PANS, PANDAS and Neurodivergence
The relationship between PANS, PANDAS and neurodivergence is complex and often misunderstood. This confusion can lead to misdiagnosis and inadequate support.
Neurodivergence or Neurodiversity?
Neurodiversity refers to the natural and valuable differences in how people think, learn, communicate and experience the world. It includes all kinds of minds and recognises that variation in brain function is a fundamental part of human diversity.
Neurodivergence refers to people whose brains work in ways that are different from dominant social expectations. This includes variations in thinking, learning, sensing and communicating, for example, Autism, ADHD, dyslexia or dyspraxia. Neurodivergent individuals may benefit from support and accommodations that celebrate their strengths whilst supporting needs and areas of difficulty.
PANS and PANDAS can present with traits that closely resemble those seen in neurodivergent profiles such as Autism, ADHD, Dyslexia, Dyspraxia, or Dyscalculia.
This overlap can sometimes lead to delays in diagnosis and support, particularly when new or acute symptoms are mistakenly attributed to an existing neurodivergence. This is known as diagnostic overshadowing.
It is important to recognise that PANS and PANDAS can co-occur alongside neurodivergence, and that neurodivergent children and young people may experience an intensification of traits such as sensory sensitivities, anxiety, sleep difficulties, or eating challenges during a flare.
A key distinguishing feature of PANS and PANDAS is their more acute onset following illness, which sets them apart from innate neurodivergence. Crucially, PANS and PANDAS are treatable, and early recognition can lead to effective interventions. Taking a thorough developmental history is essential to ensure that children and young people receive an accurate assessment and appropriate care that honours both their neurodivergence and any acute medical needs.
“Changes in behaviour I assume to be PANS were seen as part of his existing autism diagnosis, or I suspect they thought he might be becoming psychotic. In general, the rapid onset of regression, aggressive behaviour and eating problems were assumed to be either my fault, or simply psychiatric symptoms.”
– Parent of a child with PANS
“We must build systems that embrace complexity, honour lived experience, and support children and young people in a holistic way. The relationship between PANS, PANDAS and neurodivergence is complex, and our understanding continues to evolve. Every child deserves to be seen, heard, and understood, and to have equitable access to medical evaluation when PANS or PANDAS is suspected.”
– Tina Coope, Education Lead, PANS PANDAS UK
Understanding the whole picture
Better understanding is essential to improve support and outcomes for children, young people and families. The following terms are sometimes used to describe difficulties experienced by families in our community:
Diagnostic Overshadowing
Our community tell us that some children or young people have their symptoms of PANS or PANDAS incorrectly attributed to their neurodivergence. This is known as ‘diagnostic overshadowing’. It can result in missed or delayed recognition of PANS or PANDAS, and a lack of appropriate support.
Co-occurrence
Neurodivergence and PANS or PANDAS are not mutually exclusive. Children who are neurodivergent can also develop PANS or PANDAS. Each child or young person’s experience is unique; therefore, a comprehensive developmental history is essential to understand their current situation.
Misdiagnosis and Missed Diagnoses
Families in our community have raised concerns that their child may have been misdiagnosed as being autistic, or having ADHD, when the underlying cause may be PANS or PANDAS. The overlap in neurodivergent traits and PANS or PANDAS symptoms can make it difficult to distinguish between conditions without a thorough, individualised assessment from a professional who understands PANS or PANDAS and Autism, ADHD and other neurodivergences.
Overlapping traits may include:
- Sensory sensitivities, such as aversion to clothing textures or loud environments
- Sleep disturbances
- Anxiety and/or emotional dysregulation.
Trauma Misattribution
In some cases, symptoms of PANS or PANDAS are misattributed to trauma. This can place families in a difficult position, especially when they are advocating for a medical evaluation. It is essential to consider all possible explanations and avoid assumptions.
Acquired Neurodivergence
Some families report that their previously neurotypical child developed longer-term neurodivergent traits following the onset of PANS or PANDAS. This is sometimes referred to as acquired neurodivergence. More research is needed to understand these experiences and their implications.
Moving Forward
There is a lack of research, training, and awareness about the intersectionality of PANS, PANDAS, and neurodivergence. Families report that this is contributing to misdiagnosis, diagnostic overshadowing, unmet needs and, in some cases, caregiver blame and accusations of Fabricated Induced Illness (FII). Listening to families and conducting comprehensive developmental histories are key steps toward better outcomes. These priorities are being directly addressed in the pending Local Authority Guidance on PANS or PANDAS, which is due in 2026.
This article is written in grateful collaboration with Helen Edgar, autistic advocate, author and creator of Autistic Realms.
Better understanding is essential to improve support and outcomes for children, young people and families.
The following terms are sometimes used to describe difficulties experienced by families in our community:
Diagnostic Overshadowing
Our community tell us that some children or young people have their symptoms of PANS or PANDAS incorrectly attributed to their neurodivergence. This is known as ‘diagnostic overshadowing’. It can result in missed or delayed recognition of PANS or PANDAS, and a lack of appropriate support.
Co-occurrence
Neurodivergence and PANS or PANDAS are not mutually exclusive. Children who are neurodivergent can also develop PANS or PANDAS. Each child or young person’s experience is unique; therefore, a comprehensive developmental history is essential to understand their current situation.
Misdiagnosis and Missed Diagnoses
Families in our community have raised concerns that their child may have been misdiagnosed as being autistic, or having ADHD, when the underlying cause may be PANS or PANDAS. The overlap in neurodivergent traits and PANS or PANDAS symptoms can make it difficult to distinguish between conditions without a thorough, individualised assessment from a professional who understands PANS or PANDAS and Autism, ADHD and other neurodivergences.
Overlapping traits may include:
- Sensory sensitivities, such as aversion to clothing textures or loud environments
- Sleep disturbances
- Anxiety and/or emotional dysregulation.
Trauma Misattribution
In some cases, symptoms of PANS or PANDAS are misattributed to trauma. This can place families in a difficult position, especially when they are advocating for a medical evaluation. It is essential to consider all possible explanations and avoid assumptions.
Acquired Neurodivergence
Some families report that their previously neurotypical child developed longer-term neurodivergent traits following the onset of PANS or PANDAS. This is sometimes referred to as acquired neurodivergence. More research is needed to understand these experiences and their implications.
