PANS and PANDAS Syndrome Support Services

Has Your Child Changed Overnight?

Level Up Wellness Group provides expert, evidence-based assessment and treatment for children and youth experiencing symptoms of Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS).

Our multidisciplinary team, led by Dr. Melody Morin, offers a compassionate, integrated approach to bridge the gap between psychological and medical care. We provide services for families in Alberta, Ontario, and Yukon.

If your child is experiencing a sudden, dramatic onset of neuropsychiatric symptoms, you are not alone, and there are answers. This can manifest as:

Sudden, severe Obsessive-Compulsive Disorder (OCD)
A new or sudden onset of tics
Sudden, severe anxiety (especially separation anxiety)
Dramatic mood swings, irritability, or rage
A new, severe restriction of food
Sudden behavioral regression (e.g., “baby talk”)
A sudden drop in school performance or handwriting
New onset of urinary urgency or bedwetting

PANS and PANDAS Treatment

Our PANS/PANDAS Program: A Personal Mission

For Dr. Melody Morin, the founder of Level Up Wellness Group, PANS/PANDAS care is not only part of her clinical work—it is deeply personal.

Her journey into this specialty began at home when her own daughter faced sudden and profound neuropsychiatric changes linked to multiple infections, including Borrelia burgdorferi (Lyme disease). Despite clear symptoms, the path to diagnosis was overwhelming and isolating. Navigating complex medical systems, advocating for proper testing, and searching for compassionate, knowledgeable care shaped not only her daughter’s healing journey but also Dr. Melody’s professional mission.

Today, she brings that lived experience to Level Up. She understands the anxiety, urgency, and uncertainty parents face when their child’s personality changes seemingly overnight. She believes families deserve providers who listen, investigate thoroughly, and walk alongside them using evidence-based practice.

Dr. Melody has personally selected the medical team and providers in our PANS/PANDAS program to ensure your family is met with the highest level of expertise and, most importantly, with hope.

What is PANS (Pediatric Acute-onset Neuropsychiatric Syndrome)?

PANS is a clinical diagnosis for children who experience a sudden, “lightning-like” onset of neuropsychiatric symptoms. Unlike typical psychiatric disorders that may develop gradually, PANS symptoms can appear “out of the blue,” with parents often able to name the exact day their child changed.

PANS Diagnostic Criteria

A PANS diagnosis is clinical and based on the symptom presentation. It requires:

Core Requirement: An abrupt, dramatic onset of Obsessive-Compulsive Disorder (OCD) OR Severe Eating Restrictions.
Comorbidity Requirement: The concurrent onset of symptoms in at least TWO of the following seven categories:

Anxiety (particularly sudden, severe separation anxiety)
Emotional Lability (sudden mood swings) and/or Depression
Irritability, Aggression, and/or Severely Oppositional Behaviours
Behavioural (Developmental) Regression (e.g., “baby talk,” loss of age-appropriate skills)
Deterioration in School Performance (e.g., “brain fog,” memory issues, handwriting decline)
Sensory or Motor Abnormalities (e.g., new tics, sensitivity to light, sound, or textures)
Somatic Signs and Symptoms (e.g., sleep disturbances, new onset of bedwetting or urinary frequency)

Critically, these symptoms must not be better explained by another known neurologic or medical disorder.

What is PANDAS? A Specific Subtype of PANS

PANDAS is a specific subset of PANS first described by Dr. Susan Swedo at the NIMH. It is diagnosed when a child meets the full criteria for PANS, but the symptoms are specifically linked to a Group A Streptococcal (GAS) infection.

The PANDAS criteria are:

Presence of OCD and/or tics.
Symptom onset between 3 years of age and puberty.
Acute onset and an episodic (relapsing-remitting) course.
A temporal relationship with a Group A Streptococcal infection.

Association with neurological abnormalities (like motor hyperactivity or choreiform movements).

"Typical" Pediatric OCD vs. PANS/PANDAS

"Typical" Pediatric OCD

PANS/PANDAS

Key Clinical Differentiators

While the core OCD symptoms may look the same, research highlights key differences. Compared to children with typical OCD, children with PANDAS often show significantly greater:

Urinary urgency or frequency
Hyperactivity and impulsivity
Deterioration in handwriting
Tic severity

This constellation of ancillary symptoms is a key indicator that points toward a PANS/PANDAS diagnosis.

The "Why": How an Infection Can Cause Neuropsychiatric Symptoms

PANS/PANDAS is a post-infectious autoimmune syndrome. The illness is not caused by the pathogen itself, but by the body’s own disordered immune response to it.

The Infectious Trigger

The process begins when a susceptible child is infected. In PANDAS, this trigger is Group A Strep. In the broader PANS syndrome, known triggers can include:

Mycoplasma pneumoniae (walking pneumonia)
Influenza (the flu)
Lyme Disease (Borrelia burgdorferi) and co-infections (e.g., Bartonella)
Epstein-Barr Virus (Mono)
Varicella (Chickenpox)
Sinusitis

The Mechanism: Molecular Mimicry

The autoimmune attack is a case of mistaken identity known as molecular mimicry.

Infection: The body is infected by a pathogen (e.g., strep).
Immune Response: The immune system correctly creates antibodies to fight the infection.
Mistaken Identity: Unfortunately, proteins on the pathogen “mimic” or look similar to proteins on the host’s own healthy brain cells (specifically in the basal ganglia).
Autoimmune Attack: The antibodies cross the blood-brain barrier and, mistaking brain cells for the invader, launch an autoimmune attack.

Inflammation: This attack causes neuroinflammation (inflammation of the brain), which in turn triggers the sudden onset of neuropsychiatric symptoms.

PANS/PANDAS in a Canadian Context

PANS/PANDAS is a growing area of concern in Canadian pediatrics. A 2021 study by the Canadian Paediatric Surveillance Program (CPSP) identified 84 reported cases across Canada over a two-year period.

This surveillance highlighted several key challenges for Canadian families:

Significant Practice Variation: The study revealed that how clinicians diagnose, assess, and treat PANS/PANDAS varies significantly across the country.
Diagnostic Discrepancy: In 41% of reported cases, there was a discrepancy in diagnostic certainty between families (who were more certain) and their physicians (who were less certain).
Misdiagnosis is Common: The CPSP study found that only 22% of cases had a symptom onset described as truly “sudden.” This may explain why many children are first misdiagnosed with primary psychiatric conditions, as the onset may occur over days or weeks.

This data confirms the difficult “diagnostic odyssey” many families face, an experience that is central to our clinic’s mission.

The Diagnostic Challenge: Why It's Often Missed

PANS/PANDAS is a clinical diagnosis made by a skilled provider based on a child’s history and symptom cluster. For many families, this is the most frustrating part of the journey. You may be told “it’s just anxiety” or “it’s just a phase,” even when you know in your core that something has drastically changed. This “diagnostic odyssey” can take years, partly because diagnostic protocols are still evolving, even among specialists.

There is no single blood test that can confirm or rule out PANS/PANDAS.

The Limits of Laboratory Tests

Families and clinicians often seek lab tests for answers, but in PANS/PANDAS, these tests can be misleading:

Strep Swabs (Rapid & Throat Cultures): These tests only detect a current infection in the throat. They are known to miss 30-50% of active cases and cannot detect strep in other parts of the body (e.g., perianal, gut, sinuses). Most importantly, they will be negative if the triggering infection has already resolved.
Antibody Titers (ASO, Anti-DNase B): These blood tests only show past exposure to strep. A positive titer is common in most school-aged children and does not prove PANDAS. A negative titer does not rule it out, as the antibody response may have faded or the trigger may not have been strep (in the case of PANS).

A knowledgeable provider uses these tests as part of a larger clinical puzzle, not as a standalone answer. The diagnosis relies on the story, not just the lab values.

Understanding the Symptoms: More Than Just OCD

While the diagnostic criteria list the 7 comorbidities, two areas often cause the most distress and confusion for families.

Severe Food Restriction

This is not “picky eating.” It is a sudden and severe restriction of food intake, which can lead to rapid weight loss. It is often driven by PANS-related symptoms such as:

Contamination fears (a form of OCD)
Sudden sensory sensitivities (textures, smells)
Fear of choking or vomiting
Gastrointestinal or abdominal pain

"Brain Fog" and ADHD-Like Symptoms

Many parents report their child suddenly developing “ADHD.” This is often a misinterpretation of symptoms caused by neuroinflammation. These can include:

A sudden drop in cognitive functioning (“brain fog”)
Difficulty with memory, organization, and executive functioning
A dramatic deterioration in handwriting
Hyperactivity and restlessness driven by underlying anxiety or tics

More Than a Diagnosis: The Impact on Family & School

PANS/PANDAS is a crisis that affects the entire family and disrupts every aspect of a child’s life.

At Home: The syndrome places immense strain on family dynamics. Parents are often confused and overwhelmed, facing a child they no longer recognize. The CPSP study found that 64% of Canadian families experienced significant family stress and mental health concerns. Siblings may also struggle with frustration, fear, or resentment as the ill child requires constant care.
At School: The combination of cognitive fog, anxiety, OCD, and sensory sensitivities can make the classroom environment impossible. The Canadian study noted 51% of children experienced significant school absences, and 39% withdrew from activities and friendships.

We understand this lived experience. Our model is designed to support not just the child, but the entire family system.

Our Approach: An Evidence-Based, 3-Pronged Treatment Strategy

At Level Up Wellness Group, we follow the consensus guidelines for PANS/PANDAS, which recommend a simultaneous, three-pronged treatment strategy. A single intervention (like therapy alone) is often insufficient.

Psychiatric and Behavioral Interventions

This is critical for providing immediate relief from debilitating symptoms.

Therapy: Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) are the gold-standard treatments for OCD.
Parent Support: We provide Parent Management Training (PMT) to help you respond supportively and effectively, without accommodating the OCD rituals.
Psychopharmacology: PANS/PANDAS patients are notoriously sensitive to medication. Our medical team follows a strict “start low, go slow” approach to avoid agitation or mania that can be triggered by standard doses of SSRIs or other medications.
Holistic Support: Our team, including dietitians, provides nutritional guidance to support recovery and manage somatic symptoms like gastrointestinal distress.
School Accommodations: We work with families to develop formal accommodations to support their child’s academic needs, such as managing a reduced workload during flares or providing a quiet testing space.

Treating the Infection

This prong aims to eradicate the underlying infectious trigger.

Testing: We conduct a thorough workup to identify potential triggers, including comprehensive swabs and bloodwork for Group A Strep and other pathogens like Mycoplasma pneumoniae.
Antibiotic Treatment: If an active infection is found, our Nurse Practitioner will prescribe the appropriate antimicrobial or antibiotic treatment (e.g., Amoxicillin, Azithromycin).
Antibiotic Prophylaxis: In some cases, prophylactic (preventative) antibiotics are used to prevent future strep infections from triggering a relapse. This remains a debated area of treatment, but a 2021 Canadian study suggested it may be associated with reduced exacerbation rates.

Treating the Immune System

This prong aims to calm the neuroinflammation and stop the autoimmune attack on the brain.

Anti-inflammatories: This often involves a course of nonsteroidal anti-inflammatory drugs (NSAIDs) at an immunomodulatory dose.
Corticosteroids: A short burst of steroids (like prednisone) may be used during severe flares to rapidly reduce inflammation.
Specialist Consultation: Care may involve collaboration with other specialists, such as allergist-immunologists, to manage the complex immune response.
Immunomodulatory Therapies: In more severe, refractory cases, advanced treatments may be considered. While evidence is still emerging, these include:
- Intravenous Immunoglobulin (IVIG): A treatment that uses a solution of antibodies from healthy donors to help reset the immune system.
- Therapeutic Plasma Exchange (TPE/Plasmapheresis): A procedure that “cleans” the blood by removing the autoantibodies that are attacking the brain.
- Rituximab: A potent immunosuppressive drug used in severe cases, though its use in PANS/PANDAS is still considered experimental. (Please note: We provide consultation and referrals for these advanced therapies, but we do not offer IVIG or plasmapheresis at our clinic.)
Surgical Interventions: Tonsillectomy is not currently recommended as a primary treatment for PANDAS. A major prospective study found no significant difference in outcomes for children who had their tonsils removed.

Your Path to Answers: Level Up Assessment Process

We have designed a specific, streamlined process to guide families through this complex evaluation. Our primary pathway is led by our specialized Nurse Practitioner (NP), who can support residents of Alberta, British Columbia, and Ontario.

For families in Alberta seeking comprehensive care, we also offer an optional, integrated pathway that includes specialized psychological support.

Our Primary Pathway: The NP-Led Assessment (AB, BC & ON)

This pathway allows you to book directly with our Nurse Practitioner to begin the medical assessment.

Step 1: Family Inquiry & Questionnaire Your journey begins by calling our clinic. Our Client Relations team will direct you to complete our mandatory online PANS/PANDAS questionnaire. This detailed history is essential for our Nurse Practitioner to review.
Step 2: PANDAS/PANS Appointment #1 (The “Investigation”) You will meet with our NP for your first 45-minute virtual medical consultation. This session is focused on information gathering and explaining the PANS/PANDAS medical approach. The NP will conduct a comprehensive clinical interview and medical history to assess symptoms (Prong 1) and will focus on Prongs 2 (Infection) and 3 (Inflammation) by:
- Ordering necessary lab work (e.g., comprehensive bloodwork, strep titers, Mycoplasma tests) to identify potential triggers.
- Reviewing any existing diagnostic reports from other providers, if applicable.
Please note: This initial appointment is for assessment and ordering lab work only. Treatment planning occurs in the follow-up appointment.
Step 3: PANDAS/PANS Appointment #2 (The “Treatment Plan”) Once your lab results are received, you will have a second 45-minute medical consultation with the NP. During this appointment, the NP will review all findings (your history and your lab results) to create your comprehensive treatment plan. This plan is built to address Prongs 2 (Infection) and 3 (Inflammation).

Optional Integrated Pathway (Alberta Residents Only)

For families in Alberta seeking comprehensive psychological support alongside medical management, we offer an integrated care model.

Step 1: Psychological Intake (The “Story”) You may choose to begin with a 60-minute, parent-only virtual session with our PANDAS/PANS psychology team, managed and supervised by our Clinical Director, Dr. Melody Morin (Registered Psychologist). They will conduct a comprehensive clinical interview to assess your child’s symptoms (Prong 1) and provide the basis for future therapeutic supports.
Step 2: Integrated Medical Referral (The “Bridge”) Following the psychological intake, Dr. Morin’s team will make a direct internal referral to our Nurse Practitioner (NP). The NP will then proceed with the medical investigation and treatment (Prongs 2 & 3) as outlined in the primary pathway (Appointments #1 and #2).
Step 3: Collaborative Care (Your “Team”) Your Psychologist (managing Prong 1) and your Nurse Practitioner (managing Prongs 2 & 3) will work together as your dedicated team, ensuring your child’s psychological and medical care are fully aligned.

The Clinical Debate: Why is PANS/PANDAS Controversial?

Families are often frustrated to learn that PANS/PANDAS is a controversial diagnosis. Many Canadian physicians remain skeptical, which can delay or block access to care. This uncertainty stems from several factors:

Diagnostic Uncertainty: Because the diagnosis is clinical, critics argue the criteria are too broad and may lead to “over-diagnosing” children who have primary psychiatric illnesses like OCD or Tourette’s.
The Evidence Base: As academic reviews note, the evidence for PANS/PANDAS is still developing and is “limited by small sample sizes, retrospective designs, and lack of standardized outcome measures.” Large-scale epidemiological studies have failed to consistently link strep infections to psychiatric symptom onset.
Under-diagnosis: Conversely, advocates and many families argue that under-diagnosis is the greater problem, leaving children to suffer for years with a treatable medical condition that has been mislabeled as “just psychiatric.”

Our clinic acknowledges this debate. We operate on the principle that a thorough evaluation by a knowledgeable, multidisciplinary team is the best way to differentiate PANS/PANDAS from other conditions and ensure children get the appropriate, evidence-based care they deserve.

Clinical Course & Prognosis

The clinical course of PANS/PANDAS varies. A 2021 longitudinal study from Sweden identified three common trajectories for patients:

Remitting (6%): Symptoms resolve and do not return.
Relapsing-Remitting (59%): The most common course, where patients experience acute flares followed by periods of remission (full or partial).
Chronic-Static/Progressive (35%): Symptoms persist most of the time, often with an earlier age of onset and greater impairment.

While full remission is uncommon, most children show improvement with integrated treatment. Early identification and a comprehensive, multi-pronged treatment plan appear to be associated with better long-term outcomes.

Advanced Pathophysiology (For Clinicians)

While the simple “molecular mimicry” model is a useful explanation, the underlying mechanism is more complex. Current research is focused on specific autoantibodies and neuroinflammation.

Dopamine Receptor Autoantibodies: Research published in 2024 by Menendez et al. has provided strong evidence that PANDAS/PANS is associated with autoantibodies that target dopamine receptors, particularly the D1 and D2 receptors. These antibodies appear to enhance dopamine signaling, leading to the hyperactive dopaminergic state that causes OCD, tics, and behavioral dysregulation.
Basal Ganglia Dysfunction: The specific “ancillary symptoms” of PANDAS—such as urinary urgency, hyperactivity, and handwriting deterioration—are linked to dysfunction in the basal ganglia, the part of the brain targeted by the autoimmune attack (Bernstein et al., 2010).
Neuroinflammation: Other studies point to broader immune dysfunction, including elevated inflammatory cytokines (IL-1β, TNF-α), blood-brain barrier dysfunction, and microglial (the brain’s immune cells) activation in the basal ganglia.

Neuroimaging: Brain MRIs in acute PANDAS patients have shown enlarged volumes in the basal ganglia (caudate, putamen, globus pallidus), which may normalize with immunomodulatory therapy. This parallels findings in Sydenham’s chorea, strengthening the link between these post-streptococcal syndromes

How to Get Started: Your First Call

If your child’s world has been turned upside down by sudden and terrifying symptoms, we are here to provide clear answers and a comprehensive plan. You are not alone, and your concerns are valid.

Your first step is a phone call with our compassionate Client Relations team. They will listen to your story and guide you to our mandatory PANS/PANDAS questionnaire. This detailed history is the essential first step our clinical team needs to review before your intake.

You do not have to navigate this alone. Call our clinic or click below to start the conversation.

Resources & Authoritative Sources

Psychiatric and Behavioural Interventions

For families and clinicians seeking more information, we recommend the following expert organizations:

Key Clinical References

American Academy of Pediatrics. (2025). “Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS).” Pediatrics, 155(3).
Archilla, L., & Singla, M. (2024). “PANDAS/PANS: A Clinical Approach.”
Beier, D., et al. (2024). “Sydenham Chorea.” StatPearls – NIH Bookshelf.
Bellanti, J. (2023). “The PANDAS/PANS Disorders. Is It Time for More Allergist-Immunologists to Get Involved?” Allergy and Asthma Proceedings.
Bernstein, G., et al. (2010). “Comparison of Clinical Characteristics of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections and Childhood Obsessive-Compulsive Disorder.” Journal of Child and Adolescent Psychopharmacology.
Calaprice, D., et al. (2017). “Clinical Management of PANS: Part III (Treatment and Prevention of Infections).” Journal of Child and Adolescent Psychopharmacology.
Chang, K., et al. (2015). “Clinical Evaluation of Youth with PANS: A Consensus Statement.”
Cunningham, M. (2023). “Postinfectious Inflammation, Autoimmunity, and Obsessive Compulsive Disorder.” Developmental Neuroscience, 45(6).
Frankovich, J., et al. (2017). “Clinical Management of PANS: Part I (Psychiatric and Behavioral Interventions) & Part II (Use of Immunomodulatory Therapies).” Journal of Child and Adolescent Psychopharmacology.
Goren, E., et al. (2024). “Frequency and impact of PANDAS/PANS diagnosis in Canada: A 2-year national surveillance study.” Pediatrics.
Gromark, C., et al. (2021). “A Two-to-Five Year Follow-Up of a Pediatric Acute-Onset Neuropsychiatric Syndrome Cohort.” Child Psychiatry and Human Development, 52.
Menendez, G., et al. (2024). “Dopamine receptor autoantibody signaling in infectious neuropsychiatric disorders.” Journal of Clinical Investigation.
Swedo, S. E., et al. (1998). “Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections: Clinical Description of the First 50 Cases.” American Journal of Psychiatry.
Thienemann, M., et al. (2017). “Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome.” Journal of Child and Adolescent Psychopharmacology, 27(7).
Wilbur, C., et al. (2019). “PANDAS/PANS in childhood: Controversies and evidence.” Journal of Child and Adolescent Psychopharmacology, 29(8).