Assessment and Treatment of PANS/PANDAS: A Multidisciplinary Approach and Therapeutic Considerations

Abstract

Pediatric acute-onset neuropsychiatric syndrome (PANS) is a disorder characterized by an abrupt onset of neuropsychiatric symptoms in children, including obsessions/compulsions and/or restrictive eating. It can be challenging to identify the cause of PANS, but triggers are typically infections or other inflammatory reactions. A subset of these children meet criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). Children diagnosed with PANDAS have a recent streptococcal infection and exhibit symptoms consistent with obsessive compulsive disorder (OCD) or tics. Evidence for treatment has been inconsistent, as studies have been limited by small samples sizes and there are no FDA approved treatments at this time. Treatments explored have included medical approaches to target infection, inflammation, and psychiatric symptoms as well as behavioral interventions. The effectiveness of non-medicine brain-based treatments offered by psychology is often underrecognized by families and pediatricians seeking a medical cure for this post-infectious or para-infectious neuropsychiatric condition. We present two cases of children treated using a cognitive-behavioral approach integrating the family system with the support of a multidisciplinary team. In both cases, children achieved substantial symptom reduction. Clinical considerations for treatment and assessment of children with PANS/PANDAS are discussed.