When Everything Changes Suddenly: Understanding Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) in Kids and Teens

(From the lens of The Highland Center for Mental and Behavioral Health - a Dallas-based therapy practice that welcomes clients and patients from all over Texas)

Sometimes, a parent comes to us and says something that stops us in our tracks. “It’s like we don’t even know our child anymore.” That feeling is at the heart of what families experience when a child develops Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). One day, a child may seem like themselves: playful, predictable, and familiar. The next, a sudden surge of anxiety, obsessive thoughts, or dramatic behavior emerges almost overnight. For parents, siblings, and the child themselves, it can feel as if the ground has shifted beneath their feet, leaving everyone unsteady and unsure of how to move forward.

Many families share another layer of frustration: the feeling of being gaslit, dismissed, or let down by the medical system. Parents may be told that symptoms are “just stress,” “behavioral,” or “growing pains,” leaving them questioning their instincts and worrying that they are overreacting. That lack of recognition can deepen the anxiety and isolation families feel, making it even harder to know where to turn. At The Highland Center for Mental and Behavioral Health, we validate that experience and acknowledge how exhausting it can be to advocate for a child when the system feels unresponsive or confusing.

We approach PANS with both sensitivity and clarity. Families often describe a mixture of relief and fear when they finally put words to what’s happening: relief that there’s a name for this sudden change, and fear of what it might mean for the future. Our role begins by holding space for that emotional turbulence. We listen to the story of how the symptoms appeared, how they’ve escalated, and how the family has been coping. There is no judgment, no rush. We validate the reality of living with unpredictable and intense shifts in behavior, mood, and thought, while gently helping families separate the child from the illness, so that love and understanding remain intact.

One of the most common struggles families face is trying to make sense of these rapid changes. Parents often feel guilt, wondering if something they did or didn’t do caused this. Siblings may feel overlooked as attention focuses on the child who suddenly seems different. And children themselves are often confused, frustrated, or frightened by their own reactions, which can be unlike anything they’ve felt before. We help each member of the family articulate these emotions, normalize them, and understand that the intensity is part of the condition, not a reflection of failure or character.

Therapeutically, our work focuses on building stability, communication, and coping strategies. We provide children with tools to manage intrusive thoughts, sudden anxiety, and emotional dysregulation, while helping parents recognize patterns, anticipate triggers, and respond with calm confidence rather than panic. Family sessions often focus on rebuilding trust, strengthening connection, and creating a predictable structure that allows the child to feel safe again.

Living with PANS can feel isolating, but families are not alone. We help parents advocate for their child in school, navigate the stress of medical appointments, and support siblings who may be struggling in ways that aren’t immediately visible. At the same time, children learn that they are not “broken” or “bad,” that these symptoms are a challenge they can face with help, and that the world still contains moments of stability and joy even when everything feels unpredictable. Slowly, the family begins to regain a sense of rhythm, one small, consistent step at a time.

PANS changes a child’s life in sudden, sometimes bewildering ways, but it does not define who they are.

At The Highland Center for Mental and Behavioral Health, we guide families through these abrupt shifts with compassion, understanding, and practical support. Our goal is to help children reclaim a sense of safety and identity, while helping families navigate the emotional, social, and behavioral challenges that come with sudden neuropsychiatric onset. Even in the midst of uncertainty, hope and connection can still be found.