A unique set of symptoms characterizes PANS and PANDAS. The PANS diagnostic criteria are based on the acute onset of OCD and/or eating restrictions, with concurrent symptoms in at least 2 of 7 categories of neurological, cognitive, or behavioral symptoms. PANS PANDAS symptom presentation, the severity of symptoms, and the trigger can vary from patient to patient. PANS symptoms are triggered by infections, inflammatory reactions, or metabolic disturbances.

See full PANS Diagnostic Criteria

PANS PANDAS Symptoms ASPIRE chart

  • Obsessions (OCD vs PANS/PANDAS)
    • Perfectionism
    • Fear of Contamination
    • Fear of Losing Control
    • Fear of Harm
    • Scrupulosity
    • Unwanted Sexual Thoughts
  • Compulsions
    • Checking
    • Repeating
    • Washing/Cleaning
    • Mental Compulsions
    • Confessing/Reassurance Seeking
    • Trying to achieve “Just Right”
    • Avoidance (tasks, places, people)
  • Severe Eating Restriction (See More)
    • Includes Food and Liquids
    • ARFID – Avoidant of particular foods and/or limited intake
    • Fear of: Contamination/Poisoning, Choking, Swallowing­­­­­, Vomiting, Anaphylaxis
    • Sensory Issues: Hypersensitivity – textures, smells, tastes
    • Ritualistic Eating
    • Body Dysmorphia
    • Swallowing issues
    • Loss of appetite
  • Anxiety (See More)
  •  Depression
    • Emotional Lability/Mood Swings
  • Aggression
    • Severe Oppositional Defiance – ODD
    • Rage
  • Behavioral Regression
    • Baby Talk
    • Tantrums
    • Developmental Regression
  • Sensory and Motoric Abnormalities (See more on Sensory Processing, Tics)
    • Sensory Processing Issues
    • Motor and/or Vocal Tics
    • Choreiform Movements
    • Hallucinations
    • Hyperactivity
    • Dysgraphia
    • Akathisia
  • Decline in Academic Skills (See PANS @School)
  • Somatic Symptoms (See Sleep Problems)
    • Daytime Urinary Frequency
    • Nighttime Bedwetting – Enuresis
    • Urinary Urgency
    • Problems Falling or Staying Asleep
    • Night Terrors
    • Lack of REM Sleep & other Physiological Reasons

Symptom Frequency

Symptom Frequency Aspire pans pandas

The PANS Diagnostic Criteria require the new or worsening of OCD and/or severely restricted eating along with symptoms from two out of seven categories.  However, many patients have many more symptoms than just the required ones. It is interesting to note that the somatic symptoms such as urinary frequency, mydriasis, and insomnia, help differentiate PANDAS from Tourette syndrome or non-PANDAS OCD.

Dr. Miroslav Kovacevic presented on PANS PANDAS symptom frequency at the PANS/PANDAS Advisory Summit in 2017. The PANS Research Consortium pooled data several members collected within their practices.

A Spectrum Disorder

Spectrum of Symptoms Severity Trigger PANS PANDAS Aspire

PANS has multiple triggers, severities, and symptoms. It is essentially a spectrum disorder. Referring to PANS as a spectrum disorder does not mean it is part of the Autism Spectrum Disorder. It means that one patient with PANS can have very different profiles due to variations in symptomology and triggers. This graphic is only an example of symptoms, severity, and triggers. This graphic is not meant to encompass every combination possible. It is to convey that one cannot assume that because they know one patient with PANS, every patient is going to be similar.

Learn more about PANS and Autism in ASPIRE’s Professional Advisory Board’s Toolkit on PANS/PANDAS Guidelines for Children with Autism. This informational toolkit discusses the unique challenges of diagnosing PANS PANDAS in children with Autism, what it can look like in the school setting, the PANS diagnostic criteria, and treatment guidelines.

Learn more about PANS & PANDAS Symptom Severity
Learn more about PANS PANDAS Disease Course

Symptoms In Depth - Articles

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Leah’s Story

Leah’s Story

In August of 2014 our daughter, Leah, was 6 years old.  We had just returned home from a month-long trip to Illinois to visit family.  When we arrived home in Arizona, she suddenly (overnight) developed a fear of vomit.