Obsessive-Compulsive Disorder in Children

The condition is normally diagnosed between the ages of seven and 12. This is the age when children enter a more social phase of their lives and often notice that their behaviour is different when compared to the behavior of peers.

Definition of Obsessive-Compulsive Disorder

Children with OCD have worries and fears that turn into obsessions and compulsions. These are often driven by the belief that performing certain rituals will prevent the dreaded thing from happening.

The result is a cycle of obsession, anxiety, compulsion, temporary relief and obsession.

What are the Signs and Symptoms of OCD in Kids?

Obsessions are thoughts, ideas and impulses that recur on a regular basis. An older child will recognize these as abnormal but is unable to control them. Common obsessions include the following:

• The urge to attack or stab another person;
• Obsessive thoughts of death and disease;
• Blasphemous thoughts against God;
• Thoughts of bestiality;
• Excessive fear of sickness;
• Obsessions with luminous objects.

Compulsions are repetitive behaviours performed by the child to try and deal with the obsessions. These behaviours do not bring them pleasure but simply offer a measure of relief from the obsessions until the cycle begins again. Compulsions fall into two main groups: ideational compulsions, which involve the thoughts, and motor compulsions, involving the body and movement.

How Does OCD Manifest in Children?

Although there are many types of behaviours associated with OCD, they are all recognizable by the obsessive-compulsive component.

Obsessive behaviors include:

• Fear of dirt and germs;
• Distasteful reaction to bodily fluids and waste;
• Fear of accidentally harming another;
• Fear of a disaster such as fire, accident, illness or death;
• Fear of losing control;
• A need for order and perfection;
• A need for symmetry and order; and
• Obsession with numbers and counting.

Compulsive behaviours include:

• Counting and making mental or written lists;
• Mechanical rote prayers;
• Hair pulling and self-mutilation;
• Physical acts such as eating, urinating, sex acts and smoking;
• Touching;
• Tics, clapping, rocking, rubbing, throat clearing;
• Hand washing, showering, cleaning house, checking for illness; and
• Checking that doors are locked.

Treatments for Children with OCD

Once the child receives a diagnosis of OCD from a psychiatrist, there are two avenues of treatment: cognitive behavioural therapy and medications.

Cognitive behavioural therapy (CBT) helps patients to understand which thoughts are inappropriate, bizarre and destructive and helps them to replace them with useful, realistic helpful thoughts. A therapist will work on this with the child and parents and will teach them how to reinforce the ideas at home.

CBT also includes exposure and response therapy where children are supported as they face their fears in increasing measures. This includes actions such as touching items they consider dirty and refraining from washing their hands too often.

Medications that are effective in children are serotonin reuptake inhibitors. They work by increasing the concentration of serotonin in the brain. Serotonin is a chemical messenger that is associated with OCD.

It is possible for a child to live a relatively normal life if the OCD is treated appropriately and effectively. This can only be achieved when family members get involved and work with the children and their doctors.

Resources:

100 Questions and Answers about Your Child's Obsessive-compulsive Disorder by Josiane Corbet, MD, Jones and Bartlett Publishers, 2010, ISBN 0-7637-7154-6