Helping a Child with OCD

Most children have routines they like to follow. Bedtime rituals such as being tucked in by mom or having dad read a story, and morning rituals such as brushing teeth first and then hair, can be comforting for children and can ease the process of going to bed and getting ready in the morning. Children - as well as most adults - appreciate some routine and stability in life. However, if a child insists on performing time-consuming and seemingly purposeless rituals, such as washing their hands every time they touch a toy car or doll, or checking and re-checking their room to be sure everything is in a certain order before they are able to leave for school, then there may be cause for concern. Such behaviors may indicate that a child is suffering from Obsessive-Compulsive Disorder.

What is OCD?

People with Obsessive-Compulsive Disorder (OCD) suffer from unwanted and intrusive thoughts that they can't seem to get out of their heads (obsessions) and feel compelled to repeatedly perform ritualistic behaviors and routines (compulsions) to try and ease their anxiety. The obsessions and compulsions take up a great deal of time and can cause significant distress. Some children and adolescents with OCD spend hours performing complicated rituals involving hand-washing, counting or checking in order to ward off persistent, unwelcome thoughts, feelings or images. Others live in terror that they will accidentally do something wrong, such as harm someone or throw something out by mistake. Unlike simple worrying, children with OCD may feel powerless to stop their thoughts and behaviors. Children and adolescents may not have the awareness to understand their behaviors are irrational.

Obsessions and rituals can interfere substantially with a child's normal routine, schoolwork, family or social activities. If left untreated, OCD can interfere with all aspects of a child's life.

How Common is OCD in Children?

As many as one in 100 children may suffer from OCD. The peak age for diagnosis of OCD in children is ten years old, although it can strike children as young as two or three. Boys are more likely to develop OCD before puberty, while girls tend to develop it during adolescence, when the numbers become even. OCD tends to occur in families.

What are Common Obsessions and Compulsions in Children?

Many children with OCD will suffer from a fear of contamination or germs at some point, along with a washing compulsion such as hand washing or showing. Other common obsessions include:

• Fear of harm or danger to loved one or self (i.e., if I count to five every time I talk to my father, he won't die)
• A need for perfection (i.e., re-writing an assignment instead of erasing a mistake)
• Fear of losing something valuable
• A need for symmetry and order
• Intrusive words or sounds
• Aggressive/sexual thoughts
• Religious fixations

Common compulsions include:

• Washing and rewashing hands to avoid exposure to germs
• Arranging or ordering objects in a very specific way
• Repeating a name, phrase or tune
• Counting or touching rituals
• Hoarding or saving useless items
• Seeking reassurance or doing things until they seem perfect

What Signs Should You Look for in a Child?

It may be difficult for parents to recognize symptoms in a child, as children may go to great lengths to hide their behaviors. Sometimes symptoms may go on for months or years before a parent notices a problem. Children and adolescents may be able to resist obsessions and compulsions at school but not at home, or vice versa. The symptoms may fluctuate and be greater during a stressful period. Common signs to look for include: