PANDAS, Sudden OCD, and Autism: A Psychiatrist’s Narrative Guide for Parents

By Dr. Arielle Rubin, MD — Child & Adolescent Psychiatrist
Founder, Autism Roadmaps® | Co-Founder, Rubin Center Psychiatry

When OCD Symptoms First Appear in Autistic Children, Parents Ask: “Could This Be PANDAS?”

When OCD-like symptoms first appear in an autistic child or teen—contamination fears, intrusive thoughts, checking rituals, fear-based rigidity, sudden anxiety spikes—parents often feel unsure where these symptoms are coming from. Autism already overlaps with OCD in many meaningful ways, and the boundaries between the two conditions can be hard to see.

It also matters that 12–17% of autistic individuals have OCD, a much higher rate than the general population. So when these symptoms emerge, the question of whether PANDAS could be playing a role comes up frequently in my child psychiatry practice at Rubin Center Psychiatry.

One of the most common questions I hear in this scenario is:
“Could this be PANDAS?”

Many families encounter the term online, through parent groups, or while trying to make sense of sudden or intense symptoms. It is a completely appropriate question—especially when the onset is abrupt, severe, or feels unlike the child’s typical autistic baseline.

What PANDAS Actually Is — And Why Most Autism/OCD  Cases I See Don’t Fit

PANDAS refers to a very specific, immune-triggered process: a sudden-onset neuropsychiatric syndrome caused by a recent strep infection, leading to abrupt OCD symptoms, tics, mood changes, or behavioral regression.

Because the definition is narrow, when parents ask whether their child’s new OCD symptoms could be PANDAS, my honest answer—most of the time—is no. Most OCD presentations in autistic children do not follow the classic PANDAS pattern.

However, there are times when I become more suspicious, and those cases tend to follow a very clear and specific pattern.

When I Become More Suspicious of PANDAS 

The Symptom Clusters That Raise Concern

My concern rises when a child develops a cluster of symptoms that appear quickly—sometimes within days—and particularly when they follow:

• a known strep infection
• an illness whose timing matches symptom onset
• lab markers (when present) that support the infectious timeline

The symptoms that prompt deeper evaluation include:

• sudden, severe OCD
• intrusive or fear-based thoughts appearing out of nowhere
• dramatic sleep disruption
• new or significantly worsened tics
• urinary frequency or accidents
• handwriting decline or clumsiness
• rage episodes or panic attacks
• behavioral or emotional regression

It’s never one symptom that signals PANDAS.
It’s the constellation + context + timing that matter.

OCD vs. PANDAS in Autism — Understanding the Difference

H3: How Classic OCD Typically Develops in Autistic Children

Classic OCD usually develops gradually, building structure and predictability over time. It tends to follow patterns that make sense within a child’s developmental, sensory, and emotional context.

H3: How PANDAS-Triggered OCD Stands Out

PANDAS-related OCD, in contrast, tends to:

• appear abruptly
• escalate intensely
• feel “foreign” or unlike the child’s usual autistic patterns
• disrupt functioning far more dramatically

Parents often describe it as:

“This isn’t just OCD… this is something else.”

That speed and foreignness are clinically meaningful and help differentiate PANDAS from standard OCD or autistic rigidity.

When PANDAS Appears in Autism, the Presentation Is Often Extremely Complex

In the autistic children and teens where I’ve truly suspected PANDAS or PANS, the presentations have been far more complex than classic OCD alone. These cases often involve:

• sudden, overwhelming intrusive thoughts
• abrupt and profound depression
• refusal to eat due to contamination fears
• total sleep reversal or near-total insomnia
• severe anxiety attacks
• dissociation or “not feeling real”
• dramatic behavioral regression
• and in the most severe cases,
  suicidal thoughts or brief psychotic-like symptoms

These are the scenarios where the timing, severity, and infectious context prompt a thorough PANDAS/PANS evaluation in our clinic.

What This Means for Families at Rubin Center Psychiatry

Autism, OCD, illness, and immune shifts can intersect in complex and confusing ways. Most OCD in autistic children follows a gradual developmental pathway, not a sudden one. But when symptoms are abrupt, severe, or tightly tied to illness, it’s worth reviewing the full pattern with an experienced child psychiatrist.

In the rare cases where PANDAS or PANS is responsible, the presentation is usually dramatic, multifaceted, and far beyond typical OCD.

Whether the underlying cause is PANDAS, PANS, classic OCD, autistic anxiety, or a mix of factors, our goal at Rubin Center Psychiatry is always the same:
to understand the pattern clearly and build a compassionate, evidence-informed plan that helps your child return to stability.

STAY TUNED FOR PANDAS Blog #2 — How PANDAS Is Actually Evaluated

If you’re wondering how we actually evaluate for PANDAS—
what labs we order, which tests are useful vs. misleading, and how we distinguish PANDAS from other causes—stay tuned for my next blog, where I’ll walk you step-by-step through the diagnostic workup we use at Rubin Center Psychiatry.

About the Author

Dr. Arielle Rubin, MD is a double board-certified Child & Adolescent Psychiatrist and the founder of Autism Roadmaps®, an online education platform supporting parents of autistic children and teens. She is also the Co-Founder of Rubin Center Psychiatry in Tempe, Arizona, where she specializes in autism, ADHD, OCD, anxiety, and complex mood disorders across childhood and adolescence.