Diagnostic criteria

Both PANS and PANDAS are clinical diagnoses, meaning there is no single blood test that confirms them. Doctors compare what they are seeing against published criteria. Here are the frameworks they use, explained plainly.¹,²,⁶

PANDAS criteria (Swedo et al., 1998)

All five of the following must be present:¹

1. Presence of OCD or a tic disorder. Obsessive thoughts, compulsive behaviors, or motor/vocal tics.
2. Pediatric onset. Symptoms began before puberty.
3. Episodic course. Symptoms come and go in distinct flares, not a steady worsening or steady plateau.
4. Association with strep infection. A flare follows a documented or strongly suspected group A strep infection.
5. Association with neurological abnormalities. During flares, the child shows other neurological signs, like motor hyperactivity or unusual movements.

PANS criteria (Chang et al., 2015)

PANS uses a broader set of criteria. All three of the following must be present:²

1. Abrupt, dramatic onset of OCD or severely restricted food intake. This is the sudden-onset hallmark.
2. Concurrent presence of at least two additional symptoms with similar abrupt onset and severity, from the following seven categories:

   • Anxiety
   • Emotional lability or depression
   • Irritability, aggression, or oppositional behavior
   • Behavioral or developmental regression
   • Deterioration in school performance
   • Sensory or motor abnormalities (including tics, handwriting changes, hyperactivity)
   • Somatic signs or symptoms (sleep disturbance, bedwetting, urinary frequency)
3. Symptoms are not better explained by another known neurologic or medical disorder. For example, Sydenham chorea, lupus, or autoimmune encephalitis must be considered and ruled out.

The 2025 AAP Clinical Report

In March 2025, the American Academy of Pediatrics published its first clinical report on PANS.⁶ The AAP framing aligns with the criteria above and emphasizes a family-centered, multidisciplinary approach involving pediatrics, psychiatry, and rheumatology or immunology where available.

If your provider is unfamiliar with PANS, the AAP report is a credible, peer-reviewed reference you can bring to the conversation. The Sources page has the link.