Occupational Performance Fluctuates With PANS Disease State
Newby MJ, Lane SJ, Haracz K, et al. Occupational performance patterns in children with paediatric acute-onset neuropsychiatric syndrome. Australian Occupational Therapy Journal. 2024;72:e12995. doi:10.1111/1440-1630.12995
- Children with PANS show significant declines in occupational performance and socialisation during symptom exacerbations
- Adaptive Behaviour Composite and socialisation scores were significantly lower during exacerbation compared with remission
- During remission, occupational performance returned to age-typical ranges across all measured domains
- Findings highlight the episodic, relapsing–remitting nature of functional impairment in PANS
- Authors emphasize the importance of occupational therapy during flare-ups and caution against assessment-based misinterpretation during exacerbations
The study found statistically significant declines in overall occupational performance and socialization during PANS exacerbations, with Adaptive Behavior Composite and socialization domain scores markedly lower during flares compared with remission; communication and daily living skills also trended lower during exacerbation, though these differences did not reach statistical significance. In contrast, during remission, children demonstrated occupational performance within age-typical normative ranges across all VABS domains, including socialization. Together, these findings support PANS as a state-dependent condition with fluctuating functional impairment rather than a static neurodevelopmental disorder. The authors note that socialization deficits observed during exacerbations may resemble autistic traits if assessed in isolation, highlighting the importance of timing when conducting developmental, behavioral, or educational evaluations. The study underscores the need for ongoing monitoring, phase-aware assessment, and interventions tailored to the episodic nature of PANS, with a clear role for occupational therapy during exacerbations and multidisciplinary allied health involvement when indicated.
Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) is characterized by abrupt onset and a fluctuating clinical course, yet the functional consequences of these symptom shifts are often underrecognized. A 2024 prospective study by Newby and colleagues examined how PANS affects children’s occupational performance during periods of symptom exacerbation and remission, using the Vineland Adaptive Behavior Scales (VABS), a norm-referenced measure of daily functioning.
The study followed children aged 4.6 to 13.1 years whose parents completed standardized assessments during two distinct phases: an active PANS exacerbation and a period of remission. Results showed a statistically significant decline in overall occupational performance and socialization during exacerbations, reflected by lower Adaptive Behavior Composite scores and socialization domain scores. These findings indicate that during flares, children experience meaningful functional impairments in everyday activities, including social participation and general daily functioning.
Importantly, when the same children were assessed during remission, their occupational performance fell within typical age-based norms across all VABS domains, including communication, daily living skills, and socialization. This finding underscores a key feature of PANS: functional impairments are state-dependent, rather than fixed or developmentally intrinsic.
The authors highlight that socialization was the largest contributor to functional decline during exacerbations. Reduced social engagement, difficulty responding to social cues, and withdrawal during flares may place children at risk of being misclassified with other neurodevelopmental conditions if assessments occur only during periods of illness. The study cautions that evaluations conducted during exacerbations may not accurately reflect a child’s baseline abilities.
From a clinical standpoint, the findings reinforce the importance of timing in assessment, ongoing monitoring, and interventions tailored to the episodic nature of PANS. The authors emphasize a clear role for occupational therapy during exacerbations to support daily functioning and quality of life, while also noting that some children may require continued support if they do not return fully to baseline during remission.
Overall, this study provides prospective, norm-referenced evidence that children with PANS experience marked but reversible declines in occupational performance, reinforcing the need for multidisciplinary care models that recognize fluctuation as a defining feature of the condition rather than a diagnostic confound.
Gabriella True
