Obsessive-Compulsive Disorder (continued)

OCD in kids 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.

It's important to understand that the obsessive-compulsive behavior is not something that a child can stop by trying harder. OCD is a disorder, just like any physical disorder such as diabetes or asthma, and is not something kids can control or have caused themselves. It is also not something that parents have caused, although life events may at times worsen or trigger the onset of OCD in kids who are prone to develop it.

Common OCD Behaviors in Kids

OCD can make daily life difficult for the kids that it affects and for their families. The behaviors often take up a great deal of time and energy, 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 their own thoughts or actions, kids with OCD also may suffer from low self-esteem or from shame or embarrassment about what they're thinking or feeling (since they often realize that their fears are unrealistic, or that their rituals are not realistically going to prevent their feared events).

They also may feel pressured because they don't have enough time to do everything. A 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. Kids might have difficulties with attention or concentration because of the intrusive thoughts.

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

These 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, or rereading, erasing, and rewriting
• checking rituals to make sure that an appliance is off or a door is locked, and repeatedly 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 kids 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 it's just a phase.

When a child with OCD tries to contain these thoughts or behaviors, this creates anxiety. Kids who feel embarrassed or as if they're "going crazy" may try to blend the OCD into the normal daily routine until they can't control it anymore.

It's common for kids to ask a parent to join 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, which brings families into treatment.