Obsessive-compulsive disorder (OCD) is estimated to affect one in every 100 children. It is a neurobiological anxiety disorder characterized by "a pattern of intrusive, distressing thoughts and repetitive behaviors." [A.D.A.M. Health Encyclopedia] This week, we'll focus on OCD in children, how symptoms manifest and what parents can do to help their child. Next week, we'll look at how OCD might interfere with school.
Obsessions and Compulsions
Obsessions are recurring and intrusive thoughts. They are typically exaggerated fears, such as being worried about germs or having everything neat and tidy. In order to alleviate these fears, people with OCD perform rituals over and over - compulsions. One of the most common examples is having a fear of germs and washing hands repeatedly. (See also: The Difference Between Obsessions and Compulsions)
OCD is considered neurobiological because it is caused by an imbalance of certain chemicals in the brain. OCD has been found to run in families and is considered to be, at least in part, hereditary.
It is commonly thought that stress contributes to developing OCD but that is not true. Stress can trigger symptoms of OCD or make symptoms worse but is not the cause of OCD.
Children and OCD
Usually symptoms of OCD appear around the age of 10, but some children may have shown signs of anxiety or OCD tendencies as young as two years old. Girls tend to have a later onset, during adolescence, whereas boys often develop OCD prior to puberty.
Some common obsessions in children:
- Fear of germs
- Fear of danger to parents or siblings
- Needing perfection, symmetry or order
- Fear of being violent
Some common compulsions in children:
- Repeatedly washing hands
- Arranging items in a specific way
- Repeating names, words or sounds over and over
- Continually asking for reassurance
- Doing something over and over until "perfect"
How OCD Impacts a Child's Life
The obsessions and compulsions of OCD can interfere with in all areas of a child's life. Some examples are:
- Intrusive thoughts and fearsmake it difficult to concentrate
- The need for perfection causes a child to rewrite a sentence over and over
- Not completing tests because of the need to have all information perfect, including handwriting
- Inability to stop a ritual without extreme distress
- A need to have all clothes, shoes, books or other objects in a certain, specific order
- Difficulty moving from task to task unless orginal task is completed "just so"
- The need to say or hear a certain word or phrase over and over
In addition, children with OCD can have physical symptoms often associated with anxiety, such as headaches or stomach aches.
Diagnosing OCD in Children
OCD should be diagnosed by a mental health professional in both children and adults. According to diagnostic criteria, obsessions and compulsions must take up at least one hour of the child's time each day and they must disrupt a child's normal functioning.
There are several treatment options for children with OCD
Cognitive Behavioral Therapy (CBT) - working with a child to develop alternative thinking patterns
Exposure and Response Therapy (ERT)- this is a type of CBT in which the child is exposed to an obsession but prevented from performing a ritual. After a number of exposures, the child no longer feels the need to respond with the ritual
Medication - for some children, medication is effective in reducing symptoms of OCD. Medication, however, does not cure OCD and other methods of therapy should be used in addition to medication
Obsessive Compulsive Disorder, Date Unknown, Author Unknown, KidsHealth.org
Obsessive-Compulsive Disorder in Children and Adolescents, 2001, Staff Writer, The American Academy of Child and Adolescent Psychiatry (AACAP)