Most behavioral conditions in children develop gradually over weeks or months. PANS and PANDAS are different. The overnight change — the one that makes parents say "that is not my child" — is actually one of the defining features of these conditions. Parents often remember the exact date, sometimes the exact hour, when everything shifted. A child who went to bed fine woke up with debilitating OCD, separation anxiety, food refusal, or rage. If the change in your child was sudden, dramatic, and came with multiple new symptoms at once, it is worth asking a provider with PANS and PANDAS experience whether these conditions could be part of the picture.