PANDAS/PANS symptoms may cause deficits in performance, particularly in the areas of:

• Attendance (due to lack of sleep, fatigue).
• Cognition (including behavior; academics, including reading, writing and math; sensory overload).
• Fine motor skills (handwriting and task completion). 
• Perceptual and physical issues that affect fine/gross motor skills.
• Urinary frequency and control.
• Ability to eat normally.
• Social issues with peers.

Depending on the severity, which may change over time, PANDAS/PANS may impact a student’s ability to:

• Attend and travel to school-related activities.
• Sustain focused attention and executive functioning.
• Adapt to transitions and stresses.
• Understand and remember information.
• Communicate effectively, both orally and in writing.
• Behave in age-appropriate ways and demonstrate self-care and daily living skills.
• Maintain their previous level of physical and mental stamina.

• School nurses working with PANDAS/PANS students can implement the following steps: 
  • Start with collaboration and recognize the need for the educators, providers, family and, when possible, the student, to provide feedback and work together. 
  • Consider interventions that will address symptoms affecting attendance and participation during the school day, including lack of sleep, fatigue/poor stamina, inability to eat normally, urinary frequency, movement issues, tics, fine motor skill deterioration, separation anxiety, OCD symptoms, poor cognitive stamina and sensory overload. 
  • Consider schedule changes, alternative activities and placements, transportation logistics and attendance flexibility. 
  • Consider occupational therapy, physical therapy and social skills support.

It’s important to develop safe and effective responses to inappropriate behaviors by reducing stimulation and demands on students, redirecting student’s attention and implementing cognitive behavioral techniques and other therapeutic measures. 

It’s also important to consider how your school applies federal safeguards regarding staff’s inappropriate disciplinary actions or techniques. Consider aspects of an emergency plan to address behavioral situations at school that includes behavioral interventions and immediate support (by a parent, staff member, therapist, emergency medical support) and use of specific language and phrases. 

In terms of academics and testing, workload accommodations and modifications will likely include:

• Provisions for extra time.
• Distraction-free settings.
• Assistive technology.
• Alternate methods of access and completion.
• Prioritization of task completion designed to reflect competence.
• Use of notetakers.
• Reduced academic or homework load.
• Rest periods with a nurse.
• Adapted physical education and home/hospital instruction.