Look. Foundation

Resource Guide for School Counselors

Click each symptom below to learn more. This list provides a general overview and is not a complete list, as PANS/PANDAS can present differently in each child or young adult.

View our PANS/PANDAS Screening Tool for a comprehensive overview of symptoms.

Obsessions

Obsessions

• Perfectionism

• Fear of losing control

• Fear of contamination

• Unwanted sexual thoughts

Compulsions

Compulsions

• Checking/repeating

• Washing/cleaning

• Reassurance seeking

• Trying to achieve “just right”

Restricted Eating

Restricted Eating

• Reduced food preferences

• Fear of contamination or poisoning

• Fear of choking, swallowing, or vomiting

Decline in Academic Performance

Decline in Academic Performance

• Hyperactive, impulsive

• Forgetting previously mastered skills

• Sudden trouble with reading, writing, or math

Anxiety

Anxiety

• Unfounded, irrational fears

• Separation anxiety

• Anxiety interferes with normal activities

• School avoidance

Mood Disorders

Mood Disorders

• Emotional dysregulation - depression, mania, irritability, anger, rage

• Severe oppositional behavior

Somatic Symptoms

Somatic Symptoms

• Urinary frequency and urgency

• Temperature dysregulation

• Brain fog

Sensory Abnormalities

Sensory Abnormalities

• Emotional or physical discomfort from sounds, lights, textures, or smells

• Visual and auditory hallucinations

Create an Exposure Ladder

What is an Exposure Ladder?
An exposure ladder is a therapeutic tool that helps students gradually face situations that cause them anxiety. It organizes challenges from least to most distressing, allowing students to build confidence and resilience step by step.

Consider a situation in which you are struggling to master due to anxiety or discomfort. Write that event under #5 in the situation category. That event would signify you reaching the top of your ladder. Then, consider what one small step below that would be. Keep shrinking your exposure while tracking where your anxiety would be on a scale of 0-10. It is also important to track your willingness to engage in the exposure situation. Just because you are anxious does not mean you won’t be willing to try to engage in an exposure.

Why is it helpful?
For students overwhelmed by anxiety, avoidance often makes things worse over time. Exposure ladders promote small, manageable progress, helping students reduce fear, improve coping skills, and regain control over their school experience and daily life.

This collection provides scenarios to help educators, counselors, and school staff recognize and respond to possible presentations of PANS/PANDAS (Pediatric Acute-onset Neuropsychiatric Syndrome / Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) in both elementary and high school students.

The following case studies are based on a compilation of student experiences and observations. All scenarios are fictional and do not represent any actual Look. grant recipients, Look. Foundation affiliates, or specific individuals.

The tools and resources provided in this section of the Look. Foundation website are intended for educational and informational purposes only. They are designed to support teachers, school nurses, school counselors, and other school-based professionals in understanding PANS and PANDAS.

These materials do not provide medical advice, diagnosis, or treatment, and are not a substitute for evaluation or care by a qualified healthcare provider. The Look. Foundation does not offer medical, legal, or educational policy guidance.

School personnel should not use these resources to diagnose students or determine medical treatment. Health-related concerns should be referred to appropriate medical professionals. Decisions regarding educational support, accommodations, or services should be made in accordance with applicable federal laws and regulations, including the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act, and in collaboration with families and relevant professionals.

The Look. Foundation provides these materials as a general educational resource and is not responsible for individual decisions or actions taken by schools or professionals based on their use.