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Does Your Child Have Obsessive-Compulsive Disorder?

All children have worries and doubts. But some kids and teens who have obsessive-compulsive disorder (OCD) can't stop worrying, no matter how much they want the worrying to go away. Those worries compel them to behave in certain ways over and over again.

An estimated 2% of children in the United States experience OCD, which is characterized by a pattern of rituals and obsessive thinking that generally lasts more than an hour each day, causes a child distress, and interferes with daily activities. The condition is more prevalent than many other childhood disorders or illnesses, but kids often keep the symptoms hidden from their families because they're embarrassed about them.

OCD in children is usually diagnosed between the ages of 7 and 12. Since these are the years when kids naturally feel concerned about fitting in with their friends, the discomfort and stress brought on by OCD can make them feel scared, out of control, and alone.

If your child shows signs of OCD, talk to your child's doctor about ways to help your child to cope with these persistent thoughts and behaviors and not let them interfere with daily life. Family support and cooperation are crucial to successful treatment of OCD.

What Is OCD?
OCD is an anxiety disorder in which the brain gets stuck on a particular thought or urge and can't let go. OCD manifests itself in obsessive thinking or beliefs that tell a child: "If you don't do X, then something uncomfortable or even life-threatening will happen." Think of OCD as an "overactive alarm system." The rise in anxiety or worry is so strong that the child feels like he or she must perform the task or dwell on the thought, over and over again, to the point where it interferes with everyday life. Most children realize that they really don't have to repeat the behaviors over and over again, but the anxiety can be so great that they feel that repetition is "required" to neutralize the uncomfortable feeling.

Obsessions are repeated thoughts or impulses that are out of place - they cause the child to experience anxiety or distress. They're out of the child's control and different from normal thoughts. The child usually attempts to ignore or suppress obsessive thoughts or impulses by neutralizing them with another thought or action - a compulsion. For example, a child who is plagued with doubts about having turned off the stove might compulsively check the stove, again and again, to ensure that it is off.

Compulsions, or rituals, are the deliberate and repeated behaviors a child with OCD performs to relieve the anxiety caused by the obsessive thoughts. For example, a child who has a fear of germs may repeatedly wash his or her hands until the skin becomes raw; a child who has an obsession with neatness will redo a test paper so many times that he or she may tear a hole in it from constant erasing. Other times, compulsions might seem less clearly related to the obsessive thought.

In some young children, the compulsive behavior occurs without the obsessive thoughts beforehand.

It's important to understand that the obsessive-compulsive behavior is not something that a child with OCD can stop if he or she just tries harder. OCD is a disorder, just like any physical disorder - it's not something the child can control.

Common OCD Behaviors in Children
OCD can make daily life difficult for the kids that it affects and their families. The behaviors often take up a great deal of time and energy of the child with OCD, making it more difficult to complete tasks, such as homework or chores, or to enjoy life. In addition to feeling frustrated or guilty for not being able to control his or her own thoughts or actions, a child with OCD also may suffer from low self-esteem from the shame or embarrassment about what he or she is thinking or feeling.

A child with OCD also may feel pressured because he or she doesn't have enough time to do everything. The child might become irritable because he or she feels compelled to stay awake late into the night or miss an activity or outing to complete the compulsive rituals. The child might have difficulties with attention or concentration because of the intrusive thoughts.

It is common for these obsessions and compulsions to be related to food. A child with OCD might feel compelled to eat just a restricted range of foods, thus compromising his or her own nutrition needs.

Among kids and teens with OCD, the most common obsessions include:

• 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

The following compulsions are the most common among kids and teens:

• 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, checking to make sure that an appliance is off or a door is locked, and 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
• cleaning rituals related to the house or other items

Signs and Symptoms of OCD
Recognizing OCD is often difficult because a child can become adept at hiding the behaviors. It's not uncommon for a child to engage in ritualistic behavior for months, or even years, before parents know about it. Also, a child may not engage in the ritual at school, so parents might think that the ritual is just a phase the child is going through.

When a child with OCD tries to contain these thoughts or behaviors, this creates anxiety. A child who feels embarrassed or as if he or she is "going crazy" may try to blend the OCD into the normal daily routine until he or she just can't contain it anymore.

It is common for a child to ask the parent to join him or her in the ritualistic behavior: First the child has to do something and then the parent has to do something else. If a child says, "I didn't touch something with germs, did I?" the parent might have to respond, "No, you're OK," and the ritual will begin again for a certain number of times. Initially, the parent might not notice what is happening. Tantrums, overt signs of worry, and difficult behaviors are common when parents fail to participate in their child's rituals. It is often this behavior, as much as the OCD itself, that brings families into treatment.

Parents can look for the following possible signs of OCD:

• raw, chapped hands from constant washing
• unusually high rate of soap or paper towel usage
• high, unexplained utility bills
• a sudden drop in test grades
• unproductive hours spent doing homework
• holes erased through test papers and homework
• requests for family members to repeat strange phrases or keep answering the same question
• a persistent fear of illness
• a dramatic increase in laundry
• an exceptionally long amount of time spent getting ready for bed
• a continual fear that something terrible will happen to someone
• constant checks of the health of family members
• reluctance to leave the house at the same time as other family members

Environmental and stress factors can signal the onset of OCD. These can include ordinary developmental transitions (such as starting school) as well as significant losses or changes (such as the death of a loved one or moving).

Diagnosing OCD
In screening for OCD, your child's doctor or mental health professional will likely ask about your child's obsessions and compulsions in language that your child will understand, such as:

• Do you have worries, thoughts, images, feelings, or ideas that bother you?
• Do you have to check things over and over again?
• Do you have to wash your hands a lot, more than most kids?
• Do you count to a certain number or do things a certain number of times?
• Do you collect things that others might throw away (like hair or fingernail clippings)?
• Do things have to be "just so"?
• Are there things you have to do before you go to bed?

Because it might be normal for a child who doesn't have OCD to answer yes to any of these questions, your child's doctor also will ask about your family's history of OCD, Tourette syndrome, and other motor or vocal tic disorders. OCD has a genetic component, which means that children whose family members have had any of these disorders may be more prone to OCD.

Tic disorders often resemble OCD symptoms: up to half of people with Tourette syndrome also have OCD (but only a small percentage of children with OCD also have Tourette syndrome).

Disorders that frequently occur with OCD include other anxiety disorders, depression, disruptive behavior disorders such as attention deficit hyperactivity disorder, learning disorders, trichotillomania (compulsive hair pulling), and habit disorders such as nail biting or skin picking.

In rare cases, OCD symptoms or tics that come on very suddenly may be associated with a recent group A streptococcus infection (strep throat or, less commonly, scarlet fever). This phenomenon is known as PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections). No one knows for sure why PANDAS occurs. One theory is that strep infections trigger an antibody response in some children that causes changes in the basal ganglia, a part of the brain that has been implicated in OCD.

Of course, just because your child has had strep throat doesn't mean he or she will also have PANDAS. Almost all school-age children have strep throat at some point, and the vast majority recover with no complications. Similarly, most kids who have OCD or tics do not have PANDAS. The condition may be considered only if a child's OCD symptoms or tics are directly preceded by, or significantly worsen after, a strep infection.

Treating OCD
The most successful treatments for children with OCD are behavioral therapy and medication. Behavioral therapy, also known as cognitive-behavioral psychotherapy (CBT) helps a child learn to change thoughts and feelings by first changing behavior. It involves exposing the child to his or her fears to decrease the surrounding anxiety. For example, a child who is afraid of dirt might be exposed to something he or she considers dirty until the child no longer fears it.

For exposure to be successful, it is often combined with response prevention, in which the child's rituals or avoidance behaviors are blocked. For example, the child who fears dirt must not only stay in contact with the dirty object, he or she also must not be allowed to wash repeatedly. Some treatment plans involve having the child "bossing back" the OCD, giving it a nasty nickname, and visualizing it as something the child can control.

OCD can sometimes worsen if it's not treated in a consistent, logical, and supportive manner. So it's important to find a therapist who has training and experience in treating OCD. Family support and cooperation also go a long way toward helping a child cope with OCD.
 
Many kids can do well with behavioral therapy alone while others will need a combination of behavioral therapy and medication. Therapy can help your child and family learn strategies to manage the ebb and flow of OCD symptoms, while medication, such as selective serotonin reuptake inhibitors (SSRIs), often can reduce the impulse to engage in the ritualistic behavior.

You and your child's doctors should agree upon the most appropriate strategy to cope with your child's OCD.

How Can I Help My Child?
It's important to understand that OCD is never the child's fault. Once a child is in treatment, it's important for parents to participate, to learn more about OCD, and to modify expectations and be supportive. Keep in mind that kids with OCD get better at different rates so try to avoid any day-to-day comparisons of your child's behaviors, and recognize and praise any small improvements. Keep in mind that it's the OCD that is causing the problem, not the child. The more that personal criticism can be avoided, the better.

It can be helpful to your child to keep family routines as normal as possible, and for all family members to learn strategies to help the child with OCD.

Reviewed by: David V. Sheslow, PhD
Date reviewed: July 2005
Originally reviewed by: Paul M. Robins, PhD

Original Source: http://kidshealth.org/PageManager.jsp?dn=KidsHealth&lic=1&ps=107&cat_id=146&article_set=21761
Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.

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