What is Obsessive Compulsive Disorder in Children?
All children have little worries and doubts, but when they can’t stop thinking about them and it starts to affect their daily functioning it becomes a problem. OCD is a type of anxiety disorder which is characterized by obsessions and compulsions. Sometimes OCD kids will become worried by certain thoughts or images; these are called obsessions.
OCD children might have disturbing thoughts of harming someone, even though they wouldn’t - and certainly don’t want to. The problem is that kids with OCD cannot stop these obsessions no matter how badly they want to, which can be extremely stressful.
Other OCD children might feel compelled to do certain actions over and over again, these are called compulsions or rituals. Even though the child might be aware that what they are doing ‘doesn’t make sense’, they feel extremely anxious if they don’t follow through with the action.
Sometimes these compulsions are thought to prevent a terrible imagined event or outcome. In this case the child feels personally responsible for doing the action so that nothing bad happens.
While some might think this is just a case of superstition, with OCD ritualistic behavior has great psychological impact. In other instances these actions can serve to counter-act a disturbing obsessive thought.
Diagnosing Obsessive Compulsive Disorder in Children
A psychologist or psychiatrist usually does a thorough assessment before diagnosing OCD. In your consultation you will probably be asked to give a detailed description of your child’s troubling behaviors as well as any family history of anxiety or other disorders such as Tourette’s syndrome.
It is advisable to write these down before the consultation, noting the time your child spends on each ritual, so that you can provide a more accurate and detailed description.
Your child will also be asked a series of age-appropriate questions about his/her worries and compulsions and how they might be affecting his/her daily life. Once a diagnosis is made, be sure to ask about all possible treatment options and explore which ones would best suit your child!
While psychiatric drugs are often prescribed as a matter of course, these are not always the only option and research has shown that a combination of treatment modalities is usually the most successful way of treating OCD in children .
Symptoms of Obsessive Compulsive Disorder in Children
The symptoms of OCD in children vary and are often personal and unique to the child with the disorder. Some common obsessions and compulsions that you might recognize in your child are:
Common obsessions include:
Fear of dirt or germs
Need for symmetry and order
Fixation with body waste
Lucky and unlucky numbers
Aggressive or sexual thoughts that are seen as "bad" or "immoral"
Fear that something terrible will happen to a loved one
Common compulsions include:
Chronic coughing or throat clearing
Washing hands over and over again
Repetitive and lengthy teeth-brushing or showering
Repetitive checking of doors and switches
Collecting and hoarding specific items
Counting items over and over
Repeating specific words and phrases in a particular order
Rearranging things to create order and ‘balance’
Repeating actions a certain amount of times
Having a strict ritual before going to bed that has to be followed exactly
Rituals to ‘undo’ a thought or to prevent an unwanted event
While obsessions are always present in OCD, compulsions are not necessarily a part of the disorder. While they are common, compulsions do not occur in every case of OCD. Some children, typically younger toddlers, experience only the intrusive, repetitive thoughts and worries (obsessions), without accompanying compulsions.
Recognizing the Characteristics of OCD in Children
Remember that kids are sometimes prone to ‘magical thinking’ (e.g. don’t step on the cracks or the bears will get you!) and some of the symptoms listed above can be perfectly normal – especially in the toddler or older child with an active imagination.
However, you know you have a problem when your child is constantly distressed by these thoughts or behaviors or when they interfere significantly with functioning.
In many cases children try to contain or mask their obsessions and rituals. For this reason, parents often don’t realize for some time that their child has OCD or may think the few odd behaviors they do see are just a passing phase. As OCD usually comes on gradually, these behaviors may come on so slowly, that they seem normal to the parent.
A child may ask the parent to participate in some of the rituals at first, seeking reassurance that everything is OK. "I touched dirt, am I ok?" to which the parent responds "You’re fine."
Failure to respond in this routine way may result in tantrums, or acting-out behavior. Very young children, such as toddlers, may ask parents to repeat a word or phrase ‘till it sounds right’.
Here are some warning signs to look out for in your child:
Extreme tiredness and sleeping disorders, as they stay up late at night obsessing and performing necessary bed-time rituals
Sore, dry hands from constant hand-washing
Going through more soap than usual
Constant concerns about germs
A noticeable increase in laundry
Avoidance of activities that involve getting dirty
A sudden drop in test grades
Handing in assignments late or not at all
Often being late for school
Odd requests for people to repeat words or phrases
An extremely long amount of time spent getting ready for bed or school
A constant worry about the well-being of family members
What Causes OCD in Children?
There is no definite theory as to what causes OCD in children. The matter is mainly separated into two schools of thought.
Genetics - studies suggest that a tendency towards anxiety may be hereditary.
Brain chemistry abnormalities - Brain imaging studies have shown that people with OCD sometimes show different neuro-chemical brain activities than those without OCD.
Some children feel that thinking something bad is morally just as bad as doing it. "If I think of hitting you, it’s morally the same as actually hitting you and so I must be a terrible and violent person."
Some children feel overly responsible for what happens around them and think certain thoughts are dangerous. "If I think that, it might actually happen and then I will be to blame."
Help for Obsessive Compulsive Disorder in Children
There are a wide variety of OCD treatments for children and it is advisable to explore all options before deciding on a treatment plan.
Cognitive Behavioral Therapy (CBT)
This form of therapy has been a very successful OCD treatment for children since it can be adapted to suit the needs of each child. Cognitive behavioral therapy focuses on the irrational thoughts behind the obsessions and compulsions and teaches children to overcome them. For example, kids may be encouraged to gradually face their fears and change their responses to these fears.
If a child fears dirt, a CBT therapist will help to challenge toddlers or older kids perception that dirt is dangerous and will encourage fun games that involve getting the hands dirty. This is done slowly and sensitively at your child’s own pace. Through exposure to the object or situation, the child learns not to fear it.
CBT also encourages toddlers or older kids to stop ritualistic behaviors by offering more constructive ways of dealing with anxiety. This form of therapy has promising long term effects, and works best with the co-operation of family members!
Several medications have been shown to help with the symptoms of OCD, some of which are clomipramine, fluoxetine, fluvoxamine, sertraline, and paroxetine. While these anti-depressant drugs may be successful at lessening the symptoms, they do not address the root of the disorder and symptoms will generally reappear once the medication is stopped.
These drugs also cause unwanted side effects such as dry mouth, nausea, and drowsiness which can be distressing to any child and possibly inhibit learning. While prescription medication can be effective as part of a broader treatment plan, it is not always necessary for treatment.
It is strongly advised that you research these drugs thoroughly and make an informed decision.
Natural herbal and homeopathic remedies
There are a number of herbal and homeopathic remedies that may assist in the struggle against OCD. The benefit of a natural approach is that correctly formulated remedies can have all the benefits of medicinal treatment without the negative side effects of prescription drugs.
OCD is strongly associated with imbalances in brain chemistry and there are a number of herbal remedies that have been shown to be effective in restoring chemical balance and neurological health in the brain. In addition, because anxiety levels contribute significantly to OCD symptoms, herbal and homeopathic remedies that help to reduce anxiety levels may also be of benefit in the treatment of OCD.
Used alone or in conjunction with psychotherapy, herbal and homeopathic remedies can be used in OCD treatment for children to help bring your child peace of mind in a gentle, natural way. Some commonly recommended remedies include Hypericum perforatum (St John’s Wort), Passiflora incarnata, Scuttelaria laterifolia (Scullcap) and Valerian.
Discuss this option with your doctor or consult a homeopath or naturopath for advice.