Mental health care has long relied on standard-of-care therapeutic frameworks—models developed largely around conditions that present in relatively predictable and consistent ways. PANS and PANDAS, by contrast, can be highly fluctuating and relapsing-remitting, with symptoms and functioning changing in relation to underlying neuroimmune processes.

A child’s presentation, needs, and capacity for therapeutic work may shift from week to week, and sometimes from day to day. For clinicians, this variability creates a need for more nuanced guidance around the timing, pacing, and selection of interventions.

When a child’s clinical state can change so rapidly, the question is not simply, "what treatment works?" Instead, we are called to ask multiple questions: "is this intervention appropriate, how should it be paced, and what needs to change when the child’s capacity changes?"

Existing mental health frameworks do not always provide clear answers to these questions, leaving clinicians to adapt established models in real time without a sufficiently developed roadmap for doing so.