What is OCD in Children?
OCD involves unwanted intrusive thoughts, images, or urges (obsessions) that create anxiety, which the child attempts to relieve by performing rituals (compulsions).
These rituals can be overt and noticeable (e.g., handwashing, counting, avoiding objects, rearranging materials, etc.) or can be less noticeable or mental (e.g., silently analyzing, reiterating phrases, counting, etc.).
The intrusive thoughts and fears that a child with OCD experiences are usually not logically connected to the compulsions they perform. However, you may notice your child’s distress and find them engaging in compulsive behaviors in an attempt to temporarily relieve their anxiety.
Common obsessions you may see in children include but are not limited to:
- fear of contamination from germs, bodily fluids, or waste,
- fear of something bad happening to themselves or others,
- fear that they will cause harm to themselves or others,
- fears that something terrible may happen if a certain ritual is not performed,
- extreme discomfort when certain items are not perfectly arranged or organized a certain way.
Common compulsions include:
- avoidance of feared stimuli,
- compulsively washing hands,
- constantly checking on things, like potential sources of harm,
- lining up objects or rearranging items symmetrically,
- repeatedly asking for reassurance despite already having been given an answer.
Does My Child Have OCD?
Obsessive-Compulsive Disorder (OCD) affects people of all ages and often starts in childhood. OCD can appear in children as young as 5 or 6 but usually appears in preteens and late teenagehood.
If you notice that your child seems unreasonably anxious more often than not and that they perform repetitive behaviors to relieve their anxiety, you may want to contact a licensed professional and schedule an appointment for your child.
What Causes OCD in Children?
Nobody knows exactly what causes OCD, but research suggests that there are three key factors that play a role in its development.
Factor #1: Genetics
Studies suggest that OCD has a strong genetic component. Children with first degree relatives diagnosed with OCD or other anxiety disorders may be more likely to develop the disorder.
In addition to genetic predisposition, OCD can develop through learned behavior. A child with a genetic predisposition to OCD may then develop or exacerbate their symptoms with coping behaviors they learn from their surroundings and experiences.
Factor #2: Trauma or Stress
Traumatic or stressful events often trigger symptoms to begin in the child, although there does not need to be an obvious trigger for symptoms to develop.
Factor #3: Infections
Children who have been infected with PANDAS, a post-infectious autoimmune syndrome involving Streptococcus pyogenes (streptococcal-A infection) are also at risk for developing the disorder. Typically, the symptoms of PANDAS include the sudden onset of OCD behaviors approximately 4-6 weeks after having a strep infection.
OCD in Children vs OCD in Adults
OCD can be difficult for young children to understand, and they are likely to handle their obsessions and compulsions differently than an adult.
Children may not be aware of why they feel such strong urges to engage in rituals or that these urges are abnormal. They may lack the self-awareness to recognize their obsessions and compulsions, and often do not communicate their distress. Your child’s anxiety may even be masked as angry outbursts when confronted with a feared situation or if prevented from performing a compulsion.
Children can also engage in something called, “magical thinking” where the child erroneously believes that their thoughts can cause bad luck or unwanted events. They then perform rituals in an attempt to prevent these bad things from happening.
Treatment: How can I help my child?
To help your child, it is important to find the right treatment. When looking for a good fit in a therapist, consider their personality, communication style, and ability to connect with your child.
Additionally, a therapist who specializes in Exposure and Response Prevention (ERP) Therapy and OCD is most likely to be effective for your child. ERP is a form of Cognitive Behavioral Therapy (CBT) which helps children to learn connections between one’s thoughts, emotions, and behaviors. This will allow your child to identify and change maladaptive thought patterns that negatively influence their emotions and behaviors.
ERP involves strategically confronting the patient with their feared situation, thereby triggering their anxiety in a controlled setting. The therapist would then help the child avoid the compulsions they ordinarily perform in response to their anxiety. This process helps the person with OCD break the obsession-compulsion cycle.
Because ritual engagement maintains the disorder, it is imperative that they cease for the OCD to lose its power. An ERP therapist will teach your child strategies to refrain from engaging in these rituals and assist them to create exposures, hence increasing the child’s tolerance in feared situations.
Your Role as a Parent
Psychoeducation for parents is an essential part of your child’s treatment. ERP is a family-oriented process. Although well-intentioned, many parents unknowingly assist their children in compulsive actions that maintain the disorder. The more parents assist with the compulsions, the more the disorder is maintained. Examples may include:
- buying excessive amounts of hand sanitizer,
- assisting the child with compulsive hand washing,
- excessively washing the child’s clothes,
- assisting the child as they reorganize items in an attempt to be symmetrical or perfectly aligned,
- allowing or assisting the child with avoidance behaviors,
- providing reassurance (e.g. “No you will not harm your sister”, for a child with Harm OCD).
Intolerance for uncertainty is at the heart of OCD. You can help your child learn to tolerate uncertainty by refraining from providing reassurance and learning to communicate alternative ideas.
For example, if your child compulsively seeks reassurance by asking questions like, “Will I get sick if I don’t wash my hands?”, you can avoid enabling their OCD by avoiding providing reassurance. Instead, you can answer them with phrases like:
- “I don’t know…what do you think?”
- “It may or may not happen.”
- “Unfortunately, I can’t answer that for you.”
OCD can cause significant distress. Emotional support, providing hope, and becoming part of your child’s treatment is essential to successfully manage the disorder. Skills learned through ERP therapy are both necessary and long-lasting, since OCD tends to wax and wane over the course of one’s lifetime. Treatment for OCD can be a challenging process, but with love and support from family members, school staff, and others involved in the child’s life, treatment is likely to be effective.
If you would like to get in touch with a specialized therapist trained in ERP, you can contact the NOCD team and schedule a free call.