Childhood Post-Infectious Neuroimmune Disorders are characterized by the acute onset of debilitating symptoms including:

  • Significant change in emotional stability and behavior 
  • New-onset anxiety symptoms (obsessive compulsive symptoms, trichotillomania and restricted eating) 
  • New-onset tics and movements disorders 
  • Profound changes in mood regulation (panic attacks, rage, aggression, and suicidal thoughts) 
  • Major decline in motor function impacting handwriting and learning 


In this group of disorders, psychiatric illness arises from an organic etiology; symptoms are indicative of an infectious trigger and a misdirected immune system. A child beset by emotional or behavioral symptoms is exhibiting an aberrant response to infection. Often, the underlying cause is missed, and, without medical intervention, the child’s functioning deteriorates in school, home, and/or community settings. 

Children are frequently misdiagnosed, because of a lack of understanding and awareness, with a litany of psychiatric disorders including: Attention Deficit Disorder, Generalized Anxiety Disorder, Tourette Syndrome, Obsessive Compulsive Disorder, Oppositional Defiant Disorder, eating disorders, and Bipolar Disorder. 


Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) was first described at length in 1998 to describe sudden onset of OCD and other physical and behavioral changes in children following streptococcal infection. This disease appears to share many characteristics with Sydenham’s Chorea and Autoimmune Encephalitis. Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) shares many similar symptoms but is triggered by an infection or environmental factor other than streptococcus. Neither condition is well understood, and it is imperative for research to move faster to develop much needed therapies for children. 

Influential Papers

Immunoneuropsychiatry – novel perspectives on brain disorders. By Pape K, Tamouza R, Leboyer M, Zipp F. Jun 2019

Parental Infections Before, During, and After Pregnancy as Risk Factors for Mental Disorders in Childhood and Adolescence: A Nationwide Danish Study. By Lydholm CN, Köhler-Forsberg O, Nordentoft M, Yolken RH, Mortensen PB, Petersen L, and Benros ME. Feb 2019

Recurrent group A Streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant TFH cells. By Dan JM, Havenar-Daughton C, Kendric K, Al-Kolla R, Kaushik K, Rosales SL, Anderson EL, LaRock CN, Vijayanand P, Seumois G, Layfield D, Cutress RI, Ottensmeier CH, Lindestam Arlehamn CS, Sette A, Nizet V, Bothwell M, Brigger M, and Crotty S. Feb 2019

A Nationwide Study in Denmark of the Association Between Treated Infections and the Subsequent Risk of Mental Disorders in Children and Adolescents.  Köhler-Forsberg O, Petersen L, Gasse C, Mortensen PB, Dalsgaard S, Yolken RH, Mors O, and Benros ME. Dec 2018

Association of Streptoccocal Infections with Mental Disorders: Testing key aspects of the PANDAS Hypothesis in a Nationwide Study. By Orlovska S, Vestergaard CH, Bech BH, Nordentoft M, Vestergaard M, and Benros ME. Jul 2017

Clinical Advisors’ Key Papers

Immunoglobulin A Dysgammaglobulinemia Is Associated with PediatricOnset Obsessive-Compulsive Disorder. By Williams K, Shorser-Gentile L, Sarvode Mothi S, Berman N, Pasternack M, Geller D, and Walter J. May 2019

Psychotic symptoms in youth with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) may reflect syndrome severity and heterogeneity. By Silverman M, Frankovich J, Nguyen E, Leibold C, Yoon J, Mark Freeman G Jr., Karpel H, and Thienemann M. Mar 2019

Psychometric Evaluation of the Caregiver Burden Inventory in Children and Adolescents With PANS. By Farmer C, Thienemann M, Leibold C, Kamalani G, Sauls B, and Frankovich J. Aug 2018

Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part I-Psychiatric and Behavioral Interventions. By Thienemann M, Murphy T, Leckman J, Shaw R, Williams K, Kapphahn C, Frankovich J, Geller D, Bernstein G, Chang K, Elia J, and Swedo S. Sep 2017

Disordered eating and food restrictions in children with PANDAS/PANS. By Toufexis MD, Hommer R, Gerardi DM, Grant P, Rothschild L, D’Souza P, Williams K, Leckman J, Swedo Se, and Murphy TK. Feb 2015

Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): recommendations from the 2013 PANS Consensus Conference. By Chang K, Frankovich J, Cooperstock M, Cunningham MW, Latimer ME, Murphy TK, Pasterrnack M, Thienemann M, Williams K, Walter J, Swedo SE, and the PANS Collaborative Consortium. Feb 2015