PANS is a medical condition in which symptoms affect a student’s ability to attend school and learn.

School Impact

PANS not only impacts the physical health of a student but also causes psychological, neurological, behavioral, and developmental difficulties.

Symptomology and symptom severity vary from student to student and even from flare to flare in the same student. The goal of treatment is to achieve full recovery in order to prevent the student’s condition from becoming a chronic, debilitating illness. Treatment includes medical protocols as well as therapeutic practices. School accommodations are an essential component of a thorough and appropriate treatment protocol.

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PANS Symptoms Seen at School at a Glance

  • OCD
  • Restricted Eating
  • School Related Anxiety
  • Separation Anxiety
  • School Refusal
  • Vocal and motor tics
  • Behavioral Regression
  • Urinary Frequency
  • Behavioral Changes: Increased oppositional defiance, rage, emotional lability, depression
  • Academic Regression: decline in handwriting, arithmetic, reading skills
  • Executive Planning Issues
  • Processing Delays
  • Sensory Issues
  • Impulsivity, Inattention, Limited Concentration
  • Decreased physical & mental

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Individualized and Flexible Plans

Most PANS students require individualized school accommodations to some degree, ranging from an Individualized Education Plan (IEP) to a 504 plan, to an Individualized Health Care Plan (ICHP) to non-formalized supports built into classroom friendly strategies.

The accommodations vary depending on the student’s symptoms and severity as well as from flare to flare. Each symptom can cause its own set of difficulties at school and when combined with several symptoms, even more significant challenges must be addressed. There is neither a one size fits all presentation of symptoms nor a one size fits all set of accommodations.

Due to the changing nature of symptoms and the relapsing and remitting course of PANS, ensure plans are flexible. Plans should be written with the student’s worst days in mind while hoping for the best days. A student may initially present with one or more primary symptoms, which may resolve with treatment only to be replaced with a new set of symptoms or different manifestations of the initial symptoms. Academic performance and attendance can vary widely during exacerbations.

One month, a student may be in a debilitating flare requiring several supports but later in the school year require significantly less only to relapse again. Not all PANS students return to baseline between flares, requiring year-round accommodations even while not in an active flare. Student performance and needs can vary day-to-day and week-to-week.

Other Health Impairment (OHI) is the condition that most PANS students qualify for an IEP. Students may be eligible for an IEP under different categories as well depending on that student’s symptoms such as specific learning disability (SLD), autism spectrum disorder (ASD) or emotional and behavioral disorder (EBD). However, caution must be taken to not mislabel a student; SLD or EBD may not encompass all of the student’s issues by focusing too much on a small portion of symptoms.

“Writing the plans with the most difficult days in mind will assure that the child can receive adequate accommodations without revisiting the 504 or IEP process often.”

Clinical Management of Pediatric Acute-Onset-Neuropsychiatric Syndrome: Part I–Psychiatric and Behavioral Interventions, Margo Thienemann, MD et al

Key Take Away Points

  • Kids can get better
  • PANS/PANDAS is medical
  • PANS affects multiple domains of learning
  • Don’t blame the child for his/her illness
  • PANS is essentially a spectrum disorder
  • All treatments and accommodations must be individualized
  • Symptoms are relapsing and remitting
  • The whole team must communicate and collaborate
  • Schools need to provide fluid access in and out of service
  • Plan for the worst and hope for the best

Resources for Schools & Educators