Obsessive-Compulsive Disorder (continued)

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 trigger 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

If your child shows signs of OCD, talk to your doctor. In screening for OCD, a doctor or mental health professional will ask about your child about obsessions and compulsions in language that kids 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, the doctor also will ask about your family's history of OCD, Tourette syndrome, and other motor or vocal tic disorders to determine whether your child has a genetic predisposition to OCD.

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

Other disorders that frequently occur with OCD include other anxiety disorders, depression, disruptive behavior disorders such as attention deficit hyperactivity disorder (ADHD), learning disorders, trichotillomania (compulsive hair pulling), non-verbal learning disorders, 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 kids that causes changes in the basal ganglia, a part of the brain that has been implicated in OCD. Scientists are currently studying this to better understand the connection between streptococcus infections and OCD.

Of course, just because a child has had strep throat doesn't mean he or she will also have PANDAS. Almost all school-age kids 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.