PANS can significantly impact a student’s attendance.
School refusal is seen in probably 90-100% of PANS students often due to separation anxiety and OCD. In a qualitative study, half of the PANS students were placed in home-hospital services or were homeschooled(1). 50% of children spend time on home instruction or are removed to homeschool or home/hospital temporarily or permanently. 35% of the parents who took part in the UK PANS PANDAS survey in 2020, reported that their child had had more than 6 months off school(2). The main reasons PANS students miss school are separation anxiety, OCD, sleep disturbances, fatigue, immune and health issues, and doctor’s appointments.
No matter the length of time a student misses school, communication between families, school professionals, and medical professionals is essential to making sure the student’s needs are met. Remember a student’s functioning may change rapidly thus requiring a smooth and quick transition in and out of services. Attendance accommodations should include allowances for absences, late arrival, and early dismissal. Modifying class schedules should be considered on an as-needed basis. Explore flexible supports that weave together partial school day schedules, online learning, and in-home tutoring during times of acute exacerbations. School staff should explain district and/or state policies regarding attendance issues so parents can attain proper medical documentation describing how the student’s PANS symptoms cause attendance issues.
Planning teams should create reentry plans for those who have missed a significant amount of time. Do not assume a student is back to normal functioning just because they are attending school. Pushing too hard normalcy may result in a backslide.
Nature of Illness
PANS patients are immunocompromised and may need to be out of school to avoid exposure to infections like strep or flu. Fatigue and stamina also significantly impact attendance. For example, one child may be able to handle two straight full days of school but physically unable to attend the next two while another student can make it every day but may only be able to attend morning classes and a third student may miss extended periods of time completely due to fatigue and other symptoms. Sleep disturbances due to OCD, anxiety, and REM sleep abnormalities are seen in almost all PANS patients resulting in exhausted students.
Separation Anxiety, OCD, Depression, Aggression
Separation Anxiety and OCD are both major criteria for PANS. Separation anxiety can prevent a child from attending school or from attending a full day. OCD rituals can prevent a student from being able to leave the house at all or on time. Depression and Aggression, two other symptoms of PANS PANDAS, can also greatly impact a student’s ability to attend school.
Doctor Appointments and Treatments
Some PANS students have a large clinical team requiring many doctor and therapist visits while others have a small team. Some treatments require students to miss several days of school. Immune-related therapies, such as IVIG or plasmapheresis, take several days per round and often require several to monthly rounds to complete. Severely impacted patients may require hospitalization.