One morning, you woke up to a child you didn’t recognize.
The confident, curious child you knew seemed to disappear overnight.
Suddenly, they refused school. They couldn’t tolerate the feeling of their clothes. Lights felt too bright. Sounds were overwhelming. They stopped eating foods they once loved. They became consumed by intrusive thoughts, separation anxiety, rage, tics, or fears that made no sense to anyone—including them.
You’re left asking the same question countless parents have asked:
“What happened to my child?”
If this sounds familiar, you’re not alone.
What are PANS & PANDAS?
For some children, the sudden onset of OCD, anxiety, restrictive eating, tics, emotional dysregulation, or other neuropsychiatric symptoms may symptoms of PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) or PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections).
These conditions are believed to occur when an immune response mistakenly affects the brain, leading to an abrupt change in mood, behavior, and neurological functioning.
PANDAS is considered a subset of PANS in which symptoms are associated with a Group A Streptococcal infection. PANS may be triggered by a broader range of infections, inflammatory processes, or other immune-related events.
Research in this field continues to evolve, but one thing is clear: these children require thoughtful, multidisciplinary care.
Common Symptoms
While every child looks different, parents often describe:
Sudden-onset OCD — Intrusive thoughts, compulsions, or reassurance-seeking that seem to appear almost overnight.
Severe Separation Anxiety — Panic when away from caregivers, school refusal, or suddenly needing to be with a parent at all times (even within your house)
Restrictive Eating (ARFID) — Abrupt refusal of foods, fear of choking or vomiting, or a dramatic narrowing of “safe” foods.
Rage or Emotional Outbursts — Intense meltdowns or aggression that seem dramatically out of character.
Tics or Unusual Movements — Sudden onset of blinking, throat clearing, shoulder shrugging, facial grimacing, or other motor or vocal tics.
School Refusal — A child who once enjoyed school suddenly becomes unable or unwilling to attend.
Regression — Loss of previously mastered skills, increased dependence, or behaviors that seem much younger than the child’s age.
Sensory Sensitivities — Suddenly overwhelmed by clothing, lights, sounds, textures, or everyday sensory experiences.
Urinary Frequency or Bedwetting — New urinary urgency, frequent bathroom trips, or bedwetting after being previously toilet trained.
Symptom Flares Following Illness — OCD, anxiety, eating changes, or tics that worsen significantly after infections or immune triggers.
One of the most difficult aspects of PANS/PANDAS is its unpredictable, relapsing-remitting course. A child who seems like themselves one week may struggle significantly the next. The illness course, and it’s treatment, is not linear.
Diagnosis is Complex & Interdisciplinary
PANS/PANDAS are medical diagnoses of exclusion made by qualified physicians after other neurological, autoimmune, infectious, and psychiatric conditions have been appropriately considered.
There is currently no single laboratory test that confirms the diagnosis, and symptoms often overlap with more traditional presentations of OCD, anxiety, ADHD, tic disorders, autism, or other developmental conditions.
This is why evaluation often involves collaboration among pediatricians, rheumatologists, neurologists, psychiatrists, psychologists, therapists, school teams, and other specialists.
My Role as a Mental Health Counselor
While I do not diagnose or medically treat PANS/PANDAS, comprehensive mental health care is an essential part of treatment.
My role includes:
Assessing OCD, anxiety, ARFID, and related mental health symptoms
Providing evidence-based treatment such as Exposure and Response Prevention (ERP)
Supporting parents through one of the most challenging experiences a family can face
Helping families navigate school accommodations and educational supports
Recognizing symptom patterns that may warrant further medical evaluation
Collaborating with physicians and other members of your child’s treatment team
Recommendations I provide are grounded in current research, published clinical consensus guidelines, and evidence-based mental health practice while remaining firmly within my scope as a Licensed Mental Health Counselor.
Treatment Requires a Team Approach
Children with PANS/PANDAS often require an interdisciplinary approach.
Depending on the child, treatment may include:
Medical Care
Medical treatment is managed by qualified physicians and may include treatment of infections, anti-inflammatory approaches, immunomodulatory therapies, or other medical interventions when clinically appropriate.
Mental Health Care
Evidence-based therapy helps children address OCD, anxiety, ARFID, emotional regulation, school avoidance, and family accommodation while supporting recovery and resilience.
School Support
Many children benefit from individualized educational supports through IEPs or 504 Plans during periods of symptom exacerbation.
No single provider can address every aspect of PANS/PANDAS—and they shouldn’t have to. The strongest outcomes occur when medical, mental health, educational, and family supports work together.
Ways that I Can Help
Ongoing Therapy (NYS Residents Only)
Weekly or biweekly therapy for children and families focusing on OCD, anxiety, ERP, parent coaching, and navigating the emotional impact of PANS/PANDAS.
→ Submit Inquiry to Become a Client
Pediatric OCD, Anxiety & Neuroimmune Consultation (NYS Residents Only)
A comprehensive 90-minute consultation designed to clarify symptoms, identify contributing factors, screen for neuroimmune red flags, and provide a personalized roadmap for next steps.
Includes an optional written report for families and providers.
PANS/PANDAS Clinician Consultation
For families, schools, and professionals seeking guidance regarding behavioral health, school accommodations, evidence-based mental health treatment, and navigating multidisciplinary care.
On-Demand Webinar
Understanding PANS/PANDAS: A Research-Informed Clinical Overview
A comprehensive 1 hour, 50 minute training reviewing the current research, clinical consensus guidelines, and the role of mental health within multidisciplinary PANS/PANDAS care.
Designed for parents, mental health professionals, physicians, educators, therapists, and anyone wanting a deeper understanding of these complex conditions.
Parent’s Guide to PANS/PANDAS
A practical, research-informed guide created to help families understand symptoms, treatment pathways, school supports, and available resources.
Written in parent-friendly language and designed to help families feel more informed and less alone.
Additional Resources
I’ve compiled many of the organizations, research articles, school resources, and clinical guidelines I most frequently recommend to families.
Whether you’re just beginning this journey or looking to deepen your understanding, these resources are an excellent place to start.
→ View Recommended Resources
Let’s start a conversation.
Please submit all therapy inquiries using the form below. I make every effort to respond to all messages within two business days. If my schedule is full, I’m happy to help connect you with another therapist who can support you. Before submitting your inquiry, please take a moment to review my FAQ page so you have a clear understanding of the services I offer and the associated fees.
I look forward to supporting you!
Barb Shepard, LMHC, PLLC 