Parents of children with PANS/PANDAS often have questions about when and if therapy will be effective for their child’s symptoms. This question can feel tricky, especially if you were previously told that your child was “only” dealing with anxiety or OCD and providers did not acknowledge or dismiss the possibility of PANS or an immune-mediated cause for the symptoms. Maybe you even tried therapy in the past, and it failed.
The first, and most important thing to note is that you can’t therapy inflammation away. Therapy won’t change the atypical or misdirected immune response that is triggering inflammation. In order to address the underlying causes of inflammation, you must address the susceptibility to that misdirected immune response. Homeopathy is the only modality that addresses this susceptibility.
With that said, it’s also important to recognize that Pediatric Acute‑onset Neuropsychiatric Syndrome (PANS) / Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) doesn’t occur in a vacuum. There are many areas where therapy can be helpful along the journey to full recovery from PANS/PANDAS. Therapy can help not only the child with PANS, but also help siblings and parents to process and heal from the PANS experience.
Before you consider any of the following therapies, talk with your provider to determine whether it’s the right time. You know your child best, but having a provider’s perspective on how far into recovery they are, what is still inflammation-based, and what is more likely to respond to therapy can be very helpful. Giving yourself the best chance for success with therapy, especially with young children, is vital because in many cases, we don’t get a second shot.
Another thing to note before getting started: not all therapists understand PANS/PANDAS. Rather than simply selecting the closest therapist covered by insurance, it can be very beneficial to connect with a local PANS/PANDAS parent support group for referrals. If no such group is available in your area, you can contact the therapist’s office directly and ask a few questions to ensure they have the experience and understanding your situation requires before scheduling your intake.
PANS/PANDAS Is a Family Condition
While it might be just one child in your family who carries the diagnosis, PANS/PANDAS affects everyone. The impacted child(ren) need a lot of attention, which can shift focus away from other relationships, limit what the family can do together, and leave everyone feeling unseen, unheard, and misunderstood. Family therapy can sometimes help by providing a safe, neutral space to process the experience together and develop strategies to repair relationships.
PANS/PANDAS is especially challenging in marriages. Many couples find they are not aligned in their understanding of the condition, their approach to behaviors, or their treatment choices. PANS/PANDAS often places significant financial strain on families because of loss of work, out-of-pocket medical expenses, home accommodations, or purchases made to manage OCD symptoms. Couples also rarely get time alone when a PANS/PANDAS child is in the home. Between intense separation anxiety, OCD, or rages, it can sometimes feel impossible to leave the child with a trusted babysitter. Parents, especially mothers, can even become the direct focus of the child’s OCD, making escapes or breaks feel unsafe or not worthwhile. That’s to say, couples counseling can be very helpful. Not just because the parents deserve to feel supported (and you do!) but because the better you are feeling and the more you’re communicating, the easier your child’s healing path tends to become.
One last point: how you are doing does impact how your child is doing. As parents, we often say that no one knows our child better than we do, but the reverse is also true. Our children are deeply attuned to us and how we feel. They take cues from us about how safe they should feel from infancy on. A PANS/PANDAS child is especially looking to you to understand just how frightened they ought to be by what’s happening to them. The more support you get for yourself during this very hard condition, the better you will be able to support your child. So even if no one else in your family wants to go to therapy with you, individual therapy can help you, and that, in turn, can shift the dynamics for the whole family.
Parenting Children with PANS/PANDAS Is Not for the Faint of Heart
If you are a PANS/PANDAS parent, you already know this. You’ve likely accepted the fact that no ordinary parenting book will work for your child, and you’re right. Just like you can’t therapy away inflammation, you can’t simply parent it away either. In many cases, parenting takes a bit of a back seat to survival. That often “works” for a while, because children with PANS/PANDAS get stuck or even regress developmentally.
But as your child heals and inflammation settles, you will often find yourself with a different version of your child. If you’ve used homeopathy as part of your recovery strategy, you may see your child begin to make developmental catch-up at some point. Once it starts, it often moves quickly: you might see them speed through cognitive catch-up within months. A child who was three years behind in math might catch up over a summer once their body feels safe enough to tackle multiplication tables. Social and emotional development tends to be less linear—because it depends on feedback from parents and peers.
This is when parenting support can be particularly valuable. Parents typically learn and grow alongside their kids: they figure out what the child needs at each age and stage, it’s a gradual process, admittedly with some bigger jumps (ahem, leaps) at certain points. Parenting a child who is finally able to re-engage in the world and take accountability for their actions and emotions, after possibly years of little or no control, can feel like whiplash. Having expert support can help both you and your child experience more ease in this transition.
Grief / Trauma
Both you and your child are likely to carry some degree of grief and/or trauma from the PANS/PANDAS journey. There are so many things that PANS/PANDAS rob from childhood and from your parenting experience. It is completely normal to feel grief. You’re likely to feel it most intensely in the throes of PANS/PANDAS; your child may feel it more as they recover. Grief therapy can help everyone in the family process what was lost and move forward into what still awaits.
Trauma therapy may be one of the most vital “later-stage” therapies for full recovery from PANS/PANDAS. Let’s be honest: sometimes PANS/PANDAS is really scary. Even in milder cases without physical threat, the waxing and waning pattern of flares can leave you living in a constant state of alert. Every sound that resembles a tic, every note from school about circulating illness, can spark nights of sleepless worry. I’ve seen many parents who don’t realize how much PANS-related PTSD they carry until their child starts recovering. They see their child doing better than they have in years, and yet they still can’t relax. They tell me, “I’m more anxious now than I was when PANS/PANDAS was at its worst.” Therapies grounded in trauma, such as Eye Movement Desensitization and Reprocessing (EMDR) or Somatic Experiencing, can do wonders for both you and your child. Because remember: your child, even as they begin to recover, is still looking to you for cues that they are safe.
We have more information about trauma and useful therapies in our podcast interview series with Dr. Karen Lamb. You can find our podcast here or wherever you listen. Look for episodes 91-93.
Other Specific Therapies
Sometimes OCD, even when inflammation-based, can become habitual in the brain. When you’re seeing recovery proceed as expected, general anxiety is down, rages have ceased, the immune system is behaving more typically, but the OCD seems stuck or stubborn, dedicated OCD-specific therapies can help. These are designed to provide exposure to the intrusive or repetitive thought in a safe, controlled space so the child can practice not engaging with the compulsion. This kind of therapy isn’t usually effective in the early phase of PANS/PANDAS recovery, but can be extremely beneficial later on.
There’s a strong overlap between Attention Deficit Hyperactivity Disorder (ADHD) and PANS/PANDAS. Sometimes the ADHD symptoms are exclusively inflammation-based, and they resolve as the immune system heals. Other times, the wiring is underlying the ADHD symptoms and PANS/PANDAS makes it much worse. When the wiring is underlying the ADHD presentation, you often see improvements alongside PANS/PANDAS recovery, but then a plateau where wiring takes over, and symptoms become more persistent in the absence of flares. At this moment, your child might benefit from therapy or coaching for executive function.
Lastly, while this isn’t a lightweight therapy, I’d be remiss not to mention Dialectical Behavior Therapy (DBT). Originally designed for borderline personality disorder, the concepts in DBT are useful for almost every human being. Its focus is on identifying and regulating emotions, increasing distress tolerance, practicing mindfulness, expanding healthy interpersonal communication, and establishing boundaries. You might not need a full, intensive DBT group protocol, but your child and your family could benefit from introducing the basic DBT concepts.
True recovery from PANS/PANDAS happens when the body, mind, and family are all supported in the right ways and at the right times. While homeopathy addresses the root susceptibility that drives inflammation, therapies like those discussed here can help rebuild emotional safety, connection, and confidence along the way. Be patient with the process, trust the timing, and remember—you and your child are both healing, together.
