If you are parenting a child, teen, or young adult with PANS or PANDAS, you may have noticed that the experience changes over time.

What families need in the beginning is often very different from what they need later on.

Over the years in my work with PANS/PANDAS families, I’ve noticed that many parents move through approximately three different phases of PANS/PANDAS parenting.

These phases are not perfectly linear.

Families sometimes move back and forth between them, especially during flares or setbacks.

But understanding these phases can help parents make more sense of why the experience of parenting a child with PANS/PANDAS changes over time — and why different kinds of support may become important at different stages.

You may already recognize yourself in one of these phases as you read.

Phase 1: Crisis, Diagnosis, and Survival Mode

For many families, Phase 1 begins with confusion, fear, and urgency.

Sometimes symptoms appear suddenly and dramatically.

Other times, symptoms build more gradually before parents fully realize something significant is happening.

During Phase 1, parents may find themselves navigating:

OCD that takes over daily life
severe anxiety
restrictive eating
rage or emotional dysregulation
school refusal
tics
sleep disruption
intense family stress

During this phase, many parents feel like they are living in constant survival mode while trying to manage:

medical appointments
research about PANS/PANDAS
school meetings
treatment decisions
trial and error
uncertainty about what is happening

During Phase 1, parents are trying to stabilize the situation while simultaneously learning an entirely new way of parenting and responding.

Many families find themselves naturally shifting to a low-demand parenting approach during this phase because the child or teen’s nervous system is often highly overwhelmed and reactive.

If you’re currently in this phase, you may also find these blogs helpful:

What Therapy Often Looks Like in Phase 1

In this stage, therapy is often focused on:

psychoeducation about PANS/PANDAS
parent support
family support
reducing shame and confusion
helping parents understand symptoms through a nervous system lens
co-regulation and stabilization

For many families, Phase 1 is less about traditional therapy interventions and more about helping everyone get through an incredibly stressful and destabilizing period.

Phase 2: Stabilization, Flares, and Ongoing Management

Phase 2 often begins when there is some stabilization with medical treatment and symptoms are no longer quite as acute.

Many parents describe this phase as:
“better… but still really hard.”

There may be fewer crises.

But families are often still managing:

flares
setbacks
anxiety
OCD
mood variability and anger
school struggles
ongoing uncertainty

Parents in Phase 2 often remain highly vigilant because they know symptoms can shift quickly.

What worked one month may stop working during the next flare.

Parenting still requires constant adjustment and flexibility.

This phase can feel emotionally exhausting for many parents. If you are in Phase 2, these blogs may be helpful:

While Phase 2 is still very challenging, children, teens, and young adults may begin having more capacity to understand what is happening internally and learn tools to manage symptoms more effectively.

What Therapy Often Looks Like in Phase 2

In this phase, therapy may begin incorporating:

CBT
DBT (Dialectical Behavior Therapy) to support emotional distress
ERP with thoughtful modifications based on symptom severity and nervous system overwhelm
SPACE therapy (Supportive Parenting for Anxious Childhood Emotions) www.spacetreatment.net
emotional regulation skills
support around anxiety, OCD, anger, and depression
parent coaching and support

Kids, teens, young adults and parents often still need significant emotional support in Phase 2.

Many are carrying chronic stress, hypervigilance, exhaustion, and ongoing uncertainty while trying to hold daily life together.

Phase 3: Recovery, Processing, and Rebuilding

Phase 3 often emerges when medical symptoms have significantly improved or stabilized.

For some families, this may mean a 70–100% reduction in symptoms.

And while there is often relief in this phase, many families are surprised to discover that emotional healing may still need attention.

Once the constant crisis management slows down, parents and children sometimes begin processing the full weight of what they have been through.

Parents may notice:

hypervigilance
burnout
anxiety
difficulty relaxing
PTSD or PTSD-like symptoms
Children, teens, and young adults may also need support processing:
medical trauma
missed developmental experiences
identity changes
social losses
fear around symptoms returning
lingering anxiety or OCD patterns

This phase is often less about surviving symptoms and more about rebuilding a sense of safety, trust, identity, and stability after a long and difficult journey.

What Therapy Often Looks Like in Phase 3

For parents, therapy may include:

supportive therapy
nervous system recovery
EMDR
Internal Family Systems (IFS)
processing chronic stress and trauma
reconnecting with themselves outside of survival mode

For children, teens, and young adults, therapy may focus on:

processing what they have been through
EMDR
continued support for anxiety or OCD
identity development
building confidence and independence
re-engaging more fully in life

Every Family’s Path Looks Different

Not every family moves through these phases in the same way.

Some families move through phases more quickly.

Some families’ journeys are longer.

And many families move back and forth between phases depending on symptoms, flares, treatment changes, and life stressors.

But understanding these phases can help families make more sense of their experiences, recognize how much they’ve been carrying, and feel more hopeful about the future.

Over time, many families do find greater stability, healing, and connection again — even after very difficult periods.

Need Support?

I work with children, teens, adults, and parents navigating PANS and PANDAS throughout New York State.

My approach integrates support for both the child’s nervous system and the enormous emotional stress parents often carry while navigating this journey.

You can schedule a free, relaxed 15-minute consultation through the link below to see if this feels like a good fit.

Schedule a free 15 minute consultation

Therapy for PANS PANDAS New York — **Julie Cox, LCSW** is a fully licensed therapist with 25 years of experience supporting children, teens, parents, and adults in New York and Delaware.
She specializes in working
with families navigating **PANDAS and PANS**, offering child and parent-centered support based on co-regulation, nervous system education, and evidence-based approaches that help reduce anxiety, OCD symptoms, and demand-avoidance behaviors.
She helps parents feel more empowered and supported while caring for children experiencing neuroinflammatory symptoms.
**Therapy for PANDAS/PANS**

The 3 Phases of PANS/PANDAS Parenting