One morning, you woke up to a child you didn’t recognize.

The confident, happy and curious child you once knew changed almost overnight into someone you barely recognized. Suddenly, they became terrified to go to school, and everyday routines turned into battles. Lights felt too bright, sounds too loud, and once-favorite foods suddenly seemed disgusting or even dangerous.

They clung to you with relentless anxiety; lashed out in rage over the smallest things; or repeated phrases endlessly until they were “just right.” You watched helplessly as their body started moving in odd ways you have never seen before, like drinking, shrugging or excessively coughing or clearing their throat. Their eating habits may have shrunk to a handful of bland, white foods, and your once-engaged child withdrew into a world of fear and rage. You’re left asking the question so many parents in your shoes have asked: what happened to my child?

What are PANS and PANDAS?

For some families, this sudden shift can be explained by PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) or PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections). These are theorized to be neuroimmune inflammatory conditions where a child’s immune system mistakenly attacks the brain after an infection or other immune trigger, causing sudden changes in mood, behavior, and neurological function.

In PANS, triggers can include a wider range of infections such as flu A or mycoplasma. PANDAS is a subset of PANS in which the trigger is a streptococcal infection.

Per the latest research, children who do develop PANS/PANDAS are thought to be genetically or immunologically predisposed, making their brains vulnerable to immune-related inflammation.

Common Signs and Symptoms

One of the hallmarks of PANS/PANDAS is the sudden onset of symptoms. Parents often describe it as an “overnight” change. However, some children experience a more insidious onset, or one that is difficult to pinpoint—especially if they are diagnosed years after the initial triggering event.

This diagnosis places an exceptional amount of stress on a family. The relapsing-remitting nature of PANDAS/PANS means you never quite know what each day will bring. One morning, your child might pad down the stairs and say, “Hey Mom, what’s for breakfast?” The next, they may be screaming that the lights are too bright and can’t even stand the feeling of their clothes on their body. It impacts the whole family system—siblings, relationships, routines, and your sense of safety in your own home.

These assessments involve a detailed medical, behavioral, and psychosocial history conducted by a multidisciplinary team of qualified professionals who have expertise in working with neuroimmune conditions.

PANS-31 is a symptom-rating scale that has demonstrating strong internal consistency and validity in measuring symptom severity in children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and can be utilized as part of the assessment process.

To diagnose PANDAS, the patient must fulfill the following criteria:

Presence of OCD and/or tics, particularly multiple, complex or unusual tics

Symptoms of the disorder first become evident between 3 years of age and puberty

Acute onset and episodic (relapsing-remitting) course

Temporal relationship with Group A Streptococcal infection

Association with Neurological Abnormalities

Source: PANDAS Physician Network

To diagnose PANS, the patient must fulfill the following criteria:

An abrupt, acute, dramatic onset of obsessive-compulsive disorder or severely restricted food intakeConcurrent presence of additional neuropsychiatric symptoms with similarly severe and acute onset from at least 2 of the following categories:

· Anxiety
· Emotional Lability and/or Depression
· Irritability, Aggression, and/or Severe Oppositional Behaviors
· Behavioral (Developmental) Regression
· Sudden Deterioration in School Performance
· Motor or Sensory Abnormalities
· Somatic Signs and Symptoms, including Sleep Disturbances, Enuresis, or
Urinary Frequency

Symptoms are not better explained by a known neurologic or medical disorder

Source: PANDAS Physician Network

Diagnosis is Complex

Diagnosing PANS is undoubtedly complex. Symptoms often overlap with other conditions such as traditional OCD, anxiety disorders, ADHD, or tic disorders. There isn’t a single test that confirms the diagnosis, so physicians carefully rule out other medical, neurological, and autoimmune causes including Sydenham chorea from rheumatic fever, neuropsychiatric lupus, and other immune-related disorders.

These challenges mean that some families face skepticism from providers. Parents may need to advocate strongly for their child. If PANS or PANDAS is indicated, these symptoms are not not simply phases in which the “wait and see” approach can be applied. Rather, these conditions represent medically significant events requiring urgent attention from an interdisciplinary team.

It may not always be PANS/PANDAS, but this possibility deserves careful consideration. Mothers know their children best, and their intuition should be considered worthy of a well-trained, attentive listener who takes their concerns seriously. Awareness is growing (especially in Syracuse, NY!), yet many families still travel to specialists familiar with PANS/PANDAS to receive a thorough evaluation.

The good news is that families who carefully track symptom onset, seek appropriate specialist input, and advocate effectively can obtain the answers and treatment plans their children need. Recovery from PANS/PANDAS is entirely possible with the right medical and psychological support.

Treatment Options

Treatment for PANDAS/PANS is highly individualized because each child’s immune response and symptom profile are unique. A combination of medical and mental health interventions is often needed.

Alongside medical treatment, mental health support for both the child and the parents navigating an immense caregiver burden is essential. Children may experience sudden, intense OCD, anxiety, tics, or emotional dysregulation. Early intervention with evidence-based therapies, such as Exposure and Response Prevention Therapy, can prevent long-term disruption to school, friendships, and family life.

Medical Treatments May Include:

Antibiotics to target underlying infections

Anti-inflammatories (such as NSAIDs or short-term steroids)

In more severe or persistent cases, IVIG (Intravenous Immunoglobulin) to help reset the immune response

Ultimately, every child is different and treatment often involves a blend of medical, psychological, and family support strategies tailored to your unique situation.

For more on medical treatment options, PANDAS Physician Network outlines recommended guidelines for mild, moderate, and severe cases here.

My Role as your Therapist:

1. To support your child in navigating a multitude of symptoms that can change by the day, including immune-mediated OCD, anxiety, rage and aggression, depression, and other symptoms that may be impairing their ability to participate in school and function in your home.

2. To support you—the parent—through one of the most emotionally exhausting and unpredictable experiences a family can face. When a child is struggling with PANDAS or PANS, the impact ripples through every corner of family life. It touches your relationship with your partner, your other children, your work, your mental health, and the overall sense of peace in your home. There is no manual for parenting a child who may look physically well but wakes up in distress—refusing food, overwhelmed by compulsions, or suddenly unable to face the day. The unpredictability is exhausting, and the emotional weight of it all can be incredibly heavy.

3. To serve as an advocate for you, help you navigate systems of care that can be overwhelming and daunting, and provide the most up-to-date information about PANS/PANDAS care. I participate in a Special Interest Group through the IOCDF that brings together clinicians, researchers, and individuals with lived experience, with monthly presentations from some of the top PANS/PANDAS medical professionals in the world. I dedicate extensive time outside of my clinical work to broadening my depth of knowledge about PANS/PANDAS and consulting with other world-renowned professionals in this arena.

Why Specialist Care for PANS/PANDAS is Crucial

Therapy for PANS/PANDAS differs from treatment for many other diagnoses because it requires immense flexibility based on a child’s flare status and often involves frequent coordination with a medical team. During a flare, the child’s symptoms may be more intense, irrational, or resistant to typical interventions, and therapy requires even greater sensitivity and flexibility. When a child is in a flare state, the focus shifts to crisis intervention, stabilizing the family, and collaborating with the child’s medical team. Medical treatment should be prioritized during these times until the child and family are out of crisis and better able to access therapeutic interventions.

PANS/PANDAS cannot be treated in silos and requires a strong interdisciplinary team to provide support across all necessary areas: medical care, family support, psychotherapeutic support, CBT/ERP for OCD (with flexibility during flares), DBT for crisis management, sibling support, eating disorder awareness and support (including ARFID, with potential referrals to dietitians and eating disorder care teams), and referrals for rehabilitation through occupational therapy (OT) or physical therapy (PT).

I’m here to help you hold steady through those storms. While I do not provide medical advice beyond my scope of practice as a licensed mental health counselor, I can collaborate with your medical team and provide consultation, as well as direct you to research and medical articles that may be helpful to your team. My role is to help you respond in ways that support your child’s long-term recovery while also helping you care for yourself throughout the process.

Services Offered

If you are interested in ongoing therapeutic care for your child and family (weekly or biweekly sessions), please fill out the interest form here and I will respond to your inquiry within 48 hours.

In the event that my practice is full and I am unable to accept new clients, I also offer the option of a PANS/PANDAS Interdisciplinary Evaluation and Consulting Session. (Physician or Self-Referral)

This session is generally 90 minutes for the initial consultation, with the potential for periodic follow-up as needed. It may be a good fit if:

Your child has multiple diagnoses (such as ADHD, OCD, or autism) and PANS is suspected, and your team is seeking support in navigating the nuance of potential co-occurring conditions—specifically what may be related to PANS and what may reflect other underlying diagnoses.

You or your providers suspect PANS/PANDAS, but your current team is not experienced in treating it and you would like an expert lens to consult.

You already have a therapist, but want to add a PANS/PANDAS specialist to your team to consult with the therapist, family, school, and others involved in your child’s care.

Your child has a confirmed diagnosis of PANS from a medical professional, but you need guidance on addressing the mental health symptoms.

Evaluation methods include: a structured PANS/PANDAS-informed assessment guided by current research, clinical recommendations, and validated tools (such as the CY-BOCS for OCD and PANS-31); a comprehensive review of the child’s psychological, social, developmental, and medical history to screen for and assess co-occurring conditions or differential diagnoses; and a review of any records from other evaluators.

Following the evaluation: A comprehensive written report is provided to the referring physician and other members of the care team, which includes recommendations for next steps and care coordination. I also provide links to research-based interventions tailored to your child, guided by current evidence and consensus guidelines from experts in the field. When warranted, I provide referrals to trusted colleagues for further evaluation and treatment, including PANS/PANDAS medical care and/or additional psychological assessment as needed.

Important Scope of Practice Note: This assessment does not result in a formal PANS diagnosis, but it provides a very valuable piece of the puzzle from an experienced clinician on the mental health side of treatment. This evaluation is intended to complement the medical assessment and help determine whether further medical intervention for PANS/PANDAS may be appropriate. I have provided such evaluations to many families who have found this to be a critical first step in getting organized and on the right track for their child’s journey to recovery.

Referrals and Fees:

Physicians may refer families directly by contacting therapy@barbshepardcounseling.com

Fee for diagnostic consultation only (one-time session):
$475 for the diagnostic consultation and written report (includes copy of 60+ page PDF Parent Guide to PANS/PANDAS)

*Please note that I am on Out-of-Network Provider and do not directly accept insurance. It is possible that your insurance company may reimburse some or all of your session if you child attends session with you. Please contact your insurance company ahead of time to ask about their reimbursement rate for your insurance plan.*

Fees for parents/child seeking ongoing care:
$475 initial session (includes diagnostic consultation, written report, and copy of PDF Parent Guide)
$200 per subsequent session

A note on cost of this session:

I take your financial and time investment seriously. My rate for this assessment reflects not only the time spent in session and the additional time required to complete a comprehensive written report, but also the coordination involved in communicating findings to your referral sources and care team. It also reflects my ongoing investment in continuing education and engagement within the global PANS/PANDAS community, including participation in the IOCDF Special Interest Group, organizing annual PANS/PANDAS Awareness Day in Syracuse, developing free educational resources for clinicians and families through Instagram and my website, and supporting legislative efforts to help New York State join other states in mandating insurance coverage for PANS/PANDAS care.

To book your family’s consulting session, visit my booking link here. If you have questions prior to booking, please email me at therapy@barbshepardcounseling.com.

The Parent’s Guide to PANS/PANDAS

Many parents share after their first session that they wish they had known everything we discussed in session one sooner.Feeling lost without a clear roadmap is common, so I created a 65-page, parent-friendly guide for navigating PANS/PANDAS. Originally developed as a detailed, research-based CE course for mental health professionals in NYS, this guide has been adapted to give parents in crisis all of the crucial initial information that they need to know into one consolidated guide.

This guide includes information about symptoms and science of PANS/PANDAS, including how it affects the brain; pathways of navigating treatment options across medical, mental health, and school systems; and practical resources for supporting yourself.

It was designed to help parents feel informed, empowered, and less alone on this journey.

Further Resources

Whether you are just beginning to navigate this journey or looking to deepen your understanding of PANS/PANDAS, these organizations offer valuable information, research, and support for families affected by these disorders:

International OCD Foundation: PANDAS/PANS Fact Sheet – A helpful overview of the condition from a leading organization in OCD research and treatment

International OCD Foundation – Practical Advice for Practitioners and Parents

PANDAS Physicians Network – A clinical resource hub with diagnostic and treatment guidelines used by medical professionals

PANDAS Network – A nonprofit offering education, research updates, and support resources for families and clinicians

ASPIRE – A nonprofit organization dedicated to raising awareness, providing education, and advocating for children and families

PANS/PANDAS School Resources – Most PANS/PANDAS students require individualized school accommodations. These are resources to help navigate that process.

Navigating PANS/PANDAS Skepticism Effectively – Neuroimmune Foundation offers a comprehensive guide for individuals seeking to address doubts with credible resources and research. Explore verified information, peer-reviewed studies, and expert opinions to bolster your understanding and advocacy efforts.

Avoidant/Restrictive Food Intake Disorder (Resources related to PANS)

PANS & Eating Disorder/Food Restrictions & Toolkits/Handouts (ASPIRE)

Disordered Eating in Children & Adolescents with PANS, Presented by Stanford Medicine

Cognitive Behavioral Therapy Workbook for ARFID

Key Research

Overview of Treatment of Pediatric Acute-Onset Neuropsychiatric Syndrome

Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part I—Psychiatric and Behavioral Interventions 

Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part II—Use of Immunomodulatory Therapies

Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part III—Treatment and Prevention of Infections

Cognitive-behavioral therapy for PANDAS-related obsessive-compulsive disorder: findings from a preliminary waitlist controlled open trial -This study provides preliminary support for CBT/ERP in treating the PANDAS subtype of pediatric OCD. 

Epigenetic, ribosomal, and immune dysregulation in paediatric acute-onset neuropsychiatric syndrome (2025)

Disordered Eating and Food Restrictions in Children with PANDAS/PANS

Certain eating disorders may be a neuropsychiatric manifestation of PANDAS: case report

Additional PANS/PANDAS research