What is PANS/PANDAS and how is it diagnosed?
DR. SURUCHI CHANDRA | NEUROTHERAPy
BETHESDA, MARYLAND I WASHINGTON DC
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) are neuroimmune conditions in which a child’s immune system, triggered by infections or inflammation, mistakenly attacks brain tissue involved in emotion and movement. Symptoms often appear suddenly and include obsessive-compulsive behaviors, tics, anxiety, mood changes, or eating restrictions. Diagnosis involves ruling out other causes, identifying immune or infectious triggers, and assessing patterns over time. Early, integrative evaluation can shorten the course of illness and improve long-term recovery.
Parents are often blindsided by how quickly their child changes. One day, their child is thriving; the next, they may have severe anxiety, compulsive rituals, new tics, or refuse to eat. These sudden changes can feel overwhelming and are often dismissed as “behavioral.”
PANDAS is linked specifically to Group A Streptococcus (“strep”) infections.
PANS is broader, encompassing other infectious or inflammatory triggers, like mycoplasma, influenza, Epstein-Barr virus, Lyme disease, mold exposure, and even post-COVID immune activation (Saini et al., Dev Neurosci 2025).
While the concept originated with Dr. Susan Swedo at the NIH, two decades of research, including the Stanford PANS Clinic (Thienemann & Frankovich et al. 2017), now confirm distinct immune and neurologic features: autoantibodies targeting neuronal tissue, elevated inflammatory markers, and, in some cases, cerebrospinal fluid changes (Front Behav Neurosci 2024; Pooni et al.).
Parents are often blindsided by how quickly their child changes. One day, their child is thriving; the next, they may have severe anxiety, compulsive rituals, new tics, or refuse to eat. These sudden changes can feel overwhelming and are often dismissed as “behavioral.”
PANDAS is linked specifically to Group A Streptococcus (“strep”) infections.
PANS is broader, encompassing other infectious or inflammatory triggers, like mycoplasma, influenza, Epstein-Barr virus, Lyme disease, mold exposure, and even post-COVID immune activation (Saini et al., Dev Neurosci 2025).
While the concept originated with Dr. Susan Swedo at the NIH, two decades of research, including the Stanford PANS Clinic (Thienemann & Frankovich et al. 2017), now confirm distinct immune and neurologic features: autoantibodies targeting neuronal tissue, elevated inflammatory markers, and, in some cases, cerebrospinal fluid changes (Front Behav Neurosci 2024; Pooni et al.).
There is no single blood test for PANS or PANDAS. Diagnosis is based on history, symptom pattern, and exclusion of other causes.
Core steps include:
1. Comprehensive Clinical History
2. Physical and Neurological Examination
3. Targeted Laboratory Evaluation
4. Specialized Testing When Indicated
5. Symptom Tracking and Scoring Tools
Diagnosis often requires a multidisciplinary review, using psychiatry, infectious disease, immunology, neurology, ideally led by clinicians experienced in both behavior and immune regulation.
Core steps include:
1. Comprehensive Clinical History
- Sudden or dramatic onset of OCD, tics, eating restriction, or emotional lability
- Temporal relationship to infections, fevers, or inflammatory illnesses
- Family history of autoimmunity
2. Physical and Neurological Examination
- Subtle motor findings or “neurological soft signs” are common (Zebrack et al., JAMA Netw Open 2025).
- Neurologic changes help distinguish PANS from primary psychiatric conditions.
3. Targeted Laboratory Evaluation
- Strep cultures or titers (ASO, anti-DNase B)
- Broader panels for Mycoplasma pneumoniae, Epstein-Barr virus, Lyme, and post-viral immune markers
- Inflammatory and autoimmune testing (ANA, cytokine profiles, anti-neuronal antibodies (Xu et al., Brain Behav Immun 2024))
- Basic metabolic and thyroid screening
4. Specialized Testing When Indicated
- Lumbar puncture or MRI in atypical or severe cases (Pooni et al., 2024)
- Functional assessments for sleep, nutrition, and autonomic function (some children exhibit POTS (Chan et al., Front Neurol 2022))
5. Symptom Tracking and Scoring Tools
- The PANS 31-Item Symptom Rating Scale (Bernstein et al., J Child Adolesc Psychopharmacol 2024) can objectively track progress.
Diagnosis often requires a multidisciplinary review, using psychiatry, infectious disease, immunology, neurology, ideally led by clinicians experienced in both behavior and immune regulation.
How is PANS and PANDAS Diagnosed?
Why Does PANS/PANDAS Often Go Unrecognized?
In real life, few children fit the “overnight” textbook pattern described online. Many develop symptoms gradually or after multiple immune stressors together - a respiratory infection, a viral illness, or even allergies. Because the presentation overlaps with anxiety, OCD, ADHD, or restrictive eating, many families cycle through psychiatrists and therapists before anyone considers an immune or infectious component.
Recent Stanford data (Masterson et al., Dev Neurosci 2025) show that only about half of children evaluated for PANS met the criteria during their initial flare, reinforcing why careful longitudinal assessment matters. Even within tertiary care centers, PANS/PANDAS remains underrecognized, in part because this variability requires clinicians across multiple specialties to piece together patterns over time.
This is why functional, and integrative psychiatry can play a vital bridging role: bringing immunology, neurology, and psychiatry into one diagnostic lens.
Recent Stanford data (Masterson et al., Dev Neurosci 2025) show that only about half of children evaluated for PANS met the criteria during their initial flare, reinforcing why careful longitudinal assessment matters. Even within tertiary care centers, PANS/PANDAS remains underrecognized, in part because this variability requires clinicians across multiple specialties to piece together patterns over time.
This is why functional, and integrative psychiatry can play a vital bridging role: bringing immunology, neurology, and psychiatry into one diagnostic lens.
Why Does an Integrative Approach and Dr. Chandra's Expertise Matter?
Traditional models often focus solely on psychiatric symptoms or infection detection. An integrative neuroimmune approach broadens the focus to why the immune system misfired and how the brain and body are communicating.
At Suruchi Chandra, MD – Integrative Psychiatry and Neurotherapy, we combine evidence-based medical evaluation with advanced functional testing to identify hidden infections, immune activation, or environmental triggers. We also examine the gut-brain-immune axis, mitochondrial health, and nutritional deficiencies that can perpetuate inflammation and make symptoms harder to treat.
In complex cases, identifying the pattern of immune dysregulation matters as much as naming the trigger. A thorough, comprehensive evaluation often reveals connections missed in traditional care, helping families finally understand why symptoms began and what is needed for lasting recovery.
At Suruchi Chandra, MD – Integrative Psychiatry and Neurotherapy, we combine evidence-based medical evaluation with advanced functional testing to identify hidden infections, immune activation, or environmental triggers. We also examine the gut-brain-immune axis, mitochondrial health, and nutritional deficiencies that can perpetuate inflammation and make symptoms harder to treat.
In complex cases, identifying the pattern of immune dysregulation matters as much as naming the trigger. A thorough, comprehensive evaluation often reveals connections missed in traditional care, helping families finally understand why symptoms began and what is needed for lasting recovery.
Why Choose Dr. Chandra and How to Find a PANS/PANDAS Doctor Near Washington, DC?
Families often struggle to find clinicians familiar with PANS/PANDAS. Because these conditions cross specialties, it’s important to seek:
Located in Bethesda, Maryland, Suruchi Chandra, MD – Integrative Psychiatry and Neurotherapy serves families across the DMV region, including Washington, DC, Potomac, and Northern Virginia (i.e. Arlington, Fairfax, and Falls Church), through in-person and telehealth consultations.
To explore an evaluation or learn whether your child’s symptoms may fit PANS/PANDAS, you can learn more about becoming a new patient: https://chandramd.com/new-patient-info
- A physician experienced in neuroimmune and integrative psychiatry
- A care team open to collaboration with pediatricians, neurologists, and therapists
- A clinic offering comprehensive evaluation, not just strep testing
Located in Bethesda, Maryland, Suruchi Chandra, MD – Integrative Psychiatry and Neurotherapy serves families across the DMV region, including Washington, DC, Potomac, and Northern Virginia (i.e. Arlington, Fairfax, and Falls Church), through in-person and telehealth consultations.
To explore an evaluation or learn whether your child’s symptoms may fit PANS/PANDAS, you can learn more about becoming a new patient: https://chandramd.com/new-patient-info
When to Seek Care Urgently?
- Sudden onset of suicidal thoughts or severe emotional outbursts
- Rapid food refusal or dehydration
- New movement disorders, hallucinations, or confusion
- Physical symptoms such as high fever, joint swelling, or weakness
If these occur, seek emergency medical attention while arranging follow-up with a clinician experienced in neuroimmune disorders.
Next Steps
Serving patients in Bethesda, Maryland, Washington DC, and Northern Virginia.
Medically reviewed by Suruchi Chandra, MD. This content is for educational purposes only and does not substitute for individualized medical advice.
Updated January 2026
- Learn more about PANS/PANDAS
- New patient information
- About Dr. Chandra
- Read Dr. Chandra's Blog Posts: PANS & PANDAS Symptoms and Diagnosis: A Psychiatrist’s Guide and A Psychiatrist’s Guide to PANS & PANDAS Part 2: Treatment Options
Medically reviewed by Suruchi Chandra, MD. This content is for educational purposes only and does not substitute for individualized medical advice.
Updated January 2026
- National Institute of Mental Health — PANDAS & PANS Overview (https://www.nimh.nih.gov/health/publications/pandas)
- Stanford Medicine — PANS Q & A (https://med.stanford.edu/pans/about/Q-and-A.html)
- PANDAS Physicians Network — What Are PANS and PANDAS? (https://www.pandasppn.org/what-are-pans-pandas/)
- South Carolina Department of Health — Autoimmune Disorders in Children
- Masterson EE et al., Dev Neurosci 2025; Yin X et al., medRxiv 2024; Xu J et al., Brain Behav Immun 2024; Zebrack JE et al., JAMA Netw Open 2025.
Articles & Resources
About Dr. Chandra
Dr. Suruchi Chandra, MD, is a Harvard- and Yale-trained psychiatrist brings together emerging neuroscience-based therapies, trauma-informed care, nutritional approaches, and systems-level biology to advance thinking in psychiatry and help more patients find clearer paths forward.
See full bio.
