Obsessive Compulsive Disorder in Children
Regularly checking if the stove is turned off before leaving home or pressing the car alarm button two or three times just to make sure it is turned on are some of the behaviours most people may display as part of everyday life. People with Obsessive-Compulsive Disorder, however, experience these types of behaviours and associated obsessive thoughts persistently and frequently. As a result, their day to day functioning is impaired and significant distress is caused.
OCD and Anxiety
Until recently, OCD was classified as an anxiety disorder due to the large role that anxious thoughts, feelings and behaviours can play. With growing research, OCD now stands alone as a diagnosis and related disorders such as hoarding and trichotillomania (hair-pulling) are becoming increasingly recognised.
OCD is characterised by obsessive thoughts such as contamination (germs), harm to self or others, symmetry, religion or sexual themes as well as compulsions such as excessive hand washing, checking, counting or praying. In OCD one or both of these will be present and will manifest in a cycle of symptoms.
For example, thoughts about the house burning down (obsession) lead to anxiety which may be relieved by checking the stove repeatedly (compulsion). While completing a compulsion can lead some individuals to experience relief, this feeds into the unhelpful thinking pattern around the likelihood of the house burning down and thus increases the likelihood that the compulsion will be completed again and again. These thoughts and behaviours usually need to take up at least one hour per day before a diagnosis will be made.
OCD in Children
Children can also suffer from OCD, in fact, most cases are diagnosed between the ages of seven and twelve. As with adults, the presence of some obsessions and compulsions are a typical part of development, however, for some children, these can take over their life. About 0.2 - 1% of children will have OCD and about 3% of adolescents. A diagnosis of OCD will usually be considered if the thoughts and behaviours associated with the disorder continue for a long period of time, particularly if children do not seem to be deterred by the consequences of the compulsions such as getting in trouble.
Children with OCD often tend to believe that performing a compulsion (e.g. excessively washing hands) will prevent a feared outcome (e.g. going to hospital). This is made more complicated by the fact that children generally have trouble distinguishing between healthy thoughts and behaviours and symptoms of OCD. When they do feel that something is wrong they are often too ashamed to tell an adult. For this reason, we need to be aware of the warning signs and guide children through the recovery process. If concerned, you should always consult with a health professional like a Quirky Kid Psychologist.
Parents and other caregivers can look for signs that obsessions and compulsions are present. These signs will vary in different children and it is also important to be mindful that these experiences may occur for a number of reasons not related to OCD. They may include:
- Reported or observed feelings of ‘stress’
- Sleep deprivation
- Depression and/or feelings of shame
- Slowness in performing tasks (e.g. getting dressed)
- Seeming ‘manic’ or needing to be kept busy
- Decline in academic performance
- Angry outburst or challenging behaviour
- Avoiding social situations
- Family conflict over small things like setting the table
By being mindful of these signs and talking to your child you can determine if help is needed. A psychologist experienced in both child development and behavioural therapy will be most helpful and a psychiatrist can assist in deciding whether or not the medication is appropriate and necessary. OCD is usually treated using Exposure and Response Prevention or ERP which involves exposing the individual to their feared situation (e.g. touching a garbage bin) and prevents them from completing their compulsion (e.g. washing hands). This allows them to learn to ‘sit with’ feelings of anxiety and change patterns of thinking which tend to overestimate the likelihood or severity of feared outcomes (e.g. getting sick). Just talking about the problem is usually not helpful and ERP is a highly effective form of therapy for OCD. Of course, this is best performed under the direction of a qualified professional.
The impact of OCD in Families
OCD can put a strain on families and take the fun out of life for children who are affected so it is important to know how to help your child while also making sure that you have support for yourself. Although the behaviours can be difficult to deal with, children are not trying to misbehave or be annoying; they can’t help the way they are behaving and need support. On the other hand, it is important not to participate in the rituals, for example, by constantly offering reassurance.
Instead, it is best to help your child to learn how to stop these rituals with the support of a professional. Also, many children find it helpful to externalise the symptoms or disorder of OCD by giving it a nasty nickname and treating it as something outside of them. They can then “boss back” the OCD and take charge of not letting the symptoms rule their life.
Overall, it will be important to stick to family routines, avoid laying blame and be supportive of your child. Ensure that you have a support network in place for yourself and your family and that you are taking steps to manage your own stress levels while dealing with this challenge.
View article references
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- European Journal of Child and Adolescent Psychiatry, 19 (227-235) Ornstein, T. J., et. al. (2010) Neuropsychological Performance in Childhood OCD: A preliminary study.
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