It’s normal for your child to have mealtime or bedtime rituals, such as drinking from a favorite sippy cup, or reading a bedtime story. As long as a disruption in the routine doesn’t cause a dramatic meltdown, it’s nothing to worry about. But, when the slightest change in routine causes temper tantrums, or when rituals take hours and affect your family’s functioning, it could be a sign that your child may be developing obsessive-compulsive disorder (OCD).
While symptoms of OCD usually appear around are age nine or 10, it has been diagnosed in children as young as three, says Dan Geller, PhD, director of the Massachusetts General Hospital Pediatric OCD Program. Usually, kids develop a few rituals over months or years, says Geller, and eventually those rituals escalate over the course of a month or so until they’re a big problem.
There aren’t any definitive events (like trauma) that trigger OCD. Still, keep watch for separation anxiety, phobias (of dogs, bees, water) or generalized anxiety (a kid who’s a “worrier”), as children who have OCD often have other types of anxiety disorders as well. “Separation anxiety [at age four or five] may be the first clue,” says Geller, “some degree of separation anxiety is normal, but by the time kids can go to preschool, we expect them to tolerate some separation.”
If you’ve noticed that your child’s rituals are starting to interfere with their everyday life first, seek out a specialist (check the Obsessive Compulsive Foundation for pediatric specialists).
Use these tips from our experts to help your child succeed, no matter what:
- Know What the Rituals Are. If you notice that your child is developing typical rituals, like hand washing or an obsession with cleanliness, or that he seems to be over-focused on one thing, it may be time to seek help. Rituals can take many forms, and may be done entirely in the child’s head, says Dr. Patrick McGrath, president of the Anxiety Centers of Illinois and author of The OCD Answer Book.
- Seek Cognitive Behavior Therapy. Cognitive behavior therapy has proven successful with children who have anxiety disorders. Plan to sit in on your child’s therapy sessions so you can help at home. Research shows that when parents know what’s happening in therapy, the kids are more successful, says McGrath.
- Don’t Try to Talk it Out. One thing you can’t do is talk your child out of doing a ritual. Obsessive-compulsive behaviors happen in the area of the brain that responds to danger, not logic. If you talk to your child when they’re worried or doing a ritual, he’s not able to listen. Wait until after the event or ritual is over to address it.
- Work to Reduce Rituals. You can’t stop your child from doing rituals, so try to reduce them. If your child is closing a door 15 times, try to get them to do it 14 times, then 13, then 12. McGrath recommends setting up a reward and consequence program. Focus on one behavior that you both want to reduce—not just a behavior that annoys you, but one that your child wants to stop as well. Then, set up a reward for reducing the behavior and remind your child about it often. Say something like, “Remember, when you close the door 14 times, you’ve decided to challenge your OCD and that’s great, so you can play with your GameBoy for 10 minutes.”
- Be Strict and Consistent. When you set a plan to reduce your child’s rituals, stick with it. His behavior won’t change in a week, but you can focus on how well you stick with your expectations. “There is never a good time to have OCD,” says McGrath, “it’s always a bad time…so you have to incorporate treatment into your everyday life.”
- Inform Your Child’s School. Let your child’s teachers know what’s going on at home and work with the school to come up with a plan to help him succeed. Most kids who have OCD are bright, and can do well if they’re given some accommodations in their schoolwork (extra time to finish their work, a computer to type on if they’re a perfectionist). Work with the school to write a 504 Plan or Individual Learning Plan that will make sure your child gets what he needs. (Learn more about IEPs and 504 plans here).
Obsessive-compulsive disorder can be everything from a slight annoyance to a major disruption. But, even if your child seems overwhelmed now, with therapy and help at home, he can change his behavior and take charge of his OCD, changing his days and yours for the better.