Reviewed by Aaron Horn, LMFT
Obsessive-compulsive disorder (OCD) is a form of anxiety disorder that has become more prevalent in recent years. Obsessions are recurrent thoughts, while compulsions are recurrent irrational behaviors. Every child has concerns and negative thoughts sometimes, but children with OCD have unwanted obsessive thoughts, images, and urges that are hard to stop, even if they try. The obsessive thoughts often cause them to act in a certain manner, repeatedly. For instance, the fear of touching dirty objects may cause the child to use obsessive routines to manage the fear, such as washing their hands excessively.
Children are experiencing anxiety at a higher level than ever before in the United States and around the world. OCD is a product of high anxiety levels. While most children begin showing signs of OCD between ages seven and 12, only about 1-3 percent of children are diagnosed with the condition. This article covers the symptoms, causes, and treatment options for obsessive-compulsive disorder.
An Overview Of OCD
Obsessive-compulsive disorder affects both children and adults but usually starts in childhood. The American Psychiatric Association defines OCD as a mental health disorder that causes recurrent, unwanted ideas, thoughts, and feelings (Obsessions) that cause them to do certain things repeatedly (compulsions). These thoughts are not the same as the regular worries people occasionally have – they come up repeatedly, even when the person does not want to entertain the thoughts. Usually, the thoughts are impractical, scary, or illogical. People with OCD may be aware that their fears are irrational, yet they continue to worry about them.
To prevent the obsession from disturbing them, people with OCD feel bound to engage in activities to stop anxiety or a bad occurrence. For some, the action might be something “normal” (like cleaning or asking people for reassurance) that goes overboard. For others, the action may not be connected to their fears and may mean counting to a particular number or undertaking tasks in a specific order. People with OCD usually describe an unsatisfied or itchy feeling until they have fulfilled the compulsion. Although compulsive behavior makes the child feel better temporarily, the OCD thoughts come up again, causing them to perform the compulsion repeatedly.
Everyone has concerns or experiences that they need to occasionally stop performing, but the repetitive behaviors are time-consuming for children with OCD – often several hours daily. The obsessions and compulsions of OCD interfere with the person’s day-to-day activities. If the child’s repetitive behavior or concerns are starting to interfere with their lives, it could be an indication of OCD.
The Signs Of OCD In Children
As children get older, the routine and obsessive thoughts usually occur with a reason and focus, depending on their age. Preschool children usually have rituals and routines for bathing, eating, and sleeping. The routines help to stabilize their expectations and perspective of their environment. School-aged children usually form group rites as they play games, participate in team sports, and learn rhymes. Older children and teens adopt hobbies like collecting objects—these rituals aid in socializing and managing anxiety.
OCD in children can make the obsessive thoughts and compulsive rituals to become frequent and powerful. They may disrupt their daily lives and normal development. OCD is more prevalent in teenagers. Parents can play a big part in identifying early signs and symptoms of OCD in children, particularly because the issues faced by the child can be subtle initially. Before going to the signs of OCD, check out some of the common myths and misconceptions about OCD.
- You have a little OCD and like to have your papers, pencils, and other items totally organized
- You have OCD about returning borrowed books to the library on time
- You are obsessed with having a clean house
These are some of the common statements people make. In the last few years, “OCD” has turned into a common word, used as a slang term to describe highly organized or someone who is strict about a routine. The way people use OCD in regular conversations is not a precise description of what people with this disorder actually deal with. Yes, people now know that OCD exists, and that is good news. On the other hand, the notion that people with OCD are always strict about neatness and tidiness could make identifying the true signs of OCD in children more difficult. Not all children or adults with OCD are clean or organized.
The Actual Signs
Often, children get very confused or embarrassed about OCD symptoms and may find it hard to express what they are facing to their parents. A child with OCD may repeatedly talk about their concerns, even after getting reassurances about them multiple times, or frequently seem nervous about conditions that may not appear completely logical. Some of the common fears and obsessions include:
- Germs, dirt, or contaminated items
- Religion and morality, like a truthful child scared of lying
- Getting sick, infecting others, or throwing up
- The need for symmetry, order, or standard repetition
- Thoughts of violence or upsetting incidents that feel invasive (undesired by the child)
Aside from these concerns, children with OCD often feel like they need to do some things repeatedly. Some of the compulsions include:
- Handwashing, bathing, or brushing teeth more frequently than needed
- Rites that must be done the same way, every time, like an elaborate bedtime ritual
- Checking things repeatedly, like the oven, light switches, or checking homework
- Counting or sorting things in a particular manner
- Repeatedly asking for reassurance from friends or parents
The signs of OCD may be somewhat different in children. Some signs may be more prominent than others. Here are some ways OCD might manifest in children:
- Constantly leaving their assigned chair to engage in repetitive actions, like removing a book from a shelf or arranging school items in a correct order
- Staying away from playground equipment and avoiding interaction with others on the playground
- Bothered about neat handwriting or having an organized desk – sometimes to anxiety levels
- Asking to go to the bathroom regularly without medical reasons
- Inability to move from one subject to another quickly, causing anger or irritation
- Asking questions repeatedly or seeking confirmation from the teacher that an answer is right
- Retracing or counting steps, like walking the same path several times before entering the classroom
- Cleaning letters over and over until they are satisfyingly accurate
- Distraction and not paying attention in class - this might mean the child is involved in a mental ritual, such as repeating some words or numbers in their head to prevent bad occurrences
- Disinterest in playing with other children or unknown toys
- Gathering or hoarding items in large quantities
- Fear of catching germs from regular objects or animals
- Wasting time in the bathroom to wash their hands or their items
- Fear of making errors that may lead to a parent’s death, pain to the family pet, or damages to the house
- Monotonous or ritualistic actions, sometimes with irrational reasons, like checking a door handle more than once to make it is locked to prevent burglary
- Fixation with special numbers. For instance, a child may only prefer a certain number and divide their food into that specific number when eating
- Touching things in a particular order and making sure that items in the house are not disorganized (the child may often use the same words or sentences in the right way, particularly at bedtime)
- Concern about death, religious questions, or abstract ideas like evil and good
Symptoms may change over time. They are hardly constant and may lessen or worsen, depending on the child’s level of stress or tiredness. Even if there are fluctuations, this is how the disorder works and not an indication of recovery, so it is necessary to seek needed intervention.
Causes Of OCD In Children
Mental health professionals do not completely understand the cause of OCD in children. Studies suggest that biological and environmental factors may play a role in the condition. It is crucial to understand that OCD is usually not the fault of the child or their parents.
Biological factors: OCD is a neurobiological disorder, so the idea is that it is the result of an imbalance of specific brain chemicals. Research has shown an association between low levels of the neurotransmitter serotonin in the development of OCD in children. Some studies suggest that parents can transfer serotonin deficiencies to their children. Due to this, experts believe there is a genetic factor at play with OCD development.
Environment factors: Some environmental situations and stressors can trigger the development of OCD in children who are at risk of the disorder. Some of the situations that may cause or worsen the symptoms include the death of a loved one, physical or emotional abuse, abrupt changes to the living environment, parental divorce, issues or changes in school, and other traumatic incidents.
Some research indicates that a strep infection may also trigger the initial signs of OCD in those who are genetically at risk of the condition. This form of OCD is known as Pediatric, Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) if it is caused by a strep infection.
Making A Diagnosis
Parents and caregivers must be aware of the implications of OCD on children to help them get proper treatment. Since there is no laboratory test to check for OCD, medical professionals rely on comprehensive psychiatric evaluation to make a diagnosis after eliminating other potential physical causes of OCD symptoms. For the diagnosis, the child psychologist or mental expert will have to check the child. The child needs to show signs of obsessions and compulsions that are repetitive and severe enough to be adjudged disruptive to their normal lives.
Most mental health professions use the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) to make an OCD diagnosis in children. The scale covers a checklist of some common obsessions, including aggression, contamination, superstition, sexual obsession, and others.
Children with OCD also often deal with other mental health issues such as ADHD, Tourette’s syndrome, clinical depression, or anxiety disorders. This can make diagnosing the condition in children harder than in adults. Children, mostly the younger ones, may exhibit compulsion primarily. They may show repetitive traits and may also have issues explaining their obsession.
Treatment For OCD In Children
OCD can affect many aspects of a child’s life, including sleeping and eating routine, focusing on schoolwork, and interacting with others. Treatment for OCD helps a child in all these areas and help the child break a pattern of obsessions and compulsions. The treatments that work for adults are also effective for children. Medical professionals usually begin with behavioral therapy and only recommend medications in more severe cases.
Studies suggest that the most beneficial and practical form of therapy for children with OCD is a type of cognitive-behavioral therapy known as Exposure and Response Prevention, or ERP. ERP involves exposure to the obsession and concurrently stopping them from engaging in the compulsions that typically accompany them. It is usually the first treatment step.
ERP helps children realize when their concerns turn to obsession and teach them specific techniques to reduce their need to proceed with compulsive behavior. The child is encouraged to face the seeming fear and overcome it. Gradually, the drive to engage in compulsion or complete it weakens, and children can better identify and ignore OCD fears. Therefore, they will become less dependent on engaging in compulsive behavior to feel better.
Medication: if the symptoms are severe, the doctor may prescribe medications. Selective serotonin reuptake inhibitors (SSRIs) are usually the first choice for medication treatments. They help relieve OCD signs by increasing serotonin levels in the brain, helping reduce obsessive thoughts and mental compulsions.
If the child’s OCD is connected to a strep infection, the doctor will prescribe antibiotics to treat the infection. With proper treatment, there will be noticeable improvements in OCD symptoms.
If you have discovered some of the signs of obsessions and compulsions listed above and are worried that your child might be exhibiting the signs, talk to a mental health professional for advice. OCD can be difficult to diagnose, so getting expert help will ensure correct diagnosis and treatment. You can take an assessment test for OCD here.