANDAS is a medical condition. Therapy cannot cure it.
But therapy can help heal the emotional trauma that so often surrounds it.
In a safe, consistent therapeutic relationship, children — and parents — can begin to experience:
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Reduced anxiety and hypervigilance
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Support with OCD and tics
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A calmer nervous system
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Greater emotional regulation
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A space where their experience is believed and understood
Research in developmental neuroscience, including the work of Eamon McCrory, shows that safe relational experiences can influence brain chemistry, strengthen pathways that calm fear responses, and support genuine physiological regulation.
Safety changes the brain.
Feeling understood changes the body.
And when the nervous system begins to settle, families can slowly move from survival mode toward healing.
