After twenty years in and out of group homes, psychiatric hospitals, and residential treatment centers, at twenty-nine, Jo* has never been stable enough to have a job. Jo lives with his parents between hospitalizations. Despite being incredibly smart, Jo barely finished high school due to several learning disabilities. Jo’s frequent panic attacks render him unable to drive. Jo almost died of cardiac arrest from anorexia and has attempted suicide multiple times.
Twenty-four years of psychiatrists have yet to result in a combination of medications to control Jo’s severe mental illnesses, and therapy has little effect despite his wanting to recover and get on with life more than anything else. Doctors have decided that it’s okay to label Jo “treatment-resistant” and resign him to a lifetime of repeated hospitalizations that never have lasting results.
And doctors have also decided that Jo’s never-ending stream of Strep, viruses, and sinus infections couldn’t possibly have anything at all to do with his debilitating mental health problems.
Jo is not an isolated tragedy—Jo is a classic case of severe adult PANS/PANDAS that never got diagnosed or treated. There are multiple “Jo’s” in any mental health ward at any given time, and countless others like him struggling through their years as they face life-altering, yet less extreme symptoms.
With PANS/PANDAS Awareness Day upon us, instead of writing an inspiring, feel-good post, this year, I want everyone to openly proclaim an uncomfortable truth:
PANS doesn’t end in childhood.
This post is not directed at any organization or individual in particular. Rather, it is a call for every single one of us to reconsider how we talk about PANS/PANDAS and how we include or exclude those of us who no longer qualify as “pediatric.”
I’m proud that there’s more awareness of teens and adults with this condition than when I was diagnosed five years ago, but for the sake of people with PANS of all ages, we must continue to do better. And this is why I want everyone reading this to understand that ignoring adults with PANS and focusing on children is a lose-lose situation for everyone. Think I’m biased because I’m an adult with PANS? Let’s consider the facts…
Pediatric illnesses get less funding than those that affect adults.
Take a look at childhood cancer, a deadly illness that strikes fear and pity in the hearts of all who encounter it. Cancer affects around ~1 in 285 kids by the time they’re twenty—a similar rate to the 1 in 200 kids estimated for PANS. Guess what percent of NIH’s cancer funding goes to pediatric cancer?
An utterly pathetic 4%.
If skeletal, bald kids obviously suffering from a life-threatening condition cannot spark enough sympathy and alarm for more research for a cure, then why do we think that unruly, screaming kids with PANS will—kids whose behavior is mistakenly blamed on bad parenting and something they could control if they tried harder?
It is misguided if people are focusing their awareness efforts on kids with PANS in the hopes of sparking sympathy to gain more funding. If other pediatric diseases with well-established mechanisms that clearly aren’t anyone’s fault can’t generate enough funding, then we can’t possibly expect a condition that others perceive as a parenting problem to do any better.
If you want funding for PANS, you must raise the stakes for not funding it. You must shine a light on the thousands of Jo’s in the world who are losing their entire lives to PANS and can’t contribute their gifts to society. You must show that it could be anyone—whether a child, teen, or adult—who could find their whole world turned upside down by PANS someday.
Continuing to couch PANS as a pediatric illness makes it seem less serious and urgent.
If kids outgrow PANS at puberty, why look for a cure? Why put them through invasive immune-based treatments? Why not just give them some psych meds and cart them off to therapy until they grow up, and call it good? (I’m discounting severe cases for the sake of the argument.)
If you want to help kids with PANS, you need to acknowledge that they might become adults with PANS without proper intervention. Put pressure on doctors to take action. Acknowledge it as the public health crisis it is. Scare the insurance companies with the possibility of years and years of psych meds and expensive hospitalizations if they don’t cover treatments like IVIG and Rituxan and Plasmapheresis.
No insurance company will ever pay to treat PANS with such therapies if they think time alone will be a cheaper alternative. It’s a given in America that the insurance companies focus on their bottom lines, so threaten them with the prospect of a kid becoming a teen and then an adult with debilitating, treatment-resistant mental illness.
We need to stop calling PANS a “childhood neuropsychiatric disorder” if we truly want it to stay that way for the kids who get it.
There’s no scientific evidence that PANS only affects kids.
Before PANS, it was called PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus). PANDAS got classified as pediatric because most people are immune to Strep by the time they’re twelve. Thus, if people couldn’t get Strep past twelve, then they couldn’t get PANDAS.
The problem is there are always a few teens and adults who get Strep, and I would argue that a person whose immune system can’t deal with Strep effectively is a person who is more likely to have Strep trigger an autoimmune reaction.
And there’s precedence to my hypothesis because there were outbreaks of Rheumatic Fever (another post-infectious complication of Strep) among military recruits in the twentieth century—and these were men typically in their late teens to late twenties. If adults can get Rheumatic fever, they can absolutely get PANDAS.
Moreover, since PANDAS was first described in 1998, doctors have come to realize that any infection can cause the illness—not just Strep. Thus, the age requirement is now moot, and PANDAS is considered a subset of PANS.
And if anyone bothers to read the PANS diagnostic guidelines established by experts in the condition, they would see that it specifically says it’s not restricted to any age group.
PANS is only considered pediatric for research purposes.
When conducting a study, scientists need to have the most homogenous patient populations possible, so they have to restrict the age group they study. The immune systems of an eight year-old and a thirty-eight year-old are completely different, and grouping them together in the same study on PANS could compromise the validity of the results in determining treatment outcomes.
I do not fault researchers for focusing on kids in the beginning since the condition does most often start in childhood. However, I find it disappointing there still hasn’t been a single double-blind, placebo-controlled study of treating PANS in adults. The lack of studies on adults is interpreted by some rigid-thinking doctors as evidence that it doesn’t exist—but in reality, it proves only that no one has bothered to study it systematically.
I suspect that part of the reluctance within the PANS community in embracing adults also has to do with this same paucity of research. I respect not jumping to unfounded conclusions, but do we really need an official study before we can say that nothing medical magically happens on a person’s eighteenth birthday?
Adults with PANS exist because the real world isn’t a well-designed research study. So why are we all pretending that it is?
Lastly, we need to stop referring to PANS as pediatric because it prevents adults from getting the treatment they need.
If you think it’s hard to find help for a pre-pubescent kid with PANS, try being an adult who has it. Try finding doctors who will take you seriously when seeking help for an illness that has the word “Pediatric” in its name. Try convincing said doctor that it’s not too late to try to treat it. Try even finding a “PANS Specialist” who will treat you—many won’t see you if you’re over eighteen.
It wasn’t until I was seventeen that my family ever came across the term “PANDAS.” By this point, I’d been sick for six years. I’d bounced from doctor to doctor all through adolescence and tried all sorts of medications to little avail. Unfortunately, none of the doctors we asked about PANDAS knew what to do about it, and some said seventeen was probably too late to treat it anyway.
In the end, it wasn’t until two years later that I finally got the help I needed from an out-of-state, out-of-network doctor who specialized in PANS. As sad as it sounds that it took eight years for me to get treated, I consider myself one of the lucky ones—not everyone can find or afford a doctor who will help.
Although practitioners who treat kids with PANS/PANDAS are overbooked everywhere, at this time, I know of only a few doctors in the entire USA who treat adults with PANS with the recommended antibiotic, IVIG, and Rituxan therapies. People who get PANS at the wrong age deserve better—and the kids who grow up without a diagnosis do, too.
Unfortunately, with the “P” for Pediatric in PANS/PANDAS, no matter how much awareness we try to spread, adults and teens will still face obstacles in getting a proper diagnosis. There will still be that knee-jerk reaction when they ask a doctor for help for it. There will still be doctors who can’t get past the “P” to see that a person fulfills all other criteria.
Ultimately, we’re going to have to banish the “pediatric” qualifier altogether if we want better awareness for everyone whom PANS can affect.
In conclusion, I don’t want you to only share this post and say you agree—I want you to stop talking only about “children” who suffer from PANS. Stop claiming it’s a childhood disorder. Stop pretending there aren’t adults who fell through the cracks as kids. Stop ignoring that PANS can happen to anyone of any age.
And most of all, please stop propagating the myth that everyone grows out of PANS when they hit puberty or turn eighteen—there is absolutely no scientific basis for such claims. I know all of the parents of young kids with PANS would like to believe this, and perhaps it is true for a few. Nevertheless, in the long-run, perpetuating a myth based in wishful thinking is harmful to all of us.
Today, we must light a fire under the public’s and legislator’s feet with the awareness that thousands of adults are too sick with PANS to work and live productive lives. We need to make everyone understand that there are people with PANS and Lyme and autoimmune encephalitis taking up mental health resources who only marginally benefit and will never get better without medical treatments—and remind everyone of the thousands of veterans and homeless people and others not getting help because of how overburdened the mental health system is.
If we acknowledged and treated every adult with PANS, imagine how many mental health resources we could free up for so many other people who desperately need them!
As a twenty-four year-old still healing from PANS, believe me when I say I want every single kid with this horrible illness to get all of the attention and treatment they need to get better. Believe me when I say it shatters my heart every time I see a child with that unmistakable look of utter despair in their eyes because I’ve felt the same pain. Believe me when I say I hope I’m the last generation of adults who will evade proper diagnosis until we’re no longer pediatric.
But please acknowledge that adults like Jo and me matter just as much as every single child with PANS; he and I and thousands of others were also once kids with PANS. Please raise awareness of PANS as the life-stealer—not just childhood stealer—that it is. Raise awareness that PANS is a monster that may grow bigger and stronger just as the kid who has it does.
Because only when we admit that PANS can strike at any age and continue through adulthood, and only then, will we possibly earn enough recognition and urgency for the changes in medical paradigm that will allow people with PANS of all ages to get the life-saving care they need.
*”Jo” does not refer to any particular person—it’s an amalgamation of many adults with PANS whom I’ve met who have similar stories.