Obsessive-Compulsive Disorder (OCD) in Children

OCD has always been a somewhat misunderstood disorder. Many people relate OCD to being a disorder where one who is diagnosed is constantly cleaning or that they are very neat and tidy people. While repeated cleaning is a symptom of OCD there is much more to this disorder than just that. It is common for one to think of OCD as an illness that only affects adults, however, Dr Georgina Krebs says, “between 0.25% and 4% of children will develop OCD.” (Krebs G ,2014) “The average age of onset is approximately 10 years old, although children as young as 5 or 6 may be diagnosed. In rare cases, children can start showing symptoms around age 3,” according to Garcia AM, Freeman JB, Himle MB (2008)

What is OCD?

“Obsessive-Compulsive Disorder (OCD) is a common neuropsychiatric disorder characterized by the presence of obsessions and/or compulsions that are time consuming and cause distress or interference in the patient’s life (American Psychiatric Association, 2000).” OCD involves obsessions and compulsions which can be time consuming and lead to disturbance in the daily lifestyle of those affected. Obsessions usually consist of unwanted worrying, fears, ideas, that make one uncomfortable and increase anxiety. The compulsions are the repetitive behaviors that are performed to ignore the anxiety that is provoked by the obsessions. When it comes to children with OCD, they might experience the compulsions without the obsessions, the reason being that they are not able to fully recognize their symptoms which makes them unable to resist the compulsive behavior. “Children may also present tic-like compulsions, which may be confused with complex tics, mainly if the compulsions are simple rituals of touching (Rosario-Campos et al, 2005)”

Symptoms of OCD

According to Heather Yardley, PhD the most common obsessions/compulsions seen in children with OCD are:

Obsessions:

  • Fear of dirt or germs
  • Fear of contamination
  • A need for symmetry, order, and precision
  • Religious obsessions
  • Preoccupation with body wastes
  • Lucky and unlucky numbers
  • Sexual or aggressive thoughts
  • Fear of illness or harm coming to oneself or relatives
  • Preoccupation with household items
  • Intrusive sounds or words

Compulsions:

  • Grooming rituals, including hand washing, showering, and teeth brushing
  • Repeating rituals, including going in and out of doorways, needing to move through spaces in a special way, or rereading, erasing, and rewriting
  • Checking rituals to make sure that an appliance is off or a door is locked, and repeatedly checking homework
  • Rituals to undo contact with a “contaminated” person or object
  • Touching rituals
  • Rituals to prevent harming self or others
  • Ordering or arranging objects
  • Counting rituals
  • Hoarding and collecting things of no apparent value
  • Cleaning rituals related to the house or other items

Diagnosis of OCD

Since repetitive behaviors can be considered a normal part of development diagnosis of OCD in children can generally take longer than in adults. Children often take part in activities that are compulsive and ritualistic, such as bedtime routines, meal time and school routines as well. “Therefore, OCD could be conceptualized as a pathological condition with continuity with normal behaviors during different developmental periods (Evans et al, 2002).” Awareness of the symptoms at an early age can lead to a better outcome for the child when treated early on. The following are some questions to consider to help in the identification of OCD. Has your child ever shown:

 

  • A preoccupation with ordering or arranging things so much that it interferes with normal schooling?
  • A need for things to look, feel or sound “just right”?
  • Excessive worries, fears or concerns with aggressive, sexual or religious thoughts?
  • An excessive need to collect or hoard things?
  • Concerns about catching a disease after touching something or constantly worrying about dirt, which causes them to wash their hands repetitively?
 

Causes and Treatment of OCD

Genetic factors can increase the risk of OCD. Family members with OCD can pass it down to children. Comorbid disorders such as ADHD or anxiety can lead to OCD. Prenatal factors, such as excessive weight gain, preterm birth, and any type of brain injury are another few reasons that a child can develop OCD. Cognitive-behavioral therapy (CBT) has been seen to be most effective for OCD treatment. “The CBT theory of OCD integrates behavioral theory with a cognitive framework and has shown significant efficacy especially when in combination with exposure, response prevention, and cognitive restructuring.” (Watson & Rees, 2008). For children the first approach for treatment should be CBT, and if symptoms seem to be severe, there is pharmacological treatment for OCD as well. Support groups are also available for people who are diagnosed with OCD. Not only are support groups helpful for a child with OCD but parents and other family members can also benefit from them. In these groups, support and discussion about how to handle a family member with OCD can be exchanged and of course one can learn more about the disorder.

 

OCD During the Pandemic

According to a recent study many children are experiencing worsened symptoms during the pandemic and children who have a longstanding diagnosis for OCD are more at risk. Parents and caregivers need to be aware of the risks and provided guidance to help with children’s symptoms. Some ways to help a child suffering from OCD is to project calm behavior, safety assurance, normalizing feelings, and coming up with effective distractions to redirect their behaviors. Following these simple tips can ease your child’s symptoms.

 

References

Krebs G, Heyman I. Obsessive-compulsive disorder in children and adolescents. Arch Dis Child. 2015;100(5):495-9. doi:10.1136/archdischild-2014-306934

 

Garcia AM, Freeman JB, Himle MB, et al. Phenomenology of early childhood onset obsessive compulsive disorder. J Psychopathol Behav Assess. 2009;31(2):104-111. doi:10.1007/s10862-008-9094-0

 

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised. Washington, DC: American Psychiatric Association.

 

Rosario-Campos MC, Leckman, JF, Curi M et al (2005). A family study of early-onset obsessive-compulsive disorder. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 136:92-97.

 

Evans DW, Milanak ME, Medeiros B et al (2002). Magical beliefs and rituals in young children. Child Psychiatry & Human Development, 33:43-58

 

Watson HJ, Rees CS (2008). Meta-analysis of randomized, controlled treatment trials for pediatric obsessive compulsive disorder. Jour