06/05/2026
One of the important roles occupational therapy can play in PANS/ PANDAS is helping children continue to participate in everyday life when symptoms have significantly reduced their capacity to function.
While the mental health presentation in PANS understandably becomes the primary clinical focus, many children are also experiencing substantial changes in their ability to manage everyday life.
During significant flares, children may struggle with:
– attending school
– participating in learning
– managing self-care and hygiene
– eating and mealtimes
– toileting
– sleeping
– coping with everyday routines and transitions
– social participation and family activities
– sustaining attention and completing tasks
– managing the physical and cognitive demands of daily life
These functional difficulties are often driven by a combination of underlying factors that occupational therapists assess and address, including:
– sensory overwhelm
– fatigue and reduced endurance
– cognitive fog and slowed processing
–motor planning and coordination
– pain and physical discomfort
– nervous system dysregulation and reduced stress tolerance
In these periods, children are often not just anxious or emotionally distressed. They can become profoundly functionally impaired.
This is where OT can play an important role.
Occupational therapists assess how symptoms are affecting the child’s ability to function within the context of real life:
– What is realistically manageable right now?
– Which demands are exceeding capacity?
– What environmental factors are contributing to overload?
– What accommodations and supports allow participation without further dysregulation?
OTs support families, schools, and teams to adapt expectations, environments, routines, and activities so the child can continue to participate as safely and successfully as possible during periods of instability.
Importantly, OT intervention during PANS flares does not need to rely heavily on higher-level cognitive processing or insight-based approaches (e.g.: “talk” therapy). Many children simply do not have the cognitive or nervous system capacity for this during severe exacerbations. Instead, OT focuses on reducing overload, supporting regulation, preserving participation, and helping the child maintain connection, competence, routine, and engagement in everyday life.
When participation is repeatedly lost, children can quickly lose confidence, independence, social connection, and their sense of themselves as capable.
Supporting participation through periods of instability is one of the most important things OT can offer children with PANS and their families.
