A pandas symptoms checklist can help parents, caregivers, teachers, and healthcare professionals spot the signs and symptoms of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections). While a checklist cannot provide a diagnosis, it can help you keep track of possible symptoms to share with a medical professional.
PANDAS is a condition still being studied by the medical community. What is known is that it can have a sudden onset. A child who was doing well can start displaying obsessive-compulsive symptoms, tics, anxiety, and more after a streptococcal infection.
This article discusses what a pandas symptoms checklist includes, what symptoms to look out for, what to expect from a medical professional, and how recognizing the condition early can help.
Beginner’s Guide
PANDAS refers to a pediatric neuropsychiatric syndrome thought to arise when the body’s immune reaction to a streptococcal infection mistakenly affects the brain, leading to the abrupt appearance of specific behavioral and neurological symptoms. Researchers believe that streptococcus infections trigger an autoimmune response in children that causes the brain to malfunction.
The symptoms of PANDAS can appear suddenly and include obsessive-compulsive symptoms, tics, anxiety, and more. A pandas symptoms checklist can help you track your child’s symptoms.
What is a Pandas Symptoms Checklist?
A symptoms checklist is not a diagnostic tool. It is a way to keep track of symptoms that can appear suddenly. A checklist can help you recognize the signs, assess severity, prepare for a medical professional, and help you keep track of improvement or worsening of symptoms.
Healthcare professionals will likely want to do a series of tests before deciding if a child has PANDAS or something else. A medical professional will probably ask you to complete a symptoms checklist as part of the process.
How Pandas Works
Researchers are still working to understand PANDAS. The current theory about how it works is as follows:
1. The child gets a streptococcal infection
2. The infection triggers an autoimmune response
3. The autoimmune response causes the brain to malfunction
4. The child begins displaying symptoms of PANDAS
How the Pandas Checklist Works
A pandas symptoms checklist looks at what symptoms are present and how severe they are. You may want to go over the symptoms with a healthcare professional and have them help you identify which ones apply to your child.
The symptoms of PANDAS can appear suddenly. A child can be doing well one day and then start displaying obsessive-compulsive symptoms (OCS), tics, anxiety, and more the next.
A pandas symptoms checklist can help you keep track of your child’s symptoms.
Key Terms and Concepts
PANDAS vs. PANS
PANDAS is often confused with PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). The difference between the two is that PANDAS is triggered by a streptococcal infection, while PANS can have other causes. Both conditions involve sudden onset of neuropsychiatric symptoms, such as obsessive-compulsive symptoms, tics, anxiety, and more.
Sudden Onset is a Major Symptom of Pandas
One of the major symptoms of PANDAS is that it comes on suddenly. The child can be doing well one day and then start displaying symptoms of obsessive-compulsive the next.
A Pandas Symptoms Checklist
The following is a list of symptoms commonly associated with PANDAS.
Obsessive-Compulsive Pandas symptoms checklist
Many children with PANDAS display obsessive-compulsive symptoms, such as:
• Washing hands
• Checking
• Fear of germs
• Intrusive thoughts
• Obsessions
• Rituals
• Repeating words or actions
• Need for reassurance
Motor and Vocal Tics
Children with PANDAS may also display tics, such as:
• Eye blinking
• Facial movements
• Shoulder shrugging
• Head jerking
• Throat clearing
• Sniffing
• Grunting
• Sudden vocal sounds
Anxiety
Children with PANDAS may also display symptoms of anxiety, such as:
• Separation anxiety
• Generalized anxiety
• School refusal
• Panic attacks
• Fear of being alone
• Excessive worry
• Refusing to leave the parent
Emotional Symptoms
Children with PANDAS may also display emotional symptoms, such as:
• Irritability
• Mood changes
• Crying
• Anger
• Aggression
• Depression
• Emotional sensitivity
Behavioral Symptoms
Children with PANDAS may also display behavioral symptoms, such as:
• Regressing to baby-like behavior
• Being clingy
• Being unable to dress themselves
• Losing confidence
• Becoming overly dependent on the parent
Sleep Symptoms
Children with PANDAS may also display sleep symptoms, such as:
• Insomnia
• Nightmares
• Waking up suddenly
• Restlessness
• Difficulty sleeping
• Anxiety around bedtime
School Performance Decline
Children with PANDAS may also display a decline in school performance, such as:
• Poor concentration
• Poor memory
• Brain fog
• Slowness in processing
• Poor handwriting
Teachers are often the ones who first notice a change in a child’s school performance.
Sensory Symptoms
Children with PANDAS may also display sensory symptoms, such as:
• Sensitivity to loud noises
• Sensitivity to bright lights
• Sensitivity to clothing
• Sensitivity to food
• Sensitivity to crowds
Urinary Symptoms
Children with PANDAS may also display urinary symptoms, such as:
• Increased frequency of urination
• Bedwetting
• Increased urgency
Eating Changes
Eating behaviors may change suddenly and include
restricted eating
fear of choking
refusal to eat
loss of weight
or
aversive response to food textures
Movement Difficulties
Development of
poor coordination
clumsiness
inappropriate handwriting
balance difficulties, or
fine motor problems
Cognitive Symptoms
Parents may note
difficulty making decisions,
memory loss,
slowed cognition,
confusion,
inability to follow directions,
or
difficulty with specific tasks.
Detailed Guide: What Parents Should Do
When there are multiple sudden changes in behavior, start keeping track of
the date, any recent illnesses, positive strep tests, family observations, teacher reports, the severity of symptoms, changes in sleeping patterns, medication use, etc. Keeping a log can help doctors determine patterns. Using a structured PANDAS symptoms checklist can make it easier to monitor changes over time and share accurate information with your child’s healthcare provider.
How Doctors Evaluate Possible PANDAS
There are a variety of criteria to evaluate for a PANDAS diagnosis. The doctor may
review medical history
conduct a physical exam,
order lab tests,
perform neurological testing,
and
complete behavioral screening.
Reviewing Medical History
The doctor will ask about
previous illnesses
symptoms timeline
family medical history,
and
development.
Physical Exam
The physician will
rule out other conditions
Lab Tests
The healthcare provider may perform a rapid strep test, throat culture, ASO titer, and anti-DNase B test. The Centers for Disease Control and Prevention provides detailed information about Group A Streptococcal infections, their symptoms, testing, and treatment. Although these tests can detect a streptococcal infection, they cannot confirm PANDAS on their own.
Neurological Testing
Neurological evaluation can help determine
reflexes, motor skills, coordination, tics, etc.
Behavioral Screening
A psychological evaluation can assist with
assessing OCD and anxiety symptoms and determining their severity.
Treatment Approaches
Treatment is individualized based on the presenting symptoms.
Treating Active Strep Infection
If there is an active strep infection, antibiotics may be warranted. Although treating the infection alone may not improve neuropsychiatric symptoms, it can be very important if an infection is present.
Cognitive Behavioral Therapy
Many individuals with OCD symptoms benefit from CBT, specifically Exposure and Response Prevention Therapy. Parents can learn more about evidence-based treatment options for OCD through resources provided by the National Institute of Mental Health.
Medications
Individuals with OCD, anxiety, depression, and/or tics may benefit from medication when appropriate. Symptom management should always be individualized and reviewed by an experienced medical professional.
Additional Considerations
Many children with PANDAS need to work with a variety of specialists, including pediatricians, neurologists, psychiatrists, psychologists, occupational therapists, and school counselors.
Advanced Insights and Professional Knowledge
Although PANDAS has garnered attention over the years, there is still much to learn about the condition. Researchers are working to better understand autoimmunity, biomarkers, genetics, immune dysfunction, neuroimaging, and prognosis. There is no question that PANDAS is a serious, frightening diagnosis, and families should always be wary of unproven treatments or miracle cures that promise to help without evidence. It is essential that individuals work with qualified medical professionals who can appropriately evaluate and manage the condition.
Real-Life Use Cases
Following a case of strep throat, a child develops severe anxiety, hand-washing behaviors, and school refusal two weeks later. Parents use a pandas symptoms checklist as a reference before meeting with their pediatrician. After treatment for strep throat and anxiety, parents continue to track OCD symptoms, sleep, mood, appetite, and tics. The symptom log helps them understand when to schedule their next pediatric appointment.
The parents talk with their child’s teachers about their grades, emotional state, and behaviors. The teachers note worsening school performance and frequent emotional outbursts and difficulty focusing in class. Using the pandas symptoms checklist helps the parents keep track of relevant information and communicate more effectively with the pediatrician. A similar log can help parents talk with teachers, too.
Common Misunderstandings
Every child with OCD has PANDAS.
This is untrue. The majority of kids with OCD do not have PANDAS.
A checklist can help diagnose PANDAS.
This is untrue. Only qualified medical professionals can diagnose PANDAS based on the full range of symptoms.
Every case of strep leads to PANDAS.
This is false; most cases of strep throat do not result in PANDAS.
Having PANDAS means having lifelong symptoms.
This is untrue; although some children have chronic cases of PANDAS, many improve with treatment.
PANDAS vs. Other Childhood Conditions
PANDAS Typical OCD Tourette Syndrome Anxiety Disorders
Sudden onset Commonly Commonly VariableCommonly
Linked to strep infectionCommonlyNoNoNo
OCD symptomsCommonPrimary symptomSometimesSometimes
Motor ticsCommonLess commonPrimary symptomRare
AnxietyCommonCommonSometimesPrimary symptom
Behavioral regressionMay occurRarelyRarelyRarely
Because PANDAS can present similarly to a number of conditions, it’s always important to speak with a qualified medical professional.
Pro Tips
When using a pandas symptoms checklist, make sure to
document symptoms day-by-day
not rely on memory
note recent illnesses, especially ones involving sore throat or fever
include teacher observations
and
scan or take pictures of any handwritten logs for your records
Avoid jumping to conclusions about a PANDAS diagnosis based on internet searches. Instead, follow your pediatrician’s guidance and recommendations for further workup or treatment. Save copies of lab work and specialist notes for your records. Be persistent – it may take several visits for your child to get an accurate diagnosis.
Frequently Asked Questions
What is the purpose of a pandas symptoms checklist?
The symptoms checklist is a useful tool to help you determine when to seek medical care and what information to provide when you do.
What is usually the first symptom?
A sudden onset of either obsessive compulsive symptoms, anxiety, or motor tics is typically the first sign of PANDAS after a strep infection.
Can adults develop PANDAS?
PANDAS most commonly affects children prior to puberty. There are rare case reports of PANDAS in adults, but it is generally considered extremely uncommon.
Is every child with tics affected by PANDAS?
No. Tics can be associated with a number of other conditions in addition to PANDAS.
Can symptoms come and go?
Yes, symptoms can fluctuate over time. Some children experience periodic worsening of symptoms while others steadily improve with treatment.
Should I use a checklist before seeing a doctor?
Yes! A symptom log can help you provide much-needed context and timeline information to your pediatrician.
Conclusion
The pandas symptoms checklist is an extremely useful tool to help you recognize concerning changes in your child’s behavior that may require medical attention. It can also help facilitate communication with your pediatrician and other specialists, although it is important to remember that only qualified medical professionals can provide an official diagnosis and treatment plan. The most concerning feature of PANDAS is the sudden change in behavior, mood, movement, or cognition that often occurs right after a strep infection.
Parents who notice any of these changes in their child should seek medical care as soon as possible. By working with their pediatrician to obtain an accurate diagnosis and individualized treatment plan, children with PANDAS can get the comprehensive care they need while researchers continue to make progress toward understanding and improving outcomes for this challenging condition.
