Obsessive Compulsive Disorder (OCD) in Children

Obsessive Compulsive Disorder (OCD) is a common condition in children worldwide with about one child in every 100 in the US, being diagnosed with it. While the behaviour triggered by the condition varies in each child, the underlying problem causing it may be identified and controlled with appropriate treatments.

Sometimes OCD can be mistaken for erratic behaviour and not diagnosed until later. It is essential for parents to understand OCD and recognise its symptoms and signs to ensure that adequate and timely help is secured for their kids.

What is Obsessive Compulsive Disorder?

OCD is a neurobiological disorder that may compel kids to resort to compulsive behaviours caused due to intrusive thoughts or fears. The condition causes intense anxiety or fear, otherwise known as obsessions, in children about any particular or several things. To reduce this stress, they may often engage in compulsive acts or compulsions.

It can be characterised by sudden panics and repetitive actions and shares its symptoms with conditions like ADHD, Tourette’s syndrome, and autism.

How common is OCD in children?

OCD is considered to be the fourth most common conditions worldwide, with about one in every seven people suffering from it. It is estimated that one in every 100 children in the US has OCD. It is found to be more prevalent in developed countries in comparison with the developing countries.

OCD may manifest in kids as young as 1.5 years old. Young kids are often unable to express their fears and obsessions making diagnosis difficult if not impossible. They may also try to hide their compulsion for fear of being bullied or ridiculed.

Many adults have also found that their OCD had onset in their childhood.

Causes Of Childhood OCD

While the exact cause of OCD is still being researched, there are a few causes that may trigger OCD in children.

1. Lack of the Serotonin, a chemical neurotransmitter in the brain that aids cells in the brain to communicate with each other. This may also be genetic as it is found that children whose parents have lower levels of Serotonin, also tend to have insufficient Serotonin.
2. Infections like Streptococcal Infections like strep throat or scarlet fever may cause OCD in children which are referred to as Paediatric Autoimmune Neuropsychiatric Disorders Associated (PANDAS)
3. Abnormalities in the brain, especially in the orbital cortex, the part of the brain that is responsible for cognitive abilities and decision making, are found in brain scans of some children with OCD. This has led to believe that it may also be a cause of OCD.
4. It is also found that children suffering from depression may be prone to OCD or develop symptoms.
5. Environmental factors that cause intense anxiety may cause the child to develop compulsive habits that can be categorised under OCD.

OCD symptoms

Most symptoms of OCD in children are quite pronounced. However, there are chances that they may be missed or misunderstood. Most children engage in compulsive actions or rituals that are a result of their obsessions or irrational fears. Some of the symptoms that you can look out for include:

1. Intense fear of germs, dirt or diseases, causing them to take extreme precautions and wash hands often.
2. Insisting on wearing gloves or full sleeved clothes to prevent exposure to germs.
3. Cleaning a specific place or object multiple times.
4. Repeated cross-checking of things caused by excessive doubt – example: checking if the door is locked or the books are packed multiple times.
5. The habit of repeating a particular word or phrase several times.
6. Obsession with organising things in a precise symmetrical manner.
7. Adherence to a strict routine every single day.
8. Excessive belief in lucky and unlucky numbers and counting steps or moves each time to ensure a lucky number.
9. Doing things over and over again seeking perfection.
10. Sudden, consistent impulses or violent urges to act or do certain things.
11. Repeating words to themselves several times.
12. Repeating the same questions over and over.
13. Repeating words spoken by others to them.
14. Irrational fear of a loved one getting hurt.
15. Hoarding certain items.

Diagnosis

There is no specific lab test for the diagnosis of OCD. However, you can go a qualified mental health professional like a child psychologist or a psychiatrist, if you notice symptoms of OCD in your child. Before seeking help from a child psychologist, you may need to keep track of all the symptoms and their frequency to accurate details to the doctor.

The child psychologist will interview both you and your child or will ask you to fill out a questionnaire. Your child’s OCD test will include several questions about the symptoms and their severity to determine the seriousness of the condition. Your child will be diagnosed with a disorder only in the instance that the OCD is affecting his or her daily life in a significant manner.

Some child psychologists may also physical examination or a lab test to rule out any chances of other medical conditions. Early detection of OCD can help you seek the right treatment for your child.

Treatment for OCD in Kids

While there is no cure for OCD, effective treatment and be administered to reduce or even alleviate the symptoms, if detected early. Children with mild cases of OCD are treated with regular therapy and medications are prescribed to children with severe symptoms. A combination of both may also be used depending on the age of the child, the condition, the symptoms and its severity, and tolerance for medications.

The treatments can be classified under:

1. Psychotherapeutic

A cognitive behavioural therapy called the exposure and response therapy is used to identify the core cause of the obsession. This treatment is found to be quite effective in children and help modify their compulsions. The therapists may also pose minor restrictions like the number of times the child is allowed to repeat the action in a day, to enable him or her to eventually and gradually, eliminate the excessive ritual.

However, therapy is a long process and may be hard for little children who haven’t yet been able to understand that their obsessions may be irrational.

2. Pharmacological

In instances where therapy isn’t an option or isn’t viable, medications like Selective Serotonin Reuptake Inhibitors or SRRIs are prescribed. These selectively target the neurotransmitters in the brain and also act as anti-depressants, reducing anxiety. This can make the child more receptive to therapy.

In case the OCD is triggered due to streptococcal infection, then the antibiotics may also be prescribed to the child.

Other Disorders That Can Co-Exist With OCD

Most children are found to have another co-existing condition along with OCD. Some mental health disorders are often found in individuals and children with OCD, which include:

1. Anxiety disorders
2. Bipolar disorder
3. Depression
4. Autism Spectrum Disorders or ASD
5. ADD (Attention Deficit Disorder) or ADHD (Attention Deficit Hyperactive Disorder)
6. Eating disorders
7. Tics or Tourettes syndrome
8. Body Dysmorphic Disorder or obsession with a real or imaginary flaw in the body
9. Hoarding Disorder
10. Trichotillomania or obsessive hair pulling disorder
11. Excoriation or extreme skin picking disorder

Some of these disorders may appear as symptoms of OCD in the child and usually fall under the category of OCD related disorders.

Managing OCD During School Hours

Discussing your child’s conditions with the teachers at school is a choice that is yours to make. However, there are benefits to keeping the teachers and the school informed. The chances are that OCD may cause your child to have social, academic or emotional difficulties, which the teacher may be able to pay a little extra heed to when informed.

Also, since OCD has visible and evident symptoms, the teachers at school may already be aware of the condition as most schools train the teachers to cater towards children with behavioural disorders. You may discuss with the teachers to understand the extent of their knowledge about the disorder and take an active part in bringing them up to date on how to help a child with OCD. Books, videos, and websites that discuss the condition can be shared with the teachers as well.

Dealing With OCD In Teens

Teens with OCD are often found to have aggravated behavioural issues that are beyond control. It is important for you to take an active interest in helping your teen face OCD and get them to take part in therapy to help relieve the mental and emotional distress that OCD is causing them. Here are a few things you need to keep in mind:

• Do not criticise or complain about their symptoms of OCD. It is a disorder that they have no control over.
• Learn everything that you can about OCD and keep yourself informed.
• Talk to your teen and help them come up with methods to handle stress and relax. For example, you may take yoga or other classes with your teen.
• Ensure that you take him or her to a therapist for Cognitive Behaviour Therapy.
• Always be present and let your teen know that you can be approached for help.
• Discuss with the therapists to chalk out ways to accommodate your teen’s compulsions healthily.
• Seek help from your family and friends to ensure that everyone is on the same page to help your child overcome the disorder.
• Sign up the family for family therapy if possible to help everyone understand the condition and contribute to recovery better.
• Try your best not to lose patience and stay calm even when frustrated to avoid setting your child off. Your teen needs to know that you can be relied on at all times.
• If you come across situations that you are unsure about, do seek immediate help from your teen’s therapist or any other mental health professional.
• Always support your child and take everything one step at a time and do not rush him or her for any reason.
• Ensure that your child takes any prescribed medications regularly.

OCD, even with the right attention and treatment, can take very long before visible changes are seen, and symptoms are alleviated. Remember to choose the course of treatment that suits your child well and to which your child responds to best. It is imperative that you take an active part in helping your child deal with OCD and support and guide him every step of the way.